PRIORITY 4: Communities and providers support physical, social, and emotional health
NPM 10: Adolescent preventive medical visit (Percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year)
Local MCH Reach: During SFY2020, 44 of 70 grantees (63%) provided services to the Adolescent population.
The 2016-2017 National Survey of Children’s Health (2 years combined) showed that 77.5% of Kansas adolescents, 12 through 17 years of age, had a preventive medical visit in the past year. Of those who had health insurance, adolescents covered by public health insurance (Medicaid) were less likely to have received a preventive medical visit than those with private insurance (72.0% and 84.9%, respectively). Hispanic adolescents were less likely than non-Hispanic white adolescents to receive a preventive medical visit. About 59.3% of Hispanic children received a preventive medical visit, compared with 81.7% of non-Hispanic white adolescents. Adolescents with special health care needs were significantly more likely to have received a preventive medical visit than adolescents without special health care needs (93.5% and 72.7%, respectively). Adolescents with parents who had more education were more likely to receive a preventive medical visit. Adolescents whose parents had a bachelor’s degree, or more were most likely to have received a preventive medical visit (85.9%), followed by those whose parents had some college and adolescents whose parents had only a high school diploma (81.4% and 60.6%, respectively). Adolescents living in low-income families were less likely to receive a preventive medical visit than adolescents living in higher-income families. The lowest percent of adolescents who had received a preventive medical visit were adolescents living in households with incomes below 100 percent of poverty (64.6%), followed by adolescents from households with incomes of 100-199 percent of poverty (65.6%), adolescents in households with incomes of 200-399 percent of poverty (84.8%), and adolescents in households with incomes 400 percent or more of poverty (87.0%).
Data note: 2016-2017 is the latest available due to a 2018 wording change to the item assessing receipt of medical care in the past year with the previous wording restored in 2019. Therefore, a 2018 update is not available, and reporting updates will resume next year with 2019 data.
Objective: Develop a cross-system partnership and protocols to increase the proportion of adolescents receiving annual preventive services by 2020.
Bright FuturesTM Online Toolkit Demonstration: In December 2019, Title V offered local MCH partners the opportunity to attend an online, live demonstration of the American Academy of Pediatrics Bright FuturesTM (AAP-BF) Online Toolkit facilitated by the AAP subject matter experts. With a total of 45 participants, who were able to submit questions to the AAP team, the training was recorded and made available via the state learning management system, KS-TRAIN. An additional 83 individuals from 66 local agencies have completed the online course, with nearly 75% (62/83) participants rating the course an overall 4/5 stars. Feedback from the course participants was overwhelmingly positive.
School-Based Health Centers (SBHC): Kansas MCH believes launching SBHCs is key to addressing increased access to the annual adolescent preventive medical visit, including comprehensive screening in accordance with AAP-BF guidelines. With partners such as schools, medical providers, and community providers, this initiative was launched in 2017 to:
- Evaluate the capacity and infrastructure to provide school-based services
- Identify/develop best practices, existing policies, and effective procedures
- Develop a model or structure to provide well visits for youths in school settings
- Reduce barriers in obtaining preventative services
- Provide opportunities for adolescents to obtain routine yearly exams
- Increase youth/family understanding on the importance of the routine/annual well visit
The guide was developed to increase opportunities for accessible and affordable health care services to students. The guide is not intended to be a step-by-step handbook, but rather a tool in developing a SBHC that meets the unique needs of a community. The guide defines the phases in the process of establishing a school-based health center including:
-
types of services;
- key partners;
- overview of target population (adolescents);
- what needs to go into a business plan;
- suggestions for professional development;
- day-to-day operations;
- importance of data collection;
- how to get started; and
- useful links, additional resources, and sample documents.
During this reporting period a comprehensive SBHC Guide was added to the new Adolescent Health website, which launched in September 2020.
The first pilot began development with Valley Center (USD 262), utilizing the SBHC Guide throughout their process. This district serves around 3,000 students in south central KS (Valley Center, Park City, Kechi, Wichita), across 6 schools [one Pre-K-3 building, two K-3 schools, one intermediate (4th/5th) school, one middle (7th/8th) school, and a 5A high school]. The Superintendent and a community champion (pediatrician) presented to the local Health and Wellness Task Force and the Administration Cabinet (consisting of 18 principals) and received approval to move forward in establishing a SBHC.
Upon experiencing challenges in finding a medical sponsor to commit to the project, the team reviewed census data and noted that a full service SBHC may not be the greatest need in the community, as a high percentage of their population is covered with private insurance and receives services from community providers. However, data from the Kansas Communities That Care (KCTC) survey showed high rates of students dealing with depression, thoughts of suicide, alcohol consumption, and tobacco/other drug use. In response to this, Valley Center refocused in 2019 and applied for a Mental Health Intervention Team grant through the Kansas State Department of Education (KSDE), which was successful. The grant ($60K) was used to establish a contractual MOU between the school district and the local community mental health center (CMHC) to work collaboratively in the provision of certain behavioral, emotional, and academic services to the students in the 2019-2020 school year.
The COVID-19 pandemic shed light on the need to have additional access to medical healthcare for the students of Valley Center. The school board and administrators were once again interested and open to hearing about how to establish a school-based health center in their district. When school returned in January 2021, Valley Center opened their SBHC. A Wichita television news station reported the pilot program. See the KWCH news story here: https://www.kwch.com/2020/12/21/bringing-healthcare-access-to-students/
KAN-Be-Healthy (KBH) Training: Early, Periodic, Screening, Diagnosis and Testing (EPSDT), also known as Kan-Be-Healthy, provides comprehensive and preventive health care services for children, teenagers, and young adults under the age of 21 years who are enrolled in any Medicaid program. EPSDT provides medically necessary screening and services, even if the service is not available through the Kansas Medicaid plan.
Many local agencies need EPSDT training, so Title V partnered with the Bureau of Community Health Systems (BCHS) to develop and disseminate a survey to identify training needs to health departments serving all 105 Kansas counties. A total of 167 health department staff members representing 82 counties responded. Results showed local agencies need training in three main areas: completing a head to toe examination, conducting developmental screenings, and learning how to utilize the AAP-BF resources.
A team consisting of representatives from KDHE (Bureau of Community Health Systems, BFH, Medicaid), KAAP, and four health departments are currently working on developing an online EPSDT training. This training was initially to be held in-person but is being created in an online format to accommodate programs during the pandemic.
Kansas Title V purchased a AAP-BF License on October 31, 2019 which allowed local agencies access to all the tools and resources offered in the AAP-BF toolkit. Local agencies now have unlimited access to AAP-BF forms, educational handouts, presentations, and technical assistance. During this reporting period, a total of 83 individuals representing 49 health organizations across Kansas completed the mandatory demonstration webinar. These individuals have also received the AAP-BF online toolkit login and provided technical assistance from the Title V Child and Adolescent Health Consultant.
- Wilson County: Partnered with schools to address 5th and 6th graders on the dangers of vaping (during Red Ribbon Week and in partnership with the local Resist chapters). Additionally, MCH staff developed a survey administered to junior/seniors to ascertain the numbers of students who report vaping or smoking. They partner with local schools to offer adolescent vaccinations during school enrollment and are planning to incorporate a vaccination clinic into a free sports physicals event.
- Wyandotte County: Home visitors received training on One Key Question® (OKQ). They partner with the Wyandotte County school district to educate teens who utilize the SBHC. Specifically, during the reporting period, 125 teens were educated on OKQ with most teens answering that they do not want to become pregnant in the next 12 months and are provided birth control education and empowered to use these contraception options. In partnership with the school, Youth Health Days is held to provided height, weight, and blood pressure checks on all youth and healthy eating habits (by their Registered Dietitian). During this reporting period they attended 6 Youth Health Fair Days and reached approximately 1775 youth.
- Thomas County: Provides immunization clinics at all 3 public schools in the county, providing 102 immunizations this past year, despite staffing reductions and capacity due to COVID-19.
- Sedgwick County: Provided 442 episodes of counseling for adolescents during the reporting period, this includes psychosocial screenings and preconception education and counseling.
- Saline County: All adolescents are screened for tobacco, alcohol and drug use at their first appointment. They provide screenings for STI’s (Gonorrhea, Chlamydia, HIV, Syphilis) for all clients (unless the client opts out). Blood pressure, weight and BMI are also checked at every client visit and education (verbal/printed) is given to adolescents that are under or overweight that encompasses health nutrition and physical activity habits.
Objective: Increase the number of adolescents aged 12 through 17 years accessing positive youth development, prevention, and intervention services and programs by 2020.
During the focus groups held as part of the 5-Year Needs Assessment, youth shared that when they have questions about their health they most often go to their peers and friends first, with the internet a close second. These insights led to the creation of an interactive youth health guide, driven by the focus group discussions. The guide was modified and approved by youth prior to finalization. Title V chose a youth-focused marketing company based in Topeka, KS to create a social media campaign to promote the guide. During the campaign creative process youth provided input on the slogan, design, and participated in the creation of short video clips.
Youth Focus Groups: Engaging youth and young adults in the planning and decision-making process for Title V is a Kansas MCH priority. Title V partnered with DCCCA, a community organization that offers preventative programs and services for youth and adults to conduct 19 youth focus groups across the state (see map below for regional breakdown).
These focus groups were diverse and included special populations within the adolescent age group such as youth in the juvenile justice system, juveniles in foster care, youth with special health care needs, youth representing the LGBTQ+ community, and youth whose primary language is not English. A breakdown of the number of sessions with participants from these various groups is included below.
Youth Health Guide: DCCCA utilized the information gathered through the in-person focus groups and online survey submissions to highlight the top 10 themes that were discussed: healthy eating, fitness and physical activity, mental health, stress, helping a friend, suicide prevention, substance use, social media use, health relationships, and well visits. To support youth-serving organizations in empowering young adults to take charge of their healthcare needs, the Youth Health Guide was created, and reviewed by some of the original focus group members plus some new youth and young adults. Staff asked questions and solicited feedback to ensure their interests and desires were captured and they saw the guide as a tool that would be helpful to them when taking charge of their own personal health and as a guide to help their peers when asked for guidance. The final guide is located on the Adolescent Health and MCH Council websites and was disseminated to other bureaus (e.g., BHP) and other state agencies (e.g., KSDE, Kansas Department for Aging and Disability Services/KDADS, Attorney General/AG Office). Approximately 200 health and physical education instructors from 106 school districts received the guide and have been using it for classroom discussions.
Healthcare Provider Webinar: Title V funded the Kansas Chapter of the American Academy of Pediatrics (KAAP) to provide a free, online webinar focused on how to create a youth-friendly environment, and gain better understanding of adolescent consent and confidentiality laws. This free CME event included the following subject matter experts in adolescent medicine and healthcare law.
- Dr. Tasneem Alaqzam MD, Assistant Professor of Pediatrics and Family Medicine, Medical Director of the Adolescent Clinic - University of KS School of Medicine – Wichita
- Denise Bloch, JD, Attorney with the firm of Lathrop GPM and has a strong background in healthcare law
The live webinar, “Engaging Adolescents in Healthcare Decisions,” was recorded and made available on the KAAP website for an additional three months (June through September 2020). Of the 17 healthcare providers who completed course evaluations, 100% of them reported that they know more about how to create a youth-friendly medical environment than they did prior to completing the course. Many participants stated a renewed understanding of how important one-on-one time with adolescents is during a well visit and expressed interest in having additional trainings or demonstrations on how to approach parents when confidentiality or mandatory reporting becomes necessary. In addition, participants suggested a quick reference guide of the Kansas consent and confidentiality laws would be helpful. This feedback was provided to KAAP and further discussions are taking place to create the recommended guide.
WHY - Whole Healthy You Campaign: DCCCA was tasked to work with youth to create a youth-friendly marketing campaign focused on a) the importance of an annual adolescent well visits; and b) the difference between a sport physical and an adolescent well visit. Youth voice was integral to the creation of a new marketing slogan and campaign during this reporting period. A comprehensive marketing plan is being developed to launch “WHY – Whole Healthy You” in Spring 2021. This marketing package includes eye-popping graphics, posters with attention-grabbing questions and a QR Code to the Youth Health Guide, and 2 short video segments that include local youth actors.
Teen Pregnancy Targeted Case Management (TPTCM): TPTCM provides comprehensive case management services to pregnant and/or parenting adolescents in Kansas communities, prioritizing communities with greater numbers of adolescent Medicaid recipients. The goal is to reduce the negative consequences of teenage pregnancy, increase levels of self-sufficiency, and delay subsequent childbearing until completion of goals related to basic education/training (or 21 years). During FY2020, ten (10) grantee agencies, including seven (7) health departments, a community-based organization that provides 24/7 services to pregnant women experiencing homelessness, a federally qualified health center (FQHC), and one pregnancy/family program received TPTCM funding. Local agencies provided services to 363 pregnant and/or parenting teens across Kansas. One of the objectives of the program is that all adolescents served, and their children, will access well child/adolescent programs such as EPSDT screenings and immunizations, and thereby reduce negative consequences of teenage pregnancy. In addition to ensuring adolescents receive prenatal medical care, TPTCM case managers assist adolescents by providing linkages to healthcare resources for uninsured or underinsured teens and referring them to community resources and needed supports.
Lifting Young Families Toward Excellence (LYFTE): KDHE concluded the LYFTE project, funded by the Office of Adolescent Health (OAH) Pregnancy Assistance Fund. One of the outcomes of this project was the development of the Supporting Young Parents in Kansas, a guide for service providers across all sectors to support the unique considerations when working with expectant and parenting teens and young adults in Kansas. This guide utilized LYFTE data, feedback, and guidance from those providing direct services as supporting material for the content. A series of video links are also embedded in this guide addressing Title V’s approach to holistic care coordination. The video series consists of four key topic areas that are important when providing holistic care coordination, they are: A Holistic Care Coordination Overview, Relationships, Action Planning, and Referral and Collaboration.
Unfortunately, the final year work plan was affected by the pandemic; however, LYFTE navigators adapted to new tools and reported being comfortable using social media, which served as an asset across all sites in March 2020 when state-wide stay-at-home orders were implemented due to COVID-19. Many organizations were able to update their clients on current protocols for visits (in-person or virtual) and could also utilize Facebook Messenger Video as needed as a method of communication if clients preferred. Sites were encouraged to apply for the TPTCM program to continue providing services to teens in their communities.
Although LYFTE funding has ended, many aspects of the program are being continued with TPTCM grantees. Prior to the discontinuation of the funding, the Special Health Care Needs (SHCN) Program Manager shared information, data and tools around the SHCN Care Coordination model with LYFTE staff. TPTCM staff, with support from SHCN staff, will modify the SHCN tools, protocols and trainings, as needed, to meet the needs of their clients. This care coordination model will provide a holistic approach to assist the youth/young adult in addressing not only their medical needs, but their educational, social, financial, and legal needs.
Bullying Prevention: The Kansas School Mental Health Advisory Council, with participation from the Title V Behavioral Health Consultant, was tasked with the execution of the Blue Ribbon Task Force on Bullying’s recommendations. An implementation guidance report is currently pending final approval by the Kansas State Board of Education. A Bullying Prevention Plan and Resource Toolkit was developed and included as an appendix within the report. This toolkit outlines resources schools and other local child-serving organizations can utilize to 1) develop a plan to address bullying; 2) build adult capacity to change climate and culture; 3) further develop or enhance competencies through evidence-based instructional guides and curriculum; and 4) measure social-emotional learning at a local level.
Objective: Increase access to programs and providers serving adolescents that assess for and intervene with those at risk for suicide.
Kansas Agencies Collaborating to Empower Youth & Prevent Suicide: Title V recognizes the increasing trend of suicide-related deaths nationwide. In Kansas, suicide is the second leading cause of death for age groups 15-24 and 25-44, and the third leading cause for children and youth ages 5-14. State agencies understand that adolescent mental health is critical to holistic well-being and positive youth development. In response to this public health crisis, several state agencies convened to create a coordinated approach to youth mental health and suicide prevention strategies that address social-emotional development and mental well-being.
State level collaboration is necessary to effectively address the prevention of suicide related deaths and injuries. As a result, the Kansas State Agencies Collaborating to Empower Youth and Prevent Suicide Workgroup was established. The workgroup includes representatives from KDHE, KDADS, Department for Children and Families (DCF), KSDE, AG’s Office, and Kansas Suicide Prevention Resource Center (KSPRC). The primary goal of the multi-agency workgroup is to centralize all state-level suicide prevention recommendations, review current activities and spotlight gaps that must be addressed. KDHE published a news release about this workgroup in Fall 2019.
The workgroup was tasked with increasing awareness of suicide prevention strategies. A tip sheet and resource listing were created (see example below).
Each agency distributed the tip sheets and have made information available on their agency websites. In addition, the MCH CAHC published the tip sheets on a national State Adolescent Health Consultant listserv and immediately received correspondence from six states (Alaska, Louisiana, Nevada, New Jersey, Ohio, West Virginia) to use our youth suicide prevention tip sheets as a template for their state messaging. Additionally, the workgroup submitted a breakout session proposal and was approved to speak at the 2nd Annual Kansas Prevention Conference on state collaborations for preventing suicide in October. One hundred and forty-six people attended the two-day conference. According to the final evaluation report for the event the top five audience classifications reported showed that 23.3% were from state, local, or tribal agencies; 13.7% were healthcare professionals; 13.6% were social workers; 12.4% were from youth serving organizations; and 9.6% were youth. Among the impressive list of presenters from the workgroup, the Title V Child/Adolescent and Behavioral Health Consultants joined leadership from KDADS, KSDE, and the AG’s Office. Below is the evaluation from those that participated in this presentation.
Kansas MCH Council (KMCHC) Mental Health and Suicide Prevention Awareness Action Alert: The KMCHC Adolescent Workgroup designed a series of social media posts based on the #BeThe1To’s Five Action Steps for Helping Someone in Crisis. Everyone has a role to play in adolescent suicide prevention: parents, family members, school employees, coaches, health care professionals, community members, and friends. Therefore, two versions of the social media materials were designed. While the content is the same for both versions with the tag line “Be the one to help save a life.” The different images were used that would best resonate with each targeted population group (adults/parents or adolescents/peers). During Mental Health Awareness Month (May) and Suicide Prevention Awareness Month (September), KMCHC shared the Action Alert with the Kansas MCH network. KMCHC encourages partners to post the graphics on social media platforms throughout the year.
Local MCH Agencies: Local MCH agencies provided AAP-BF and CDC’s mental health resources during physicals and adolescent well visits. Referrals were made to mental health services, crisis centers and suicide hotlines for additional resources and to report bullying. Some local MCH agencies worked with their local school districts and law enforcement agencies to educate students on bullying prevention through the year, especially during Red Ribbon Week. Many local MCH agencies offered educational materials about healthy relationships. Defining what constitutes a healthy relationship is critical to understanding physical, social and emotional health.
- Wyandotte County: Provides the “Futures Without Violence” pocket card which includes information about healthy relationships. This card is given to every adolescent seen in family planning or STI clinics, or the SBHC. The card is designed for adolescents who do not disclose violence in their relationships at home or outside of the home during a visit. The card is a nonjudgmental tool to give to adolescents who may not feel comfortable disclosing or may have not identified that they are in an unhealthy relationship, the card provides resources in a safe manner.
- Barton County: Supported the Suicide Prevention Task Force to put on the “Glow Run” suicide prevention event. Visits to schools provide vaping education and supports and collaboration with community partners for education on youth topics (e.g., healthy relationships, human trafficking, substance use).
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