The Title V program provides many opportunities for MCH professionals, partners, and grantees, including family members and consumers, to receive training, technical assistance, and consultation. Priority 6 is dedicated to advancement of knowledge and understanding of resources, tools, and initiatives dedicate to MCH populations. Additionally, this priority focuses on taking this knowledge and translating that into action and implementation. The primary focus areas for this priority include behavioral health, trauma-informed approaches, and social determinants of health (SDOH). The measures associated with this priority are:
SPM 3: Percent of participants reporting increased self-efficacy in translating knowledge into practice after attending a state sponsored workforce development event
ESM: Percent of participants reporting increased knowledge after attending a state sponsored workforce development event
MCH Workforce – The Kansas Title V team understand and value the importance of workforce development for not only Title V staff but partners across the state. By providing workforce development opportunities providers stay up to date with the latest methods, data, and best practices. By giving providers the opportunity to learn together, natural collaboration and support occur leading to a reenergized workforce. With a well informed and supported workforce Kansas citizen will receive quality health care services to live happy and healthy lives.
Behavioral Health Initiatives
Objective 6.1: Increase the proportion of providers with increased comfort to address the behavioral health needs of MCH populations by 5% by 2025.
Pediatric Behavioral Health: The Behavioral Health Consultant serves as the project director for the HRSA funded Pediatric Mental Health Care Access program, KSKidsMAP to Mental Wellness (KSKidsMAP). The program has established a centralized telehealth network with an expert pediatric mental health team that supports primary care physicians and clinicians (PCPs) in identifying, assessing, and treating behavioral health conditions within their clinical practice.
The KSKidsMAP Team facilitates TeleECHO Clinic sessions (virtual, twice monthly) and offers mentorship to support knowledge in practice for case consultation and didactic learning on childhood and adolescent mental health needs. The TeleECHO Clinic philosophy is “enhancing primary care by moving knowledge, not patients,” and aims to create an “all teach, all learn” environment for PCPs to provide the best care for children and adolescents with behavioral health conditions. Each participant has the opportunity to present a case and receive feedback and recommendations from other participants, as well as from the KSKidsMAP Team. Following each TeleECHO Clinic session, the recommendations are summarized, and additional resources are compiled and emailed to all session participants.
In HRSA grant year 3 (July 2021 – June 2023), KSKidsMAP facilitated 23 TeleECHO Clinic Sessions, training 106 PCPs (unduplicated count). Session didactic topics include billing and coding, prior authorization for psychiatric medication, assessing for trauma, trauma informed care, substance use, intellectual and developmental disabilities, PANDAS and PANS, bipolar disorder, and physician wellness.
An evaluation survey is administered every six months to assess PCP changes in comfort level for screening, assessing, treating, and referring patients with mental and/or behavioral health concerns based on their participation in the KSKidsMAP TeleECHO Clinic. The survey is also an opportunity for PCPs to provide feedback on topics of interest and wellness needs. In addition to reporting an increase in confidence for skills and abilities related to session topics, survey respondents also indicated the KSKidsMAP TeleECHO Clinic’s interactive format is more effective than standard webinars, and all respondents gained knowledge, obtained helpful skills and techniques to improve professional practice, would recommend the KSKidsMAP TeleECHO Clinic training to a colleague, were satisfied with their experience, and felt it was a good use of their time.
In Spring 2022, KSKidsMAP facilitated a pilot TeleECHO Clinic series to support pediatric inpatient interprofessional teams by providing them the tools to address mental and behavioral health concerns within the inpatient setting in response to the nationwide pediatric mental health crisis. In Kansas, the percentage of weekly emergency department visits for suspected suicide attempts among adolescents ages 12–17 during the winter has increased from 2019 to 2021 (KDHE, ED Visits for Suspected Suicide Attempts Report). This results in an increased rate of adolescent hospitalizations due to suicide attempts or self-harm, less availability of psychiatric beds, and therefore increased “holding time” for these youth on pediatric hospital floors and in emergency departments. The KSKidsMAP Wesley Medicaid Clinic Pilot aimed to provide pediatric inpatient interprofessional teams with the knowledge and resources to provide mental health care to youth, especially those waiting for placement in a psychiatric facility.
A total of 20 PCPs participated in the 7-session training pilot. Topics addressed in this pilot project included working with autism spectrum disorder (ASD) patients and families (focus on agitation); management of autism; developmental disability with challenging behavior; emergent de-escalation of aggressive combative patients; initiation psychiatric pharmacotherapy in inpatient setting; collaborative assessment, and management of suicidality (CAMS); maximizing mental health management for patients while waiting for psychiatric placement; psychological support for patients with eating disorders; and communication with community services.
In addition to the ongoing TeleECHO Clinic, KSKidsMAP provides support to PCPs via the KSKidsMAP Provider Consultation Line. The KSKidsMAP Social Worker provides mental health and community resources, toolkits, best practice guidelines, referral information, and physician wellness recommendations. PCPs can use the Consultation Line for more than one reason at a time; in HRSA grant year 3 (July 2021 – June 2022), KSKidsMAP received 168 intakes encompassing 230 inquiries. The primary reasons for contacting the KSKidsMAP Consultation Line were request for case consultation, resources for referral, and mental health resources, such as toolkits and websites. Of the total consultation intakes, information on presenting problem was available in 80.4% (n=135/168) of cases. The primary presenting problem was need for psychotherapy resource for referral (25.6%), followed by ongoing psychopharmacological treatment (22.0%). Anxiety among child and adolescent patients (21.5%) was the number one reasons PCPs requested assistance, followed by depression (12.6%).
KSKidsMAP continued outreach activities to increase PCP enrollment and engagement with the program. In partnership with Title V, KSKidsMAP expanded outreach efforts beyond PCP clinics to local MCH programs and presented during the MCH Third Thursday Webinar series. They continued distribution of an e-newsletters on a quarterly basis, developed a program promotional video, published a program impact paper and subsequent program impact summary resource, and co-presented with the Kansas Connecting Communities (KCC) perinatal behavioral health program to the 2021 Special Legislative Committee on Kansas Mental Health and Modernization and Aetna’s (Kansas MCO) Resources Within Reach: Community Connections meetings.
Perinatal Behavioral Health: Title V completed three key initiatives to help increase workforce capacity to screen, facilitate brief interventions, make referrals to treatment, and provide education and resources to their perinatal patients at risk of experiencing a behavioral health condition:
- Pediatrics Supporting Parents (PSP) Workgroup: This workgroup convened in 2020 to support the adoption of a Kansas Medicaid Maternal Depression Screening policy. Their efforts were successful, and the policy became effective on January 1, 2021. For 2022 planning purposes, Title V anticipated providing continuous support of policy implementation by assisting with any necessary guidance to providers, developing training materials, and analyzing Medicaid claims data to determine quality improvement opportunities. All activities were completed and outlined within the Woman/Maternal Report.
- Kansas Connecting Communities (KCC): Through KCC, a Perinatal Provider Consultation Line was established and launched statewide in 2021. The Consultation Line supports perinatal providers through case consultations, providing best-practices information, and offering multiple training opportunities. The consultation line is accessible weekdays from 8am – 5pm to assist providers with their perinatal behavioral health questions. Consultation line staff can help with diagnosis, medication, treatment identification, patient resources, identifying local referral options, and connecting the calling provider with a peripartum psychiatrist for case consultations. This effort directly supports increasing health care providers’ capacity to screen, assess, treat, and refer pregnant and postpartum individuals with depression, anxiety, substance use, or other behavioral health conditions.
- Paternal Postpartum Depression: Title V continued to promote paternal postpartum depression materials and resources integrated into the Perinatal Mental Health Toolkit to: increase provider awareness about prevalence; educate about symptoms; inform on the difference of paternal postpartum depression and maternal depression; guide implementation of paternal screenings into clinic workflow; offer programming considerations; and provide resources for fathers who might be experiencing postpartum depression.
In addition to these activities, the KCC grant team facilitated several additional training opportunities:
- Kansas Moms in Mind (KMIM) Case Consultation Clinics: An initial 3-session case consultation and training clinic series was offered in November 2021 to prescribing providers (e.g., physicians, advanced nurse practitioners, etc.) involved in the treatment of perinatal mental health disorders. The clinic sessions aimed to build confidence and knowledge of perinatal prescribing best practices, as well as comfort in developing or supporting treatment plans. The three sessions focused on depression, bipolar disorder, and psychosis in the perinatal period highlighting risk of untreated conditions, risk of psychiatric medications during the perinatal period, and unique factors and special considerations for management of patients with these disorders. Fifty-two providers registered for the clinic, twenty-nine attended at least one of the three sessions.
-
KMIM 2.0: KCC expanded upon its initial 3-session KMIM Clinic Series, adding nine sessions throughout January-September 2022. Sessions include:
- Preconception Counseling: medication changes, non-medication treatment options for patients who would like to become pregnant with pre-existing mental health conditions and/or history of a perinatal mood and anxiety disorder. (16 attendees)
- ADHD in the Perinatal Period: overview of existing research on ADHD in perinatal period, risks associated with untreated ADHD, and use of stimulant and non-stimulant meds during pregnancy and breastfeeding, as well as non-medication treatment options. (23 attendees)
- Family-Focused Interventions: treatment planning with the entire family, community-based resources, programs for parents/children, how to start conversations around support with the patient with their family/partner present. (18 attendees)
- Perinatal Anxiety Disorders: epidemiology, risk factors, and comorbidities, screening recommendations, and both medication and non-medication treatment options. (28 attendees)
- Treating SSRI-Resistant Depression in the Perinatal Period: thorough review of the data on available medication alternatives to SSRIs including success for various types of depression, dosing and considerations for pregnancy and breastfeeding, titration recommendations, and non-medication treatment options. (20 attendees)
- Long-Term Treatment Planning for PMADs: long-term treatment planning including a review of the data around recurrence and relapse, best practice recommendations for monitoring and titrating off medication or moving to a maintenance dose, and conjunctive non-medication treatment options. (11 attendees)
- Perinatal Loss and Bereavement: definition and epidemiology, risk factors and comorbidities, psychiatric disorders most often seen following loss, protective factors, and resource, education, and support options to include in treatment planning. (19 attendees)
- Perinatal Substance Use Disorders (part 1): perspective and framing the conversation of addiction and understanding long-term treatment; overview of diagnoses and diagnostic criteria, prevalence, screening and referral best practices, addressing stigma, and overview of MAT treatment and treatment resources/options. (19 attendees)
- Perinatal Substance Use Disorders (part 2): management of substance use in pregnancy; overview of prevalence and legal considerations at both national and state levels, impact of substance use on maternal and infant health outcomes, opioid use and opioid antagonist therapy, NOWS/NAS, and case study review. (10 attendees)
-
Postpartum Support International (PSI) Supported Trainings: Through contract between KDHE/KCC and PSI-Kansas Chapter, PSI coordinated four webinar training sessions for perinatal providers in Kansas, including MCH programs/providers. Presenters included subject-matter experts from Kansas as well as experts identified through the PSI national network.
- Lactation and Perinatal Mood and Anxiety Disorders (PMADs): Dr. Lauren Hughes, MD, IBCLC and Emily Winters, RN, IBCLC focused on perinatal behavioral health, lactation considerations, and practices to support individuals experiencing or at risk for PMADs. (88 attendees)
- A Move Toward Cultural Humility in Perinatal Care: Dr. Meyleen Velasquez, DSW, LCSW, LICSW, PMH-C, RPT-S, presented on racial equity and cultural humility in perinatal healthcare with an emphasis on the intersection of mental health and equity. (46 attendees)
- Perinatal Mental Health and Fatherhood: Dr. Dan Singley discussed the mental health of fathers during pregnancy and transition to fatherhood, including risk for paternal perinatal depression, signs and symptoms, effective interventions, and screening recommendations. (20 attendees)
- Infertility, Grief, and Bereavement: Kara Shelman, LCSW, MPH, PMH-C detailed the unique aspects of the infertility and perinatal grief journey that can impact the risk for psychological distress, outlined the use of whole reproductive stories to assess and support mental health through infertility, perinatal loss and postpartum, and shared several therapeutic tools to use to help support individuals experiencing infertility and perinatal grief. (72 attendees)
KCC continued outreach activities to increase perinatal provider enrollment and engagement with the program.
Resilience/Preventing Adverse Childhood Experiences (ACEs): The previous Child and Adolescent Health Consultant became a trainer in January 2021 for the four-hour curriculum, Connections Matter. Connections Matter allows the public to learn about intersecting topics of ACEs, trauma, brain development, and resilience and how caring connections and trauma-informed communities can serve as a primary buffer on the negative effects of trauma in children and their development. However, this position was vacant October 2021 through May 2023. Because of the vacancy, prior plans to partner with the Kansas Children's Service League (KCSL) to provide at least two trainings to early childhood professionals, educating a minimum of 30 people, by March 2022 did not occur.
KCSL presented to the Family Advisory Council (FAC) in April 2021 regarding the Connections Matter curriculum and will be working with the Title V Family and Consumer Partnership (FCP) Consultant to integrate the teachings of this curriculum into training offerings for FAC Members and Support Peers through the Supporting You: Peer to Peer Network in the future.
Community Partnerships: Universal behavioral health screening is most effective when providers work collaboratively to ensure adequate systems of care are in place supporting accurate diagnostic assessments, appropriate treatment, and essential follow-up. Having effective partnerships or collaboration is critical when creating and sustaining a local community of care. Title V developed a Creating Effective Partnerships to Improve Behavioral Health Outcomes guide for local MCH programs. The guide includes steps for developing effective partnerships (e.g., determine needs, create new relationships, enhance existing relationships, and determine levels of involvement). Title V intended to develop a marketing strategy to promote use of the report by local MCH programs. With the Behavioral Health Consultant transitioning to co-serve as a consultant and the Consultant Unit Director and vacancies within the Woman/Maternal and Child/Adolescent Health Consultants, development of a marketing strategy was temporarily put on hold.
Trauma-Informed Approach Initiatives
Objective 6.2: Increase the proportion of MCH local agencies implementing trauma-informed approaches that support increased staff satisfaction and healthier work environments by 5% by 2025.
Resource Guide: Title V finalized the Resource Guide: Building and Maintaining a Resilient Team, Tools for the Public Health Workforce. The resource guide includes vetted resources on leadership and management during a public health crisis, building a resilient team, trauma-informed human resources best practices, and referral resources. The guide was distributed to MCH ATL grantees and partners and was published on the KDHE webpage as part of the MCH Integration Toolkits.
Social Determinants of Health Initiatives
Objective 6.3: Increase the proportion of MCH-led activities that address social determinants of health (SDOH) to reduce disparities and improve health outcomes for MCH populations by 15% annually through 2025.
MCH (Health Equity) Opportunity Project (MCHOP): Historically, the rate of infant mortality in the Black non-Hispanic population has been significantly higher than in other racial/ethnic groups. According to the KDHE Annual Summary of Vital Statistics, 2021, the Black non-Hispanic infant mortality rate in 2021 was 13.6 deaths per 1,000 live births – which was about three times the rate of White non-Hispanic births. Additional resources are needed to focus strictly on reaching and supporting this population.
The first Becoming a Mom (BaM) (Health Equity) Opportunity Project (BaMOP) was awarded in July 2022 to Baby Talk, a long-standing Kansas Perinatal Community Collaborative (KPCC) implementing the BaM® prenatal education program. Baby Talk has formed a partnership with the Wichita Black Nurse Association (WBNA) to provide BaM® classes in a trusted, faith based, setting within the black and brown community. Funding for the MCHOP will provide 3-4 WBNA nurses with Labor and Delivery experience to teach Baby Talk classes. In addition to teaching classes, the organization will recruit participants alongside the Baby Talk program. First classes are scheduled for October 2022.
The WBNA was founded in 1973 to serve the Black and Brown community in Sedgwick County. The WBNA is a well-trusted organization within both the community and the priority population. The partnership between these two organizations will allow greater outreach into the Black non-Hispanic community of Sedgwick County while providing evidence-based health and safety information with proven success at improving birth outcomes.
Birth Defects Prevention Campaign: The Centers for Disease Control and Prevention states that one in 33 children are born with a birth defect each year. Kansas is no exception; in 2020, Kansas recorded 32,957 in-state live births to resident mothers with a reported 689 of the 47 most common, reportable birth defects. The goal is to lower the incidence rate of birth defects in children born to Kansas families by increasing awareness, education, and information going to families about birth defects.
To reach MCH populations, intentional efforts to increase social media presence began in January 2022 and has continued into 2023, aligning with the National Birth Defects Prevention Month. During the month of January, new information targeted towards MCH populations using KDHE-generated materials, data, and other pre-developed materials provided by the Centers for Disease Control and Prevention, the National Birth Defects Prevention Network, and March of Dimes was utilized to support awareness campaign efforts. Work is still ongoing to develop materials that can be provided to Kansas birthing providers for distribution to those without access to social media. The Birth Defects Surveillance (BDS) program collaborated with other Screening & Surveillance programs to develop the Kansas Guide to Family Resources, an informational pamphlet spanning the prenatal period through 18 years of life for families and parents to support the health development of their children. This document included information on health care, financial, and behavioral health supports across several programs and organizations. The BDS program has also begun to have a presence in the Newborn Screening newsletter in collaboration with the Kansas newborn screening programs. In addition to collaborating on educational and informational materials, the BDS program works closely with the EHDI and CCHD programs to ensure children identified through the screening programs have been captured in the BDS program as well, and vice versa. The BDS program hopes to increase their community engagement in the coming year by participating in the community outreach events that are facilitated within the Screening & Surveillance section.
SDOH Screening: Non-medical social needs, or social determinants of health (SDOH), have a large influence on an individual’s health outcomes. Title V aimed to support MCH ATL programs in assessing clients served for social needs. Title V completed a review of available validated social needs/SDOH screeners available within the public domain for free and selected the American Academy of Family Physician’s EveryONE Project’s SDOH screening tool and added it as an optional screening form in DAISEY effective July 2022. This screening tool includes questions related to housing, food, transportation, utilities, childcare, employment, education, finances, and personal safety. A fillable PDF form of the screener was made available on the DAISEY Solutions webpage in English and Spanish for providers’ use. Guidance for this screener was also included in the updated Behavioral Health Screening Guidance for Kansas MCH Programs. The Guidance also outlined suggested protocol for required action on responses:
- For all social need risk areas other than personal safety, an automated prompt will appear, and responses will be underlined indicating the client might benefit from additional support and/or a referral for resources or services.
- For the personal safety question set, responses are scored automatically within DAISEY. A total score value greater than 10 indicated the client might benefit from additional support and/or a referral for resources or services.
- For help identifying social services available within an area, call 1-800-CHILDREN or search 1800childrenks.org.
- Providers are to indicate when a referral was facilitated using the KDHE Program Referral Form in DAISEY.
Title V monitors use of the SDOH screener and facilitated referrals in DAISEY to determine training, technical assistance, and other system improvement opportunities.
SDOH in KS-SHCN and Bridges: The KS-SHCN program and Bridges have processes for identifying SDoH needs for services and supports throughout a client's journey. The process begins with the client’s initial assessment that helps to identify SDOH which then are addressed in their jointly developed action plan and monitored/supported through holistic care coordination provided by their personal care coordinator. These issues are regularly discussed with guidance provided for care coordinators routinely through formal training, coaching and touch points.
Other MCH Workforce Development Activities
Title V Change Academy: Title V contracted with KU Center for Community Health and Development (KU-CCHD) to develop an online curriculum for use by the MCH workforce to bring about change and improvements in the MCH system. This curriculum consists of 16 learning modules based upon content from the Community Tool Box Curriculum (e.g., Creating Coalitions & Partnerships; Building Leadership; Advocacy; Influencing Policy Development). The Change Academy is currently in testing and will be available for use by the MCH workforce soon to help them gain the knowledge, skills and comfort to address the needs of the MCH populations.
Title V Staff training requirements: The MCH Navigator and online MCH Assessment continue to be utilized for new staff training. These are required as part of Title V staff onboarding (MCH 101 and MCH Orientation and others as recommended by the individual’s supervisor), so that they can become familiar with Title V. Title V supervisors are encouraged to include MCH navigator training courses in their staffs’ yearly performance reviews. During the on boarding process there are a variety of other Title V trainings that are required based on the individual's position within the Title V team (e.g., tobacco, breastfeeding, safe sleep, care coordination). The annual Governor’s Public Health and AMCHP conferences serve as additional learning opportunities for Title V staff.
Annual Home Visitor Conference: Kansas Title V and Maternal, Infant and Early Childhood Home Visiting (MIECHV) staff provided an annual Virtual Kansas Home Visiting Conference that was free to home visitors across the state. The September 2022 conference hosted more than 300 participants including home visitors and supervisors.
Local Public Health Program (LPHP) Partnership: Work continued with the LPHP to provide professional development webinars, conferences and other events to MCH Networks across Kansas. This ongoing partnership blends collaborative work between Bureaus within the Kansas Department of Health and Environment to provide professional development trainings to strengthen and support local public health agencies who deliver MCH services to individuals and families within their communities. The Governor’s Public Health Conference is held each Spring with an agenda developed by a variety of representatives from different Bureaus with a pre-conference focused exclusively on MCH workforce needs.
The Title V team participates annually in local regional public health meetings with local administrators to share Title V updates, newly developed resources and answer questions. This gives Title V staff an opportunity to have dialog with the locals about what they need for additional trainings and supports. This information is then shared with the Title V team so trainings and other supports can be developed. The Title V team contributes articles, new and resources through the Public Health Connections electronic newsletter that is sent regularly to all local public health agencies through the LPHP partnership.
MCH Third Thursday Webinar Series: In August 2021, Title V launched their MCH Third Thursday Webinar Series. The Kansas MCH Team, along with subject matter experts from across the state, began convening a monthly learning opportunity for MCH providers. The sessions focused on providing information about initiatives and resources that can be applied to MCH work across all communities. All webinar sessions were recorded, and a copy of the recording, slide deck, and referenced resource materials were made available to anyone who registers for the sessions following the live training. The following sessions were facilitated throughout this Report period:
As part of the 2022 Governor’s Public Health MCH Pre-Conference Session, attendees were encouraged to complete a feedback survey about the training series. Title V received very positive feedback about the series - “Very helpful. Like that I can go watch later or have other staff watch.” “We love the webinar series!” And, “I was unaware that we could get recording of session if we registered. I can't do these at noon on Thursdays so never signed up - I would have if I knew I could get the recording to watch later. Thanks for this info!” Attendees could also provide ideas or suggestions on future webinar topics. This information was referenced when scheduling sessions for the SFY2023 series which launched in September 2022.
To build upon initial success of the webinar series, Title V developed a Third Thursday Webinar Series Guide outlining coordination, prep, and wrap-up activities, such as sending reminders to all networks about the next session, offering opportunity for Title V and other KDHE program staff to make announcements at the beginning of each session, recording webinar sessions in Community Checkbox, etc. in an effort to ensure consistency across all sessions. Title V also adjusted the time of the webinar based on feedback from ATL programs from Noon to 1:30pm, as offering the session over the lunch hour was a barrier for some programs and providers. An oversight of the initial series was making a feedback or evaluation survey about each session available to attendees. Starting with the September 2022 session, 3-5 training objectives are obtained from the session presenter and are used to create a feedback survey in SurveyMonkey. A link to the survey is made available in the chat during each session as well as in the follow-up email. All questions included in the survey are optional and includes contact information, pre-assessment questions, post-assessment questions, and opportunity to provide additional feedback. Attendees respond to the pre-assessment and post-assessment at the same time, following the session. These sections inquire about Training/Experience: “Please assess your level of knowledge, training, and confidence as untrained, trained, or skillful,” and Confidence: “Please assess your confidence with the following skills on a scale of 0-10.” Responses collected will be used for Title V Block Grant measure reporting purposes as well as when scheduling future MCH Third Thursday Webinar sessions.
The resource packet was made available to everyone listed as a contact for their MCH program, not just the primary point of contact. As part of the communication with local programs about this resource, they were encouraged to provide feedback about the information included in their packet following their review and use of the resources. A feedback survey was created in SurveyMonkey and remained open for the first quarter of the grant year. Title V requested that providers only submit one response per person but multiple responses from a program were appropriate and encouraged. Title V received responses from 19 individuals via survey link and 1 individual via email.
Email Response: I just want to say how excited I am to get this resource packet that is tailored for our health department. A Big thank you. I have not read much of it yet but was really excited to see this. I have been asking for this kind of thing for a long time. Now if others would just follow this example. I would love to see packets, or power points designed for my county. Example how to prevent falls in elderly, how to decrease medication errors, how to help with suicide etc. I just don't have the time to research all of this info to get it out there to my people. That is where I need the help the most and you putting this packet together just for us is awesome. So, thank you again for all of that hard work.
Kansas Perinatal Community Collaborative (KPCC) Site Visits: In August 2022, the Perinatal/Infant Health Consultants visited 22 counties who were identified as a KPCC implementing the BaM prenatal education program. These were the first in-person site visits to be offered in several years. The P/I Consultants felt it important to be in the communities meeting one-on-one with staff to: identify the current status of their BaM program; identify any needs and/or technical assistance; provide a warm introduction of the P/I Consultants and their supportive role as content experts to local partners as there has been much staff turnover at the local level over the last few years. The P/I Consultants also utilized this as an opportunity to reintroduce the broader, life-course vision for the KPCC model. Communities were encouraged to review their local data (Vital Statistics, BaM data, etc.), convene local partners and stakeholders, and to collaboratively strategize together to implement programs and initiatives, beyond BaM, that address their identified local needs.
There were many common themes among the 22 KPCCs including:
-
Virtual offerings of BaM classes: a preferred way of receiving education; difficulty getting people to come back to the classroom; has created reach of much larger audience, but not necessarily that of highest risk/disparity populations. While most sites report struggling with virtual presentation (difficulty keeping audience engaged, poorer evaluation outcomes, etc.), two sites seem to have a good handle on it (Saline and Riley). Their approach has included the following:
- Teaching to virtual audience only (vs. connecting virtually to live session) (Saline Co)
- Incorporating questions throughout session and calling on participants to answer
- Requiring code word submission at end of session in order to receive credit
- Camera required to be on unless communicate need to turn off to instructor
There were also notable benefits to the virtual offering of classes:
- Father of the baby able to attend from afar (overseas deployment, out of town work, etc.)
- Able to participate when situation would have prevented in-person participation (i.e. on vacation, hospitalization, no childcare, transportation, sick, etc.)
- Participation out of county and out of state (i.e. employee’s daughter who lives in TX participating virtually, out of county referrals by family and friends)
- Challenges with BaM/KPCC implementation: A main challenge was a shortage of staffing for facilitation, data entry, partner engagement and coordination of efforts (not enough time for coordinator to truly coordinate collaborative efforts the way they should), and review of data. Another challenge was serving the illiterate and low literacy population. Many individuals do not comprehend the written curriculum or the evaluation tools; and therefore evaluation efforts do not demonstrate true knowledge gain. Serving this population takes one-on-one staff time to assist participants in completing evaluation tools. Sedgwick Co. and Southwest KS have a large refugee population (Guatamalian, Somalian, etc.) and need curriculum and evaluation for low-literacy (picture based), and more demonstrations.
- Preterm birth (PTB)/low birth weight (LBW) and induction rates: Multiple sites reported increased PTB/LBW. Lyon Co. stated hypertension and diabetes drive up their induction rates (hospital data supports this).
- Telehealth services: COVID-19 has created a new opportunity for providing vast array of telehealth services. Most public health departments, county buildings, provider practices and hospitals have more quality IT equipment and support staff now, with this, there may be opportunities to make more specialty services available through these resources.
- Social media and marketing resources: COVID-19 has also created new support for media and marketing efforts. Most sites now have agency communications staff available to them for distributing messages and educational content. There is still a need to develop the content for posting however, lack of staff time available to dedicate to the creation of this content is challenging. Sites appreciate social media content and resources that are shared. Messages addressing cultural beliefs/myths – i.e. prenatal care and breastfeeding are helpful.
- Need for a state Fetal Infant Mortality Review (FIMR): There are very few local FIMR sites as most sites could not fund/staff locally to maintain it after the initial funding went away. There are currently only 3 local FIMR sites – Wyandotte, Shawnee, Sedgwick- all urban counties. Rural areas with potentially unique contributing factors have never been looked at. Locals voiced a state FIMR would be very helpful to them, just as the recommendations that are coming from Kansas Maternal Mortality Review Committee are directing their work/efforts.
- Community Health Workers (CHWs): There has been concern with discrepancy among training hours across the different CHW models (i.e. in the KC metro area, KU COPE CHWs only have 4 hours of training for “Maternal CHW”, whereas Community Health Council of Wyandotte County have 600 training hours).
- Edinburgh Postnatal Depression Scale/Mental Health: There has been an uptick in positive screens. There is a need for continued training in this area for local staff. There is a need for help with connecting to individual providers to engage in KCC/Postpartum Support International (PSI) trainings to increase knowledge and comfort level in treating. There is a shortage of mental health providers in Southwest KS and primary care providers not comfortable with crisis situations that have occurred recently.
- Staff vacancies: Sites noted nursing staff shortages. Sites noted they cannot compete with hospital wages, agency wages, or huge sign-on bonuses. Partnering hospitals do not have enough staff to cover the floor, therefore have pulled back on any partner commitments such as to BaM facilitation. Two sites have stopped offering BaM due to staff shortages and multiple programs that were “in progress” towards launch have delayed.
Additionally, the P/I Consultants were provided feedback on the challenges of the MCH grant application and report writing process. Key takeaways from these conversations include:
- Desire for more training/assistance in grant writing.
- Sites would like to see reviewer feedback.
- Concern over staff capacity to devote adequate time and energy for applications.
- Application and reporting process needs streamlined.
- Sites were in favor of the idea of a bi-annual application and a universal application for all KDHE Bureau of Family Health programs.
Local MCH Agency Site Visits: The MCH Program Consultant and Community Partnerships Unit Director completed site visits with the following Aid-to-Local MCH grant programs.
PRIORITY: Strengths-based supports and services are available to promote healthy families and relationships.
SPM 4: Percent of children whose family members know all the time they have strengths to draw on when the family faces problems
Family and Consumer Partnership (FCP) Program
Objective 7.1: Increase the proportion of MCH-led activities with a defined program plan for family and consumer partnership (FCP) to 75% by 2025.
Family & Consumer Partnership Toolkit (FCP Toolkit): The work on this toolkit started in collaboration with our Family Advisory Council (FAC, information in section below) during FY21 and in early FY22. The outline for the toolkit was developed in partnership with University of Kansas Center for Public Partnerships and Research (KU-CPPR) and their design team. The base outline for the toolkit was released in June of 2022 and can be found on the Kansas MCH website under the Family Advisory Council tab labeled Family and Consumer Partnership Toolkit. To learn more about the progress of this toolkit you can view our plan for the next fiscal year.
Peer Supports Initiatives
Objective 7.2: Increase the number of individuals receiving peer supports through Title V-sponsored programs by 5% annually through 2025.
Supporting You: A peer-to-peer support network that was developed by our FAC based on their desires to find connections with other parents who had gone through the same or similar life circumstances. This is an informal peer-to-peer program that is designed to offer a variety of opportunities for authentic connections. The system is set up to include expansion for new programs to join the network and offer connections for different populations, each program with a specific target population is referred to as a Network Program and have their own program within the Supporting You network. Network Programs have the option to crossmatch peers that may be a good fit even if they aren’t in their network, we encourage open dialog and collaboration between the programs. The system network is constantly undergoing evaluation and system improvements.
Supporting You network user dashboards were created and implemented. Features of the dashboards include program information about how many peers they have and their active matches, a network announcement bulletin, a page to house program documents for easy access, and a match specific messaging option for peers and programs. These dashboards allow better snapshots for programs as well as easier navigation for any person signed up to offer or receive support.
The KS-SHCN program expanded the population for the Supporting You Special Health Care Needs Network by using the Maternal Child Health Bureau definition of “Children and youth with special health care needs (CHSHCN) are those who have, or are at risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally” verses the state specific definition as defined in State Statute –KSA 6-5a01 “A child with special health care needs means a person under 21 years of age who has an organic disease, defect or condition which may hinder the achievement of normal physical growth and development”. By broadening the definition to encompass all special need conditions, it provided the program greater flexibility in meeting the support needs of the larger CHSHCN population.
The program has been working with Foster Adopt Connect, the current DCF contractor, to create a Supporting You branch for foster, adoptive, and kinship families. There was a slight pause on their program development due to staffing changes at Foster Adopt Connect, but it is back up and moving with plans to launch in early 2023.
Systems Navigation Training for Families (SNTF): The Systems Navigation Training for families was halted in 2020 due to the COVID 19 pandemic but was reestablished in 2022. With the lessoning of COVID-19 cases and availability of vaccinations, in-person trainings were able to resume. These fun and interactive one day trainings are designed for parents/caregivers of individuals with special needs to learn how to navigate the various systems of care while also gaining peer-to-peer support. SNTF are led by parents for parents/caregivers. See more information on these trainings in the CSHCN section.
Systems Navigation Training for Youth (SNTY): As part of the Title V focus on transition for adolescents and young adult, the SNTF was used as a model to develop a Systems Navigation Training for Youth with and without special health care needs from ages 16 to early adulthood. Focus groups were held to gain feedback and ideas from youth on what they want to know as they go through the transition process. More information can be found in the CSHCN and Adolescent sections.
Family Leadership Programs
Objective 7.3: Increase the number of families and consumers engaging as leadership partners with the MCH workforce through the FCP Program by 5% annually through 2025.
Family Advisory Council (FAC): Expansion of the Bureau of Family Health Family Advisory Council (FAC) continued to occur in FY 2022, with all Title V populations represented. The FAC is made of five core work groups which align with our MCH council, to help move our MCH work forward in a meaningful way for the people of Kansas. The work groups are: Women/Maternal, Early Childhood (birth–5), Child (ages 6-11), Adolescents (ages 12-21), and Children and Youth with Special Health Care Needs (CSHCN). Particularly around Strategy 3.2 – “Build a culture throughout the early childhood care and education system that respects and strengthens family voice.”
The council met four times, all virtual during FY22 (Oct. 16, Jan. 15, Apr. 9, Jul. 16) where each of the five work groups were able to start on individual domain specific plans. Each work group is supported by KDHE staff and lead by two member appointed co-chairs to help drive the work forward. During each meeting there are presentations for FAC members to learn about work happening around the state and then separate time for them to work on their work group projects. Please see below for topics covered during each FAC meeting.
Family Delegate Program: During FY2022, the Delegate program was moved to the CYSHCN Director as the lead support for the Delegates work. This began with discussions between the past and current delegates and Title V Directors to identify ways to improve the Delegate program so Delegates can clearly see where they fit and the expectations from Title V that goes with the Delegate work. Based on these discussions it was determined to pause the Delegate program as currently functioning and contract with the current and past Delegates to better outline how the program should look. The same structure (as outlined in the Family Partnerships Document) will remain but with specific guidance outlined in a Delegate handbook, training expectations, regular coaching with the CYSHCN Director, orientation process as a new Delegate Elect, expectations for all three Delegate roles, special project selection criteria and expectations, an evaluation mechanism and other details as identified by the Delegates and Title V Directors. Upon completion for the formal recommendations by the Delegates, the program will resume with a stronger more supportive structure. Providing clear expectation for each Delegate and for the Title V staff supporting them in this work.
Holistic Care Coordination Initiatives
Objective 7.4: Increase the number of MCH-affiliated programs providing holistic care coordination through cross-system collaboration by three through 2025.
Building from the established KS-SHCN model, and aligned with the National Care Coordination Standards for CYSHCN, development of the implementation toolkit has begun, with the first stage of the toolkit accessible online. This toolkit is intended to support providers, practices, and programs interested in establishing a care coordination model at different stages, both in public health and primary care settings. The toolkit is organized following the National Care Coordination Standards for CYSHCN domain areas: Screening, Identification, and Assessment; Shared Plan of Care; Team Based Communication; Individual and Family Empowerment; Care Coordination Workforce; and Care Transitions. The toolkit currently includes foundational context, and considerations based on the Standards. Tools and resources for planning/implementation, evaluation and sustainability, sample job descriptions and training plans for care coordinators, and other resources to support needed technical assistance were identified and collected into a spread sheet to be added in the upcoming year. Title V was already focused on this expansion beyond the KS-SHCN program and across other MCH programs. The All in for Kansas Kids plan has identified this as a strategy under Goal 2: Community-Level Coordination and in partnership with this work is a focus on primary care settings.
The expansion for primary care has been led by the MCH Director, moving to the System of Care (SOC) Program Consultant. The expansion across MCH programming has been led by the CSHCN Director, who initially established the model and is leading the care coordination expansion efforts within the KS-SHCN program, Bridges. More information about Bridges can be found in the CSHCN Plan narrative. While these expansion efforts are happening in parallel, the synergy between all of these initiatives is complimentary and collaborative. Throughout the implementation toolkit development, the SOC Consultant has focused on outreach and promotion, provider input, and quality improvement focused development activities. During this reporting period, a video series was developed with Trozzolo Communications Group. The series consists of one short video on each of the domains from the Standards and can be found within the domain sections of our HCC Toolkit.
Expansion work also included an ECHO series in partnership with the Kansas Chapter of the American Academy of Pediatrics with pediatricians as well as individuals providing care coordination being the primary audience. The ECHO series pulled in COIVD-19, as that was an identified need by providers. The session was titled “COVID Support through Care Coordination” and consisted of the following sessions:
During this reporting period work started on building out a system for technical assistance in conjunction with the tools available in the toolkit. Two pilot sites were onboarded and worked through the readiness assessment to determine what they already provide as it relates to care coordination. Through this assessment, an individualized technical assistance plan was developed with both practices to incorporate care coordination services into practice. One practice worked towards developing a policy for referrals and follow-up. The other practice worked towards identifying what care coordination could look like in a busy practice with short staff, ideas included Standards training for care coordinator staff or improvements to their screening process.
An HCC Environmental Scan has been started to gain insights into care coordination in the state. Phase 1 was started in 2022 and focused on HCC billing, insurance, and sustainability. Phase 2 will use information gathered from phase 1 but move the focus more specifically on the children and youth with special health care needs population and their access to adequate care and insurance coverage.
To Top
Narrative Search