NPM 10: Adolescent well visit (percent of adolescents, 12-17, with a preventative medical visit in the past year)
ESM: Percent of adolescent program participants, 12 through 17, that had a well‐visit during the past 12 months
The percentage of adolescents with a preventive medical visit in the past year differed significantly by special health care needs status and whether the adolescent had a medical home. Among adolescents with special health care needs, 85.7% had received a preventive medical visit in the past year (95% CI: 78.7%-90.7%), compared to only 69.0% among those without special health care needs (95% CI: 63.2%-74.3%). For adolescents whose care met the criteria for being a medical home, 80.5% had had a preventive visit in the past year (95% CI: 74.8%-85.1%), compared to only 65.2% of those whose care did not meet the criteria for being a medical home (95% CI: 57.7%-72.1%). Across adult education categories, the percentage of adolescents with a preventive medical visit in the past year was highest (81.4%) among those for whom an adult in the household reported having a college degree or higher education (95% CI: 76.3%-85.7%) – which was significantly higher than the estimate among those for whom an adult in the household reported that their highest level of education was a high school diploma or GED* (58.0%; 95% CI: 45.3%-69.8%) or some college or technical school education (71.0%; 95% CI: 60.9%-79.4%). Note that due to a difference in wording for this indicator in 2018, data are not available for 2017-2018 or 2018-2019.
* Indicator has a confidence interval width >20% points, >1.2 times the estimate, or that is inestimable and should be interpreted with caution.
Weighted Percent of Kansas Adolescents, Ages 12-17, with a Preventive Medical Visit in the Past Year, 2016-2021†‡
* Indicates that the Annual Percent Change (APC) is significantly different from zero at the alpha = 0.05 level.
† After 2016, state-level estimates have been produced using two-year combined data. However, due to a difference in wording in the 2018 version of this question, data for 2017-2018 and 2018-2019 are not available.
‡ The 2019 estimate has a confidence interval width >20% points, >1.2 times the estimate, or that is inestimable and should be interpreted with caution.
Source: U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), National Survey of Children’s Health (NSCH)
Local MCH Reach: Based on SFY2023 MCH Aid-to-Local applications received: 34 of 61 grantees selected to work on Adolescent 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:
- More adolescents compared to children are involved in sports and receive a sports physical. Those who receive a sports physical don’t always understand how it differs from a well visit and the importance of receiving both.
- Staff turnover creates some amount of insufficient data entry and errors in DAISEY.
- The encouragement of clients to obtain a medical home means health department services are sought less frequently because they are obtained as part of a one-stop-shop at the client’s medical home.
Annual Preventable Services Initiatives
Objective 4.1: Increase the proportion of MCH Program participants, 12 through 17 years, receiving quality, comprehensive annual preventive services by 5% annually through 2025.
Bright FuturesTM: Annual preventative visits are not consistently happening for young adults, and when happening, insurance does not require documentation of all components for an annual preventative care visit, creating inconsistency in the quality of care that young adults receive. To address this issue, Title V continues to recommend that local MCH grantees adhere to the Bright FuturesTM guidelines for preventive care/well visits for adolescents. Title V continued state-level partnerships with the Kansas American Academy of Pediatrics (KAAP), Kansas Academy of Family Physicians (KAFP), Immunize Kansas Coalition, and Medicaid to promote shared recommendations for health care professionals to utilize the guidelines, tools/resources, and anticipatory guidance.
With the hire of the Child and Adolescent Health Consultant position in May 2023, planned activities will be reviewed and prioritized. Specific to this strategy, the Consultant will review available resources and offer guidance on the following: marketing strategies for preventative well visits; providing simple low-cost ideas to create youth-friendly environments through tools created by the University of Michigan Adolescent Health Institute (AHI) Adolescent Health Initiative; and supplying resources on how to incorporate appropriate procedures on transitioning youth, with and without special health care needs to adult care, starting at the age of 12. Evidence-based tools and resources through Got Transition, Bright FuturesTM, and best practices from other states will be reviewed and included as part of the technical assistance service. Read more about Title V’s health care transition work in the CSHCN Report.
Youth-Friendly Care: Title V intended to use the youth-friendly care tools from the University of Michigan Adolescent Health Institute (AHI) to offer youth-friendly care quality improvement strategies to MCH agencies that are targeting adolescents. Title V intended to offer local MCH programs technical assistance via the Child and Adolescent Health Consultant to support local programs in obtaining established goals to improve adolescent health outcomes, including opportunities to enhance, or improve, current policies and practices. The tools from AHI will be laid out in a chart depicting the different levels of providing youth-friendly care (e.g., SPARK trainings for staff meetings, Youth-led Health Center Assessment Tool, Creating and Sustaining a Youth Advisory Council, Adolescent-Centered Environment-Assessment Process, and Becoming an Adolescent Champion Model). With this guidance, MCH agencies will be equipped to implement youth-friendly care strategies. Due to the Child and Adolescent Health Consultant vacancy, youth-friendly care technical assistance was not offered to local MCH programs during this Report period. Youth-friendly tools are available on the Children and Families Workstation for local MCH programs to utilize.
Adolescent Well Visits for Youth with SHCN: As part of the Kansas Special Health Care Needs (KS-SHCN) Program, adolescents and their families are provided holistic care coordination services that include helping them understand the importance of a comprehensive annual well visit. Many times, Adolescents with special health care needs (SHCN) routinely see a variety of specialty providers throughout the year, so routine well visits are not considered a high priority. Care coordinators share the value in these appointments with the youth and their parents/guardians and if needed, help locate a provider and schedule the appointment. Adolescents and their parents/guardians are assisted by their care coordinator in preparing for the appointment in a variety of ways based on individual needs (e.g., understanding how to complete paperwork; developing questions to ask the doctor; understanding and explaining their special health need; understanding insurance; transition preparation).
KS-SHCN Care Coordinators can identify SHCN clients who are enrolled in KanCare (Kansas Medicaid) and have not had an annual well visit through the monthly shared Medicaid report. Care Coordinators connect with these SHCN clients and encourage and assist them in scheduling the appointment. If the client has private insurance the care coordinators will assist them in locating an in-network provider accepting new patients, if they do not already have one. For uninsured clients on the KS-SHCN program who qualify for Direct Assistance Programs (DAP’s) the annual well visit costs are covered by the program, so adolescents and their families do not have the barrier of cost as an obstacle to quality care.
The KS-SHCN team begins conversations and goal setting (included, which are listed on their Action Plan) with adolescents and their parents/guardians on the importance of transition when, or before the youth reach 12 years of age. All youth need quality transition planning but for youth with SHCN, there are more challenges and barriers to finding adult health care providers with knowledge and comfort in providing care for their specific medical need. This makes transition planning an even higher importance for this population, and the KS-SHCN program has been working on targeted transition strategies. While the transition work is targeted for those with special health needs the trainings, tools and resources can be used by all youth. See the CYSHCN report for more information.
Peer to Peer Awareness Campaign: Kansas has made youth across the state equal partners in deciding what health topics are important to address. Youth driven efforts have resulted in a set of best practice marketing strategies that get critical health information and resources into the hands, phones, and minds of adolescents. The end product was the WHY (Whole Healthy You) campaign that successfully launched in the spring of 2021. Title V and the 60 partnering agencies will continue to utilize the WHY campaign to bring attention to health awareness events and highlight portions of the Youth Health Guide throughout the year. Wallet-sized cards with a QR Code directing to the WHY website was available to participating schools, community mental health centers, health departments, pediatricians, and local youth clubs. Cards and frisbees were provided to attendees at the 2022 Kansas Parent Leadership Conference.
Behavioral Health Integration: Title V continued to promote the KSKidsMAP, Kansas’ Pediatric Mental Health Care Access (PMHCA), a HRSA-funded program, modified AAP algorithm for integrating pediatric mental health into well-adolescent visits. This algorithm demonstrates how the Bright FuturesTM behavioral health screening recommendations can be integrated into well visits, and highlights decision points in which the KSKidsMAP Pediatric Mental Health Team could be contacted via Provider Consultation Line to support the practitioner in identifying next steps for appropriate care and treatment.
The KSKidsMAP Team presented and shared this algorithm during the MCH Third Thursday Webinar Series, KSKidsMAP: A Resource for Responding to the Pediatric Mental Health Crisis. Title V and KSKidsMAP partnered to develop a Pediatric Mental Health Toolkit to be included as part of the MCH Toolkits. The Pediatric Mental Health Toolkit includes several health-risk topics and recordings of video didactic presentations from the KSKidsMAP TeleECHO Clinic sessions, as well as other resources. The first topic, depression, was published on the MCH Toolkits page in February 2022. Content was developed for Anxiety and Attention-deficit hyperactivity disorder (ADHD) topics, and work is underway to ensure the videos and resources are accessible and are American with Disabilities Act compliant before being published as part of the Toolkit. More information about KSKidsMAP can be found in the Cross-Cutting Report.
Local MCH Agencies:
- Barton County Health Department held two events for adolescents. In the fall of 2021, they hosted a back-to-school event where health education was provided on the importance of well visits and which providers in the community offer them. In addition, immunizations were provided to 81 adolescents. Their community health coalition, Central Kansas Partnership, formed a new task force called Youth Crew. The task force is made up of adolescents working on tobacco/nicotine and other youth drug use issues in the community. The Youth Crew led a “Kick the Habit” kickball tournament where education on tobacco and vaping was provided. Approximately 90 youth participated in the event.
- Community Health Center of Southeast Kansas (CHC-SEK) ensured that all adolescents served by MCH had a well visit. CHC-SEK is a federally qualified health center located in 13 communities in southeast Kansas, a region of the state with some of the highest rates of poverty and poor health outcomes. CHC-SEK reached this goal by having their Population Health staff run reports through Medicaid databases to identify (and contact) those without an annual wellness visit. Additionally, they overcame barriers for parents whose work schedules don’t allow to take off and travel to medical appointments by seeing adolescents in their School Based Health Clinics.
- Kearny County Hospital providers educated parents and family members of adolescents about the importance of well visits.
- Sedgwick County Health Department met their SFY 2022 goal of completing 290 adolescent well visits.
Adolescent Health and Well-being
Objective 4.2: Increase the proportion of adolescents and young adults that have knowledge of and access to quality health and positive lifestyle information, prevention resources, intervention services, and supports from peers and caring adults by 10% by 2025.
Youth Health Guide: During FY21 and as part of the Title V 5-Year Needs Assessment, adolescent focus groups were convened and provided data on topics youth and young adults were most interested in learning more about. One topic noted was the need for reputable and quality information, rather than taking their chances searching for information on the Internet. Eight major themes emerged from the focus group data analysis: healthy eating, fitness, mental wellness, substance use prevention, managing stress, technology and social media use, healthy relationships, well visits and transitioning to adult care. The Youth Health Guide provides vetted information on these topics and was an integral part of the back-to-school WHY campaign efforts.
Awareness of 2-1-1 and 1-800-CHILDREN: Kansas youth indicated during the Needs Assessment process that they are not always aware of all the community resources that are available. As such, Title V continued to promote community service organizations, such as 2-1-1 and 1-800-CHILDREN with youth, young adults, and child/adolescent serving organizations in the state. Title V intended for the Child and Adolescent Health Consultant to collaborate with Kansas Children’s Service League, the 1-800-CHILDREN access line, and 2-1-1 representatives to brainstorm ideas on how to build awareness about the statewide resource directory for the adolescent population. Due to the Child and Adolescent Health Consultant vacancy, this collaboration did not occur during this report period. Upon successful recruitment of a qualified candidate for the position, and as part of transitioning the Help Me Grow (HMG) framework implementation support work back to Title V, planned activities will be reviewed and prioritized.
Youth Transition Booklets: Several years ago, the Family Advisory Council (FAC) created a series of transition planning booklets called The Future is Now, THINK BIG!! Preparing for Transition Planning. There are three booklets available in English and Spanish that include a booklet for youth/young adults ages 14 to 19 years. The booklet consists of an easy-to-use checklist on: Self-advocacy; Health & Wellness; Healthcare System; Social & Recreation, Independent Living Skills; and School & Work. The KS-SHCN program currently uses these with adolescents and families to begin the transition conversations and help in developing transition goals and objectives for the youth’s Action Plan. When the Child and Adolescent Consultant position is filled these will be reviewed and updated to be more inclusive for all youth with input from the FAC and youth. Booklets are shared with schools, MCO’s, providers and others upon request and made available to all ATL grantees, community partners and through dissemination at Title V booths and conferences. They are also available to download at https://www.kdhe.ks.gov/789/Publications.
Through a KSKidsMAP outreach activity, the KSKidsMAP Social Worker connected an Exceptional Family Member Program (EFMP) Systems Navigator with the Fort Riley military base to Title V. The Navigator was seeking transition resources to use with the 1,200 special needs families they support on an annual basis. The Future is Now, THINK BIG!! printed booklets for ages 0-6, 7-13, and 14-19 in English and Spanish were delivered to the Program.
Justice-Involved Youth: In December 2021, the Kansas Department of Corrections Division of Juvenile Services connected with Title V to explore partnership opportunities to better support and service adolescents and their families involved in the juvenile justice system. To achieve these, the Juvenile Justice Oversight Committee (JJOC) convened a meeting with state agencies and the priority topic based on need was shifted to funding and programs regarding mental health and substance abuse treatment needs of justice involved youth. JJOC requested technical assistance from SAMHSA’s Opioid Response Network (ORN) to explore gaps in services and access, racial equity, and a more in depth understanding of challenges, opportunities and reduce identified barriers to expand access. ORN completed site visits in several locations in Kansas and compiled a summary report. Findings include: SB367 (Kansas Juvenile Justice Reform Act) has reduced the number of youth in locked facilities and has shifted service provision to local communities; Kansas does not have the behavioral health workforce and infrastructure to provide for youth and families in all communities; and the COVID-19 pandemic further strained the behavioral health system and created new challenges.
ORN reflected that there are barriers to accessing evidence-based treatment, particularly among low-income and rural families. While there is a growth in telehealth treatment opportunities, those have complications. While growth in telehealth services is often a good thing, the outcomes, experience, and quality of the treatment experience vary. The ability to engage and benefit from virtual treatment is dependent on the personality of the youth, internet speed, access to quality video equipment, level of privacy in the youth’s home, and the engagement skills and comfort of the provider. Providers who are not familiar with the communities they are serving, may lack the cultural context that is relevant in developing a treatment plan.
The ORN identified barriers and some recommendations for steps that the state can take to improve availability:
- identify and support educational programs that supervision staff can facilitate for trauma and resiliency
- support cross-sector convenings for local communities
- support opportunities to address secondary trauma that probation officers and staff experience
In August of 2022, JJOC shared the detailed results and formed a small work group with individuals representing the Kansas Department for Aging and Disability Services (KDADS), KDHE, and Kansas Department of Children and Families (DCF) to further review the information from ORN and make recommendations on implementation of new programs, services, or funding to address gaps in needs and service. Per the Report, “The goals of this work group are to identify the most critical needs and use a multi-disciplinary approach to get beyond these barriers. Kansas was once ranked 8th in the nation for its services addressing mental health. Over the past years, there has been a great decline in the state’s rankings for mental health services. With the information received from ORN, JJOC will partner with Kansas agencies to explore opportunities for improvement.”
Awareness of Community Services: Based on information the KS-SHCN team has gathered over the years of offering holistic care coordination to clients, a need for transition training was identified. While a variety of ways to provide training and support is being developed by the Title V team for clients on the program, one activity to increase transition awareness, guidance and provide tools and resources for success for all youth with and without special health care needs identified was based off the successful Systems Navigation Training for Families (SNTF). The SNTF helps parents/guardians who have children with special health care needs learn how to navigate the complicated systems of care while forming peer-to-peer connections. Read more about this in the CYSHCN report section.
In partnership with Title V Directors, an intern from Saint Louis University assisted the Title V team in the summer of 2022 to develop an adolescent transition training based on the current SNTF. While the SNTF is focused on the special need population, the new training was intended to be for all transition age adolescents and had to begin with youth voices to share what they need and the best way to provide it. Title V Directors understood that youth would relate better and provide greater insight if they were communicating with a peer, so by having the intern host focus groups and gather information about topics, activities and resources they need during their transition journey, they were able to open up and share their goals, dreams, challenges and lack of knowledge around a holistic approach to transition. Focus groups were held both virtually and in-person with 81 youth (with and without special health needs) participated and a wealth of data gathered. From information gathered during focus groups, transition research and the use of the SNTF program model, the intern was able to develop training presentation, resources, activities, tools, and a training manual for trainers for a new Systems Navigation Training for Youth (SNTY). Final review and approval are being completed by the CSHCN Director followed by the establishment of a recruitment and training process targeted for college students. Training college students to be the SNTY trainers will give youth individuals closer to their own age, who have or are still, experiencing transition themselves. Read more information on the SNTY in the CYSHCN report/plan section.
Youth continue to be encouraged to participate in leadership programs such as the Kansas Youth Leadership Forum (YLF) and the Faces of Change program offered by the Kansas Youth Empowerment Academy, and transition workshops conducted by Families Together, Inc..
Adolescent Behavioral Health and Suicide Prevention
Objective 4.3: Increase the number of local health agencies and providers serving adolescents and young adults that screen, provide brief intervention and refer to treatment for those at risk of experiencing behavioral health conditions by 5% by 2025.
Screening, Brief Intervention, and Referral to Treatment (SBIRT) Process: Title V promotes universal education and a universal screening, brief intervention, and referral to treatment (SBIRT) approach to identifying health risks across MCH programming and health care providers. The SBIRT process is used as the comprehensive, integrated, public health approach for the early identification and intervention of MCH patients exhibiting health risk behaviors. To further support the integration of behavioral health SBIRT into pediatric primary care settings and well-adolescent visits, Title V continued to promote the modified AAP algorithm developed by KSKidsMAP (Kansas’ pediatric mental health care access program for primary care physicians and clinicians; more details found in the Cross-Cutting Report/Plan).
The Health Consultant Unit partnered with Wichita State University’s Community Engagement Institute (WSU-CEI) to create additional SBIRT resources focusing on adolescent behavioral health. During this reporting period, WSU-CEI planned to: a) customize a SBIRT 101 Resource Guide and Toolkit for the adolescent population based on nationally recognized evidence-based resources, AAP/Bright Futures™ recommendations, Kansas-approved SBIRT trainings, organizational policies and procedure development and implementation guidance among other items; b) present the new adolescent SBIRT resources to the MCH grantees during a lunch and learn webinar in November; and c) recruit up to five grantees to participate in an Adolescent SBIRT Implementation Learning Collaborative and provide virtual learning events along with monthly technical assistance check-in meetings. WSU-CEI staff and the learning collaborative participants will present the ongoing work and lessons learned regarding this project at the Governor’s Public Health Conference in Spring 2022.
WSU-CEI successfully developed the SBIRT 101 Resource Guide and Adolescent Substance Use Toolkit, which are currently pending graphic design work before being published on the MCH Integration Toolkits webpage. A draft version of the resources was shared during the November 2021 MCH Third Thursday Webinar Session and modified based on feedback received from providers during the session. Due to limited capacity at the local MCH program level, providers shared they would not be able to participate in an Adolescent SBIRT Implementation Learning Collaborative at this time. They expressed interest in this type of workforce development activity in the future once they were able to fill position vacancies and program operations returned to “normal” post-pandemic.
Focusing on the ‘S’ in SBIRT: Identifying needs is a critical first step to connecting individuals and families with appropriate services. Universal screening is the optimal approach to identifying individuals who are experiencing, or at risk of experiencing, a behavioral health condition. In support of best practice recommendations, Title V strives to assure adolescents are screened for mental health, substance use, and suicide risk annually, as part of the comprehensive well-adolescent visit.
Effective July 2022, Title V added three evidence-based behavioral health pre-screening questions into the DAISEY KDHE Program Visit Form ensuring that all individuals served by Kansas MCH ATL programs are screened for anxiety, depression and substance use. The Visit Form is completed at every ATL program (e.g., Title V, PMI, TPTCM, Title X) service visit. Title V updated the Behavioral Health Screening Guidance for Kansas MCH Programs to reflect the changes as a resource for ATL providers.
The Guidance includes an overview of the DAISEY form changes, outlining suggested protocols for positive responses to the pre-screening questions. All protocols include a recommendation to administer a full screen that is validated for the population group and health risk topic. For example, an adolescent responded to the Patient Health Questionnaire - 2 (PHQ-2) prescreening questions as part of their well visit. Following the protocol, the provider would administer the modified for adolescents (PHQ-A) to help determine if further support, intervention, or treatment might be needed. Several behavioral health full screening tools were integrated into DAISEY in July 2021. As part of this integration, a Plan of Action form is populated in DAISEY for moderate or high-risk screening results. This form allows for local MCH staff to document that a brief intervention was conducted, the type of brief intervention provided, indicate referral(s) made, and summarize any emergency or support services initiated for a client experiencing a crisis.
The Guidance also includes a 1-page overview of each of the screening tools available in DAISEY and scripts for introducing the tool to a client, administering the screening, details on scoring the screen, determining risk-level and appropriate interventions. With the 2022 updates, the Guidance resource was expanded to include universal screening framework, behavioral health screening workflow, virtual screening considerations, and crisis information. The Behavioral Health Consultant also provides technical assistance to ATL programs to help improve internal program workflows and referral processes, as needed.
Youth-Driven/Centered Approaches: Increasing youth voice to address youth mental health across the state continues to be a top priority. Across the child/adolescent system, significant progress was made, led by the KDADS, the Behavioral Health Authority in Kansas. During this Report period, KDADS established a Youth Advisory Council, as part of their Governor’s Behavioral Health Services Planning Council (GBHSPC) infrastructure. The GBHSPC is made up of a cross section of mental health consumers, family members of mental health consumers, mental health service providers, state agency staff, and private citizens. The Council is actively involved in planning, implementing, monitoring, evaluating, and advising state government regarding Kansas’ mental health services. The Council initially convened to ensure Kansas met the federal government mandate of all states to have a mental health services planning and advisory council. Since the initial convening, the GBHSPC has expanded to include thirteen subcommittees, including the recently established Youth Advisory Council. Members of the Youth Advisory Council represent the voice of Gen Z from all over Kansas, advocate for their generation, advise the GBHSPC, and create real and lasting change in Kansas. Requirements for Youth Members include being 14 to 19 years old (eligible until the end of summer after high school graduation), commitment to attend bi-monthly meetings, and being passionate about voicing needs of youth at the state level. Youth interested in serving on the Council were invited to submit an online application to KDADS.
Despite staff turnover in their Youth Engagement Specialist position, KDADS also supported the expansion of the Youth Leaders in Kansas (YLinK) Program. YLinK offers an opportunity for young adults (12-18 years old) to develop community awareness and youth leadership skills. YLinK provides youth a unique learning experience while interacting with peers, supportive adults, and their communities in positive ways which lays the foundation for successful future endeavors as they learn and explore the real world and their ability to contribute. They operate with the local support and guidance of caring adult volunteers, community partners, and alongside the youth's primary caregiver(s), especially parents. YLinK is a great resource for young adults with information on the importance of education and development of individual and group leadership skills in their local community, statewide and even nationally. The program provides an array of experiences which includes, but is not limited to, improving family and peer relationships, community engagement, incorporating knowledge and training for employment and/or vocational education and self-advocacy skills. There are also opportunities for youth to participate in the state legislative process and learn about politics and advocacy at every level. There are now over 30 YLinK chapters across Kansas.
In partnership with KDADS and other state agencies (e.g., Department of Children and Families, State Department of Education, Attorney General’s Office), Title V continued promotion activities for the annual statewide youth suicide prevention art contest. KDHE posted messages on various social media accounts promoting the launch of 988 (Suicide and Crisis Hotline) and encouraging youth in grades 6-12 to use any creative medium that resonates with how they express themselves and communicates a message of hope and healing, while including promotion of use of 988. Kansas Suicide Prevention HQ compiled submissions and published images of submitted artwork on their website by grade level: 6th and 7th Grade Submissions; 8th and 9th Grade Submissions; and 10th, 11th, and 12th Grade Submissions.
Peer to Peer Supports: The KS-SHCN Program Manager and Supporting You Peer Support Administrator planned to explore expansion opportunities for the Supporting You Network to include programs serving adolescents to connect youth in need with peers who can listen and identify with life’s challenges, anxiety, depression, and thoughts of suicide. With Supporting You not being a screening or crisis program, significant progress occurring by behavioral health system partners, and limitations on peer volunteer availability, training, and crisis infrastructure support within the Supporting You Network, it was decided that this expansion project would not immediately be pursued.
Cross-agency Collaboration for Improved Adolescent Health and Well-being: Highly collaborative, ongoing work across agencies and systems will specifically assist with the creation of a unified cross-agency standardized list of best practices to be disseminated to health care providers, Kansas Community Mental Health Centers (CMHCs), schools, and community youth-serving organizations to support whole adolescent health in their communities. As previously mentioned, Title V has continued its partnerships with the DCF, KDADS, Kansas Department of Corrections’ Juvenile Services (KDOC-JS), and Kansas State Department of Education (KSDE). Title V is involved in several key stakeholder groups to ensure coordination of information/resource sharing with local MCH programs and public health approach is applied to addressing systemic issues. Of note, Title V is represented on the GBHSPC Children’s Subcommittee, the Kansas School Mental Health Advisory Council (SMHAC), the JJOC Reinvestment Subcommittee, and the Kansas Suicide Prevention Coalition. A brief summary of these Councils/Committees is included below.
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GBHSPC Children’s Subcommittee: devoted to the behavioral health needs of children and their families. The Subcommittee examines and makes recommendations to improve the array of behavioral health services offered to children and their families through CMHCs, substance use treatment providers, and other children’s service systems and collaboration between systems of care such as Psychiatric Residential Treatment Facilities (PRTFs), hospitals, juvenile justice services, and schools. For SFY2022 (July 2021-June 2022), the Children’s Subcommittee identified three goals/topic areas. They drafted and submitted their annual recommendations report to the GBHSPC and KDADS Secretary in September/October 2022. Recommendations were:
- Children and Dual Diagnoses: state agency (and other groups) should advocate to fully fund the HCBS Waiver waiting lists. State agency should look into implementing and funding a dedicated acute inpatient service, and intensive outpatient services targeting this population (IDD/MH, ASD/BH, etc.). Offer specialty trained (with reimbursement) foster families to support this population in foster care.
- KSKidsMAP: make pediatric primary care workforce development opportunities (e.g., training, technical assistance) widely available. These efforts will ensure gap-filling treatment services in mental health professional shortage areas are high-quality and follow best practice guidelines. Fully fund a statewide psychiatric access program (e.g., KSKidsMAP) to lead these activities. Fund initiatives that enhance the number of highly trained professionals practicing in Kansas, including child and adolescent psychiatrists and child psychologists.
- Continuum of Care & Parent and Community Engagement: As the system transitions from CMHCs to CCBHCs, the state needs to work to ensure family and individual therapy is made available and provided in the most accessible and family supportive way while being reimbursed at adequate and equitable rates; programs should focus on the family systems; invest more in Therapeutic Foster Homes for children in foster care; sustaining and fully funding the Mental Health Intervention Team (MHIT) Program throughout the state; require Mental Health First Aid training in various university degrees programs so that professionals working with children come to jobs with basic skills’ remove barriers to behavioral health and physical systems from billing across systems to support integrated care practices; support local communities in convening and planning to build connectivity between current providers. The state could provide guidance regarding confidentiality and protected health information to communities working to partner to overcome this common barrier; and seek funding opportunities to invest in mental health and the behavioral health workforce.
- Topic/goal areas for SFY2023 include continuing to serve as the KSKidsMAP Advisory Council, parent engagement, and diversity, equity and inclusion.
- SMHAC: The SMHAC was formed by the Kansas State Board of Education in 2017 to advise the Kansas State Board of Education of unmet needs within the state in the area of school mental health; coordinate with legislators and stakeholders to address relevant issues effectively to best meet the needs of students; and coordinate statewide collaborative social emotional character development partnerships with stakeholders that will benefit students.
- JJOC Reinvestment Subcommittee: focuses its work on the Evidence-Based Programs Account, which was created by SB 367 (Juvenile Justice Reform Act), to capture cost savings that the state saved by keeping youth out of locked facilities and in their communities. These savings must be used “for the development and implementation of evidence-based community programs and practices for juvenile offenders, juveniles experiencing mental health crisis and their families…” The subcommittee ensures that access to funding is clear to JJOC members, other system stakeholders, and the public; identifies grant recipients to record testimonials about their program/successes/ outcomes/individual stories of youth participants; strengthens communication of details on how evidence-based fund dollars have been spent; and facilitates discussions about potential new spending areas.
- Kansas Suicide Prevention Coalition: champions suicide prevention for all Kansans through equitable access to partnerships, advocacy, resources, ideas, and data. Provides oversight and actively works to execute the Kansas Suicide Prevention Plan.
Suicide Prevention: The Kansas MCH Council (KMCHC) designed two series of social media posts based on the #BeThe1To’s - 5 Action Steps for Helping Someone in Crisis. One series targets adult and the other adolescents; however, both have the same message: “Be the one to help save a life.” These images/resources are available on the KMCHC website. Increased promotion of the images occurred during Suicide Prevention (September) and Mental Health Awareness (May) months. The “Preventing Youth Suicide: Do You Know What To Do?” graphics also continued to be promoted. Both graphic series/promotional resources were updated from the National Suicide Prevention Lifeline’s 800# to ‘988’ when the mental health crisis hotline launched in July 2022.
DCF contracted with Beacon Health Options to launch a Family Mobile Crisis Helpline in October 2021. Services offered by the Helpline are available for all Kansans 20 years old or younger, including, but not restricted to, anyone currently or formerly in foster care. Families experiencing a crisis receive support over the phone to help problem solve a child’s behavioral health crisis. Helpline staff make referrals to community resources and/or recommendations to the family for stabilization services. In-person support via mobile crisis response is made available if the crisis cannot be resolved over the phone. In emergency situations, EMS, law enforcement, and/or the mobile crisis response unit is contacted to further assist. In support of these services, KDHE approved use of their agency logo on Helpline resources as an “endorsement.” Title V shared promotional flyers in English, Spanish, Marshallese, and Vietnamese with all MCH programs several times since services launched as a reminder to providers of availability of these important support services.
The State Child Death Review Board reported that in 2019, 28 children in Kansas between the ages of 10-17 died by suicide. Between the years of 2015 and 2018, suicide deaths for Kansas youth, ages 10-17, increased by 70%. This disturbing trend led the Kansas Attorney General, along with the Tower Mental Health Foundation, to form a Youth Suicide Prevention Task Force in spring 2018. In 2019, the Task Force issued a report, which among other recommendations, included the recommendation of creating a youth-focused app that would connect Kansas youth to critical resources and information, as well as creating the position of Youth Suicide Prevention Coordinator within the Office of the Attorney General. The position has focused on the coordination of multidisciplinary and interagency strategies to help communities, schools, and professionals to synchronize efforts to prevent and address youth suicide. The app launched in September 2022, coinciding with National Suicide Prevention Awareness Month, National Suicide Prevention Week, and observance of World Suicide Prevention Day. The free app, called “Kansas – A Friend AsKS,” was developed in partnership with The Jason Foundation, a national suicide prevention organization, and can be found in both the Apple App Store and the Google Play Store. The app connects youth to tools and resources to help a friend, or themselves, who may be struggling with thoughts of suicide. The app also offers the option for users to call or text the 988 mental health crisis line.
Reducing access to lethal means, such as firearms and medication, can determine whether a person at risk for suicide lives or dies. Through KSKidsMAP, Kansas’ Pediatric Mental Health Care Access, a HRSA-funded program, six sessions of Counseling on Access to Lethal Means (CALM) training was offered to physicians and clinicians in primary care settings. This virtual training focuses on how to reduce access to the methods people use to kill themselves. It covers how to: (1) identify people who could benefit from lethal means counseling, (2) ask about their access to lethal methods, and (3) work with them—and their families—to reduce access. 35 primary care providers were trained as part of this KSKidsMAP workforce development opportunity. More information about KSKidsMAP can be found in the Cross-Cutting Report.
Kansas Youth Behavioral Health System Transformations: Title V recognizes the importance of change at the systems-level to advance the health and well-being of adolescents. In an effort to do that, Title V has engaged with various State partners to modernize and reform the healthcare system in Kansas to better meet the emerging needs of the adolescent population.
Special Committee on Kansas Mental Health Modernization and Reform: The Behavioral Health Consultant served as the KDHE Secretary’s designee representing KDHE and Kansas Title V in the 2020 and 2021 Special Legislative Committee on Kansas Mental Health Modernization and Reform (MHMR) and its Services and Workforce Working Group. Through successful advocating work, the Kansas Title V Family Delegate joined the MHMR Committee during the Fall 2021 convening. The Services and Workforce Work Group presented several recommendations to the full Committee that were then included in the Report to the 2022 Kansas Legislature.
CCBHC Transition: Through behavioral health needs assessment activities, other state’s successes, and through championing system advancement through advocacy and convening and recommendation of the MHMR, the Certified Community Behavioral Health Clinic (CCBHC) model was identified as an opportunity to improve the “whole health” of Kansans. CCBHCs are a specially designated clinic that provides a comprehensive range of mental health and substance use services. CCBHCs represent an opportunity for states to improve behavioral health outcomes by providing community-based mental health and substance use services, advancing integration of behavioral health with physical health care, integrating and utilizing evidence-based practices on a more consistent basis, and promoting improved access to high quality care. Care coordination is the linchpin of the CCBHC model. Care coordination will require the CCBHC’s to deliberately organize patient care activities and sharing of information among all participants concerned with the patient’s care to achieve safer and more effective care.
The Kansas Legislature carried out the Special Committee's recommendation and Kansas Governor Kelly signed HB2208 into law in April 2021. While other states are implementing the CCBHC model, Kansas was the first state to pass legislation! Legislation outlined that six community mental health centers (CMHCs) would become certified as a CCBHC by May 1, 2022. Three additional CMHCs would achieve preliminary certification by July 1, 2022, with nine additional by July 1, 2023, and the final eight by July 1, 2024. Kansas has met 2022 goals and is on track to meet the 2023 goal.
Medicaid Policy Change – Family Therapy: A State Plan Amendment provided a policy change, effective May 1, 2022, that family psychotherapy without the patient present will be a covered Medicaid service. This service is covered based on clinical judgment. When the member is not present at the time the service is delivered, the identified member must remain the focus of the service. Family therapy services involving the participation of a non-Medicaid eligible individual(s) must be documented in the medical records as having a direct benefit for the Medicaid eligible member. The documentation must address the identified member’s individual needs on the treatment plan and outline the expected interventions and improvements in behavioral health. This policy change aligns with research and best practices of helping the family system and not just an individual child and was widely celebrated by the Kansas child-serving system!
Medicaid Policy Change – Parent Peer Support: Through advocacy and numerous recommendations by several committees, Kansas Medicaid submitted a State Plan Amendment (SPA) to increase access to parent peer support services. Currently, “Parent Support and Training” is a Medicaid covered service for families with a youth enrolled in the Home and Community-Based Services (HCBS) Serious Emotional Disturbance (SED) Waiver Program. Effective January 1, 2023, Parent Peer Support is covered for both individual and group services. Parent Peer Support providers must self-identify as a person with lived experience raising a child with a SED, substance use disorder, or co-occurring mental health diagnosis. There will be no age restrictions for the parent receiving services, however the standard of 3 years age difference between the parent and provider applies. This service is covered, when based on clinical judgement, the member may not be present at the time the service is delivered, but the identified member remains the focus of the service. Parent Peer Support services involving the participation of a non-Medicaid eligible individual(s) must be documented in the medical record as having a direct benefit for the member. This documentation must demonstrate that the service is designed to address the identified member’s individual needs on the treatment plan and outlining the expected interventions and improvements in behavioral health. This service connects the parent/guardian with an individual with lived experience to guide and support the parent/guardian in advocating for their member.
Wichita State University’s Community Engagement Institute has worked via contract with KDADS to develop Parent Peer Support training. The training pilot with existing parent peer support providers began in November 2022 and launched in December 2022/January 2023. The training will be published on Learn Worlds, the host site for Kansas’ Certified Peer Specialist (mental health) and Peer Mentor (substance use) trainings.
Local TPTCM (Teen Pregnancy Targeted Case management) Agencies:
- Barton County Health Department reported that during SFY2022, all TPTCM clients were screened using the One Key Question and educated on their pregnancy intentions that was documentation during the post-partum visit or in the last trimester. The Coordinator uses One Key Question as a tool to start the conversation about birth control and childbirth spacing during the third trimester.
- Delivering Change reported that the navigator assessed and screened clients for socio-economic needs, along with health and mental health needs. Clients were asked about prior and current mental health concerns and provided education and referrals as necessary to mental health providers. Throughout the client’s pregnancy, navigators continued to assess mental health concerns. Clients are additionally screened for mental health concerns utilizing the Edinburgh Postnatal Depression Screening at least once during their pregnancy, and twice during their postpartum period.
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