Goals & Framework

The Needs Assessment was implemented through the lens of the program’s core values (prevention and wellness, social determinants of health, life course perspective, health equity) and embodies the four guiding principles of Kansas’ work (collaboration, relationships, community norms, consumer engagement). These values and principles are described in the State Title V Program Purpose and Design section of this narrative.

Building from momentum created in the past five years, Title V leadership desired to focus on the MCH workforce and partnership engagement throughout this process. The alignment of the Title V Needs Assessment with other state assessments (e.g., Maternal and Infant Early Childhood Home Visiting, Part C/Infant-Toddler Services, Early Childhood Systems/Preschool Development Grant) provided opportunities to maximize resources and align efforts and allowed Title V to focus on needs of the MCH workforce and high-risk populations.

Stakeholder Involvement

Led by the state’s Title V MCH and CSHCN Directors and supported by Bureau of Family Health (BFH) staff and MCH epidemiologists, Kansas led a robust Needs Assessment with strong engagement among partners and external subject matter experts in the MCH field.

Title V maintained an ongoing commitment to engage diverse voices through key partnerships with conveners and facilitators that played a direct role in conducting the needs assessment.

The following table outlines key stakeholder engagement activities.

Methodology

Quantitative and qualitative methods were used to assess strengths and needs of the MCH population, program capacity, and core partnerships/collaborations that support program efforts. Upon presentation to MCH stakeholders, the qualitative data provided support and meaning to the quantitative data being reviewed. The following public-facing, stakeholder activities were utilized to collect data for the Needs Assessment.

• MCH Grantee Regional Meetings: Semi-structured focus groups with MCH-funded programs were held, represented by 108 staff representing 59 MCH programs.
• Regional Community Open Houses: Regional open houses (n=6) were held. The events consisted of five “stations” where 135 participants were able to engage in activities to collect input on: the MCH workforce; home visiting programs; MCH performance (using Kansas data); perceived MCH priorities; and open-ended input regarding what is working well, challenges, and ideas.
• Public Kiosks: Kiosks placed in high foot traffic locations (e.g., health agency waiting rooms, libraries) collected responses (n=4,703) to questions about health needs and available services. Twelve touch-screen kiosk terminals across 10 different counties. Two additional kiosks traveled across the state to various events.
• Family Strengthening and Support Participant Survey: The Standards of Quality for Family Strengthening & Support were used to collected information from MCH grantee program participants on five key areas of practice: family-centeredness, family strengthening, embracing diversity, community building, and evaluation. Local clients and families were asked to respond to the Participant Survey, providing valuable data to determine how well local grantees are doing at meeting the Standards from the families' perspective (n=362 surveys returned).
• Adolescent Focus Groups: Focus groups (n=19) with 180 middle school, high school, and college students. Support from partners assured representation by youth from varying backgrounds and social groups (e.g., schools, tribal organizations, Boys and Girls Clubs, community organizations, and juvenile justice).
• Adolescent Photo Project: Youth groups participated in a photo documentation project to capture images of community factors that influence health, specifically of things that youth felt best represented how teens view influencers of health. Photographs and supporting narrative (n=65) information was received from 19 youth participants.
• Our Tomorrows Survey: The 2019 Kansas Early Childhood Systems Building Initiative resulted in the collection of over 2,600 stories through the Sensemaker® software. Utilizing analytical tools to make sense of complex, ambiguous narratives, the team analyzed 144 stories with relevance to the existing Title V priorities and measures.
• Community Norms Survey: An online stakeholder survey, including single-answer, open-ended, and community norm questions. Through this survey, Title V could identify themes of behaviors, among the 532 responses, on what communities expect/believe, based on the values, traditions, and policies.
• Key Informant Interviews: Stakeholders (n=11) participated in semi-structured interviews to fill gaps to assure adequate input was received from certain population groups. Informants represented foundations and associations relevant to MCH and provided experiences related to issues identified and gain insights on known gaps.
• KS MCH Council (KMCHC) Virtual Meeting (April 2020): Attended by key MCH stakeholders (n=40), this meeting focused solely on key aspects of the Needs Assessment process and review of draft priorities and objectives.
• Family Advisory Council (FAC) Meetings (Sept 2019, May 2020): Engaged at the onset and conclusion of the Needs Assessment process, FAC members provided input and feedback to ensure adequate representation from families, especially those with CSHCN. During planning, the families learned about data collection methods and offered insight on how to support family participation throughout the process. Upon completion of the draft plan, the FAC offered input on how Title V could assure adequate family engagement around the draft strategies.

Data Sources Used to Inform the Process

• Population-level Data: Data was collected at the state and regional levels (6 defined MCH regions), including demographic data downloaded from the Census.
• Client-level Data: The demographic profile for MCH clients was derived from DAISEY (Data Application and Integration Solutions for the Early Years), a public health shared measurement system used by MCH-funded agencies.
• Information from Local MCH Programs: Local agency applications provided information on public health priorities and reported capacity, allowing Title V to identify community-level disparities and gaps in MCH services.
• Workforce Data: Funded positions/staff demographics were reviewed and MCH personnel completed two activities to provide data around core MCH competencies.
  • Standards of Quality for Family Strengthening & Support: Staff Self-Reflection Checklist to assess how well they feel they meet these Standards
  • Online self-assessment of MCH competencies through the MCH Navigator.
• Aggregate Data: Specific to MCH populations, aggregate data was compiled and analyzed by MCH epidemiologists.

Top Data Sources Used*

• Health Resources and Services Administration (HRSA). National Survey of Children’s Health (NSCH), 2016, 2016-2017 combined
• Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System (BRFSS), National Immunization Survey (NIS), EHDI Hearing Screening & Follow-up Survey, WONDER
• Centers for Medicare & Medicaid Services (CMS) Hospital Compare
• Feeding America. Map the Meal Gap
• Kids Count. Kids Count Data Center
• KDHE Bureau of Epidemiology and Public Health Informatics: Kansas resident data (e.g., birth, death, fetal death, linked birth and infant death, hospital discharge data)
• KDHE BFH, Nutrition and WIC Services
• Kansas Pregnancy Risk Assessment Monitoring System (PRAMS)
• Annual Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Participation Report

*Complete list available upon request.

Needs Assessment, Priority Needs, and State Action Plan

Development of MCH priority needs and the State Action Plan were informed through the Needs Assessment process. Title V convened several meetings to review the data collected, develop priority needs, create measurable objectives and actionable strategies to create the 2021-2025 MCH State Action Plan. Additional information about this process is included the Priority Needs and Links to Performance Measures section.

Strengths of MCH Populations

Given the association among economic well-being, disease, and premature death, lower levels of poverty and higher levels of education is a relative strength in Kansas (compared to the U.S.). A lower percentage of Kansans live in households with incomes below the federal poverty level (FPL) (11.9% vs. 13.4% for the U.S.) and a lower percentage of children under 18 live in households with incomes below the FPL (14.7% vs. 18%). More than 9 in 10 (90.5%) adults have a high school education or higher (compared to 87.3% for the U.S.) and 32.3% have a bachelor’s degree or higher (compared to 30.9% for the U.S.). Other strengths noted below.

Needs of MCH Populations

Despite recent improvements in health status for MCH populations in Kansas, needs remain. Kansas’ performance is still not optimal, and disparities still exist among core outcome metrics. Some of the greatest areas of concern follow.

Kansas’ Successes, Challenges, and Gaps

Stakeholders noted positive changes or “bright spots,” and also highlighted gaps that hinder better health for MCH populations. This section will focus on the issues most consistently noted during the Needs Assessment, broadly categorized into three themes: access and availability to care; behavioral health; social determinants of health (and the presence of health disparities).

Access and Availability to Care

Challenges and Gaps: Many women, infants, and children face barriers accessing health care services, either because of inadequate insurance coverage or availability of health professionals. Notable gaps include:

• Only 68% of KS children (2017) under 18 years are continuously/adequately insured
• Loss of Medicaid coverage for postpartum women (60 days after delivery); this coverage window is insufficient to adequately address issues such as postpartum depression
• Limited number of providers who do not accept Medicaid and concern about the gap between services needed and reimbursable services

Many comments were received on the shortage of health professionals (obstetrics and gynecology, general and specialty pediatrics, mental health and substance abuse treatment, and dental services) in their communities. The data supports these concerns.

• The number of family and general practitioners per 100,000 population (23.3) was significantly lower in Kansas than the national average (38.8).
• Of the 105 KS counties, a high number of counties are designated as Health Professional Shortage Areas (HPSAs) for primary medical care (80), dental care (78), and mental health care (101).
• Pediatricians are clustered in urban centers, a problem for 89 of 105 rural KS counties.
• The number of obstetricians/gynecologists per 100,000 people (1.7) is well below the national average (5.8).

Successes and MCH Efforts to Address Needs: While successful programs exist to support doctors working in rural settings, the shortage of providers remains a challenge. Title V has made significant investments to promote enhanced access to integrated, collaborative care.

• Kansas Perinatal Community Collaborative (KPCC): This model brings education, clinical care, and wraparound services together to improve outcomes for mothers. Infant mortality rates (deaths/1,000 live births) in counties with the longest-running KPCC programs (6 years) have decreased from 9.0 to 5.5 (Saline) and 11.9 to 5.7 (Geary).
• Help Me Grow (HMG): Leveraging community resources and connecting providers helps experience an organized system of resources. Through family/community outreach, provider outreach, centralized access, and evaluation, HMG promotes collaboration, mitigates the impact of adversity, and supports protective factors among families.

Behavioral Health

Challenges and Gaps: Mental health is cited as a priority issue in more Kansas Community Health Needs Assessments (CHNAs) and Community Health Improvement Plans (CHIPs) than any other issue. Mental health was cited in 34 CHNAs/CHIPs with the second highest being substance abuse (29). Mental health was also most frequently cited for service gaps (twice as often as substance abuse). Additional mental and behavioral health concerns noted:

• Increasing adolescent suicide rates (KS rates are higher than the national average)
• 51.7% of Kansas children received mental health treatment when they needed, well below the Healthy People 2020 target of 75%
• 18.9% of mothers were depressed, 25.2% experienced anxiety and 12.4% experienced postpartum depressive symptoms
   

Successes and MCH Efforts to Address Needs: Since 2018 Kansas has initiated two programs specifically focused on addressing the mental health needs of MCH populations.

• Kansas Connecting Communities (KCC): Increased screening, assessment, referrals, and access to treatment. KCC is building provider capacity to assist clients through telehealth, peer consultations, and training opportunities. Providers have access to a free Consultation Line staffed by a Social worker with training in perinatal mental health and substance abuse and a behavioral health team including a Clinical Psychiatrist.
• KSKidsMap to Mental Wellness: Promotes and supports integrating behavioral health into pediatric primary care and telehealth. An expert pediatric mental health team (social work care coordinator, child/adolescent psychologist and psychiatrist, pediatrician) provide training, technical assistance, and care coordination for primary care providers to help address the needs of children with behavioral health conditions.

Social Determinants of Health and Disparities

Challenges and Gaps: Despite ongoing recognition, concern, and “upstream” efforts, health disparities among MCH populations in Kansas persist. Affordability of housing, health insurance/access to health care, and food insecurity have been among the top issues cited in CHNAs. Kansans struggle economically, experience food insecurity, Inadequate transportation, and unhealthy/unsafe housing. Reduced child care opportunities often resulted in lost wages or employment, exacerbating economic hardship. Disparities are higher among minority populations (Black/African American, American Indian or Alaska Native, and Hispanic or Latino children live below the poverty level more often when compared to White and overall).

Suicide and alcohol/substance use are two top public health concerns by MCH programs. Additional determinants related to behavioral health/ substance use include:

• Kansas’ suicide rate per 100,000 total population is 19.3, higher than the U.S. rate of 14.2, an increase each year from 2014 to 2018.
• Racial disparities exist among mental health hospital admissions rates—the rate for Black (106.1 per 100,000) is higher than the population by 31.0 (a 41.3% difference).
• Significant disparities exist between infants born exposed to harmful substances in utero for deliveries covered by Medicaid (8.8 per 1,000 birth hospitalizations) compared to private insurance (0.8 per 1,000 birth hospitalizations).

Successes and MCH Efforts to Address Needs: The Kansas Health Institute chartbook on racial and ethnic health disparities and the Kansas Health Foundation “Healthy Communities Initiative” created a network of advocates willing to learn and discover how to impact the health using a health equity lens. Building on this focus and readiness, Title V led the following efforts.

• MCH Opportunity Project: A learning collaborative to identify and address MCH health inequities. Support and technical assistance (TA) provided by KU Center for Community Health and Development (KU-CCHD) and guided by the Kansas Healthy Communities Action Toolkit, TA included capacity-building webinars and peer-to-peer learning.
• Adolescent Suicide Awareness and Prevention Efforts: Title V concentrates efforts on suicide risk factors and overall mental health. The KMCHC Adolescent Work Group developed a series of adolescent suicide action alerts based on the #BeThe1To campaign and the 5 Action Steps for Helping Someone in Crisis. Other Title V efforts include: a resource sheet (action steps for prevention); updates to the State Suicide Prevention Plan; participation in a Suicide Prevention Community of Practice; and engagement in creating “The Role of Public Health in Addressing Suicide Prevention.

The State's public health agency, Kansas Department of Health and Environment (KDHE), is responsible for the administration (or supervision of the administration) of programs carried out with allotments under Title V [Section 509(b)]. The Secretary of KDHE, Lee Norman, MD, is appointed by the Governor and serves as the State Health Officer. The agency is comprised of three divisions: Public Health, Health Care Finance, and Environment. The Title V Maternal and Child Health (MCH) Services Block Grant program is administered by the Bureau of Family Health (BFH), one of six bureaus in KDHE’s Division of Public Health.

The mission of the Bureau is to “provide leadership to enhance the health of Kansas women and children through partnerships with families and communities.” The BFH has three goals: (1) improve access to comprehensive health, developmental and nutritional services for women and children including children with special health care needs; (2) improve the health of women and children in the State through prevention/wellness activities, a focus on social determinants of health, adopting a life-course perspective and addressing health equity; and (3) strengthen Kansas’ MCH infrastructure and systems to eliminate barriers to care and to reduce health disparities. The BFH is led by an Administration team and organized into four sections: Children & Families; System of Supports; Nutrition & WIC Services; and Early Care & Youth Programs.

The BFH programs partially funded by the federal-state Title V Block Grant include MCH, CSHCN, and Child Care. The agency organizational chart with the programs/staff funded by Title V highlighted follows.

Title V invests significantly in staff development and focuses on continuous improvement with alignment and coordination among the core team members. This is evidenced by the recent realignment/reorganization of the Bureau that: positioned staff and programs/teams to increase and improve communication and coordination; allowed for capacity to support the workforce through professional and leadership development, teambuilding, thoughtful decision-making, continuous quality improvement, and innovation; and ensure sustainability and clear the path for growth and advancement for Kansas children, families, and communities. Key changes within the BFH implemented beginning September 2019 include:

• The Cross-Cutting Section (MCH Population Domain Consultants) joined the Children & Families Section which houses core MCH programming/staffing.
• A new Children & Families (C&F) Section Unit was created to ensure consistency across community and direct service programs and facilitate development, implementation, and sustainability of strong, evidence-based services administered at the local level.
• Part C/Infant-Toddler Services and Special Health Care Needs joined the new C&F Section Unit (moved from the Special Health Services Section).
• The System of Supports Section (formerly Special Health Services) encompasses the following to build and maintain strong foundations of support for Kansas families.:
  • Screening & Surveillance (S&S) Unit: created to support public health screening and surveillance identifying congenital disorders and birth defects. Under this Unit, the Kansas Newborn Screening Program rebranded and merged hearing and heart screenings into the Point of Care Screening Program and aligned data and education efforts with the Blood Screening (genetic/metabolic) program.
  • Family and Consumer Partnership (FCP) Program: To be developed in 2020.
• The System of Supports Section Director also serves as the Title V CSHCN Director, MCH Block Grant Coordinator, and Family and Consumer Partnership Program Coordinator. Under this new alignment, capacity was added to allow stronger focus and intention on implementation of efforts to advance the Kansas State Plan for Systems of Care for CSHCN and family engagement activities. Initiatives that impact the broader Title V population (e.g., cross-cutting initiatives) will be housed in this Section.

Capacity to Provide Services by Population Health Domain

In the past five years Title V has seen significant shifts in staffing including middle management leadership changes, long-standing staff vacancies, and moderate turnover rates. While this presented challenges, it also created opportunities to expand capacity for each population domain. As such, the Bureau shifted investments to provide capacity for each MCH population domain by adding a MCH Data Analyst position and the positions outlined to the right, specific to each domain population.

In addition to staffing within the MCH program, two other KDHE Bureaus receive MCH support, including the Bureau of Community Health Systems (BCHS) for public health workforce development, capacity building, and systems development and the Bureau of Epidemiology and Public Health Informatics (BEPHI) for vital records data sharing, analysis, and reporting. MCH and SSDI funding supports two full-time MCH epidemiologists within BEPHI. Both coordinate data analyses for Title V and support MCH program evaluation and research efforts for many other activities and initiatives, particularly with regard to working with Medicaid data.

System of Care Capacity for CSHCN

The Title V program provides guidance for services for CSHCN; however, the program must meet certain expectations to provide medical treatment services to families with defined and limited diagnoses and disabilities (per state statute). Programmatic activities align with Title V requirements, recommendations, and guidance to engage as a catalyst for improving systems of care for all CSHCN. Title V funds several organizations to provide special supports for CSHCN ranging from specialty care clinics for medical complexities, cystic fibrosis, and cleft lip/cleft palate to wheelchair and posture seating supports to youth leadership development. Additionally, local health departments receive funding to operate CSHCN satellite offices, providing local support to families and assistance with navigating the system, including assistance with program applications and care coordination supports.

The vision in Kansas spans far beyond the state mandate for services and aims to assess and address needs of all CSHCN through quality improvement and evaluation to advance sustainable and systemic changes. The Title V CSHCN Director serves as the CSHCN Domain Consultant and engages in high-level systemic and policy discussions related to the systems of care for the CSHCN population, such as access to care, insurance adequacy and coverage, cross-system collaboration, expansion of holistic care coordination beyond the Title V program.

State Support for Family Consumer Partnership

Family and Consumer Partnership (FCP) is a core focus of Title V. In the next reporting period, a formal FCP Program will be created to focus on empowerment, leadership and advisory opportunities, as well as peer supports. Title V continues to support the Family Advisory Council (FAC) to provide strategic input into planning and service delivery. The FAC has primarily focused on the CSHCN population, however these efforts will be expanded across MCH domain populations to assure the client/family voice is central to all programmatic activities.

State Support for Communities

Nearly half of the funds that make up the federal-state Title V budget ($8.4 million) is allocated to approximately 80 agencies at any given time, including: local health departments, FQHCs, medical centers, and others. Funds are allocated through contracts in compliance with Title V legislation and state agency protocols. Agencies apply through an Aid to Local (ATL) grant process and awards are based on several criteria (e.g., base formula, plans and collaborations, prior performance and compliance, and likelihood of achieving desired outcomes). Services across all MCH programs at the local level are depicted in the map below. Learn more about the ATL process: https://khap2.kdhe.state.ks.us/KGMS/Default.aspx (click on MCH).

Capacity Through Partnerships

Collaboration, relationships, community norms, and family/consumer engagement are the guiding principles of the Title V program. As such, partnership and community capacity for each population domain a core focus. Title V collaborates closely with several Bureaus within the state health department, many other state agencies, health services entities, private foundations and organizations, and other statewide partners to address MCH population needs and support health services delivery at the community level. These partnerships are described in detail in the Title V Program Partnerships, Collaboration, and Coordination section of this narrative.

Recognizing the importance of investing in an adequately sized, skilled workforce, Kansas Title V has been building capacity to better monitor/track changing MCH needs, evaluate progress against program goals, and enhance state-local partnerships to advance MCH. As the Kansas vision for MCH has become more expansive and collaborative in nature, recruitment and retention of qualified staff has become an even higher priority. Great focus has been placed on recruitment and retention efforts to improve the MCH program, including updated position descriptions and interview processes better aligned with MCH competencies. For example, questions related to needs assessment, strategic planning, program development, lived experience, and understanding of health equity/disparities have been added in the interview process.

State MCH Workforce: Number, Location, and Full-time Equivalents

A workforce analysis was conducted as part of the Needs Assessment with a focus on:

• State program staff (MCH and CSHCN): provides oversight, guidance, and directives for MCH services, systems, and programs
• MCH local programs: provides core MCH services across domains
• CSHCN satellite offices and specialty service contracts: provides support for stronger systems of care for CSHCN
• Pregnancy Maintenance Initiative (PMI) local programs: provides care coordination services during pregnancy for women at high-risk for poor birth outcomes
• Teen Pregnancy Targeted Case Management (TPTCM): provides case management program for pregnant and postpartum teen mothers
• Lifting Young Families Towards Excellence (LYFTE) local programs: provides an integrated approach to life-skills development for young teen parents – including fathers - utilizing case management with a focus on health, education and employment

Of the 160.2 estimated FTEs across state, local, and contracted entities, over 100 FTEs were employed in local MCH programs and 18.5 FTEs in the state program.

The following table shows the allocation of position types/roles among MCH staff statewide. Most resources are directed toward nursing, care coordination, home visiting, and administrative and leadership roles.

Qualification of MCH Leadership & Program Staff

Senior Leadership: Senior leadership include the BFH/Title V MCH Director, System of Supports (SOS)/Title V CSHCN Director, and the Children & Families (C&F) Section Director. Serving as the core MCH Leadership Team and providing guidance and support to program staff carrying out core MCH work, and assuring alignment across programs, bureaus, and agencies, specific qualifications are outlined below.

• BFH/Title V MCH Director (Rachel Sisson, MS): With a Master's in Early Childhood Education and Bachelor's in Family Studies and Human Services, Rachel has been leading the Title V and BFH work since 2012 and has extensive experience in workforce development, program management, policy development, and alignment of statewide systems. Rachel drives policy advancement for the MCH populations through inter- and cross-agency initiatives.
• SOS/Title V CSHCN Director (Heather Smith, MPH): With a Master’s in Public Health and a Bachelor’s in Child and Family Development, Heather has been working with families of CSHCN since 2006. She has served as the Title V CSHCN Director since 2013 and has experience with program management, quality improvement, and family and consumer engagement. Heather oversees the System of Supports Section, including the Screening and Surveillance Unit (newborn hearing, heart, and blood screenings and birth defects surveillance), the Family and Consumer Partnership Program (including family leaders/advisory opportunities and peer supports), and serves as the Title V Block Grant Coordinator as of 2020.
• C&F Director (Kelli Mark): With a Bachelor’s in Human Nutrition and pending Master’s in Public Administration (May 2021), Kelli has experience with grant management and clinical experience in the hospital setting. She has expanded capacity within Title V through supervision, management, and alignment across Title V Domain Consultants through oversight of the C&F Section (direct services for the MCH population) and the team of Domain Consultants.

Consultants & Middle Management: In addition to the leadership team above, there are many staff that provide direct support in leading MCH-related activities. This team is comprised of staff dedicated to providing guidance and supports in Title V programming.

• C&F Services Unit Director (Kayzy Bigler): As a parent and the former KS-SHCN Program Manager, Kayzy shifted the program from direct service delivery to a holistic care coordination program for participants and as a result of the 2019 Bureau realignment, now oversees all direct service programs targeting the population, including MCH, Part C/Infant-Toddler Services, and SHCN Programs and affiliated state and local agency programs and contracts.
• W/M Consultant (Jennifer Marsh): With many years of experience in domestic and sexual violence, Jennifer has allowed Title V to expand its women’s health capacity to include all women of childbearing age. She’s activity engaged in developing content and interventions to support MCH state and local partners improving women/maternal health.
• P/I Consultant (Stephanie Wolf, RN): With many years of local public health service supervising one of the first local programs to implement a perinatal collaborative model, Stephanie serves as the resident perinatal expert. She oversees implementation and expansion of the proven MCH birth outcomes model and provides ongoing TA for MCH.
• C/A Consultant (Elisa Nehrbass): As a parent and former child care educator, Elisa advises on child and adolescent health, including early childhood systems.
• BH Consultant (Kelsee Torrez, MPA): With a Master’s in Public Administration and experience in grants management and the behavioral health system in Kansas, Kelsee driven Title V’s work into the behavioral health realm.
• Health Planning Consultant (Kasey Sorell, BSN, RN, CPC): Previous clinical and Medicaid program experience has positioned Kasey for progress on maternal and perinatal quality initiatives. She leads coordination for the MMRC and PQC. Kasey is currently working towards a Master’s in Business Administration.
• MCH Program Manager (Carrie Akin): After nearly a decade working with local grantees, Carrie now supervises MCH staff and affiliated programming such as home visiting, teen pregnancy case management, pregnancy maintenance initiatives, and more.

Data Supports: Title V programs would not function without the support of a dedicated team of epidemiologists (Epi) and data analysts. In addition to staff listed, there are other BEPHI experts that partner with the Title V program to provide support for the Vital, MMRC, and PRAMS data collection and/or analysis. Additionally, the Screening & Surveillance Unit Data Manager was created to offer capacity in connecting data from the newborn screening and birth defects surveillance programs with other critical MCH data sets.

• Sr. Epi (Jamie Kim, MPH): With a Master’s in Public Health and Bachelor of Science in Chemistry, Jamie has extensive experience with MCH populations and data sets, serves as the State Systems Development Initiative (SSDI) project director, and focuses on pregnant women and infants (infant and maternal mortality and morbidity, teen pregnancy, family planning, substance use), CSHCN (birth defects surveillance and newborn screening), and WIC.

• Sr. Epi (Lawrence Panas, PhD, MPH): With a Doctorate in Population Health Sciences, Master’s in Public Health and Sociology, and a Bachelor’s in Sociology and Psychology, Lawrence conducts research and policy analysis for the MCH program.
• Data Analyst (James Francis, MPH): With a Master’s in Public Health, James has expanded capacity within Title V for a data driven approach to decision making.

Parent and Family Leadership

Title V engages volunteer family leaders through the FAC, the AMCHP Family Delegate Program, and as Consultants. There are currently twelve active FAC members from both urban and rural communities. There are also an additional eight family leaders that have moved into the FAC Alumni and Mentorship Program, and one contracted FAC member serves as the FAC Peer Support Administrator. The AMCHP Family Delegate (Cassandra Sines) provides care coordination services for CSHCN, leads a systems navigation training, and serve as the program’s Peer Support Administrator under Supporting You. She also serves alongside three other families on the KMCHC.

Additional MCH Workforce Information

Demographics: Females make up nearly 95.8% of the KS MCH workforce. The median age of the MCH workforce in KS is higher than the overall state median age (45 years compared to 36 years statewide). The workforce over the age of 50 is almost one out of every four at 39.6%. As such, the MCH labor force, like the U.S. labor force, is likely to grow fastest in terms of older workers, and staff retention (particularly of older staff) will be an important priority.

The racial composition of the MCH workforce mirrors the KS population. Given the strong programmatic focus on health equity, continued growth of MCH workforce diversity should be a strategic goal of MCH statewide.

MCH Competencies: KS MCH received support from the national MCH Navigator project team at the Georgetown University National Center for Education in Maternal and Child Health (MCEMCH) to assess the knowledge and skills of the workforce using the Navigator online self-assessment. The KS MCH workforce had a relatively high knowledge score in cultural competency, but a lower score for skills around cultural competency.

MCEMCH developed a 2016-2018 “Kansas Workforce Snapshot” based on 296 responses. A copy of this snapshot can be provided upon request.

Title V is heavily focused on collaborative partnerships and demonstrate strong commitment to coordinating with others to address emerging and ongoing needs of MCH populations. Both formal and informal collaborative relationships exist that support the Title V work.

Title V Stakeholder Councils

Kansas Maternal and Child Health Council (KMCHC): The KMCHC is a multi-disciplinary team of professionals, family members, and other stakeholders that serves to: advise Title V; monitor progress; and develop recommendations. The Council is coordinated by the Kansas Chapter of the American Academy of Pediatrics (KAAP) in partnership with KDHE meets at least quarterly.

Title V Family Advisory Council (FAC): Currently, the FAC engages family and parent input around the CSHCN population. Future expansion efforts are planned to support the Title V vision that families should be involved in planning, design, implementation, and evaluation of program initiatives, across all domains. The FAC reviews program data, provides insight into strategies for data collection and the family perspective on existing and emerging issues.

Other MCHB Investments and HRSA/Federally Funded Programs

Title V works collaboratively with other MCHB investments, including but not limited to: State System Development Initiative (SSDI); Early Hearing Detection and Intervention (EHDI); Pediatric Mental Health Care Access; Maternal, Infant, and Early Childhood Home Visiting (MIECHV); Early Childhood Comprehensive Systems (ECCS); Safeguarding Two Lives; and Emergency Medical Services for Children (EMSC). Strong linkages exist among MIECHV, ECCS, and Title V programs and alignment with the behavioral health investments is underway.

Title V works with the State Primary Care Association (Community Care Network of Kansas – CCN) and FQHCs to help meet the needs of women and children served by the state’s safety net. FQHCs are funded to provide MCH and CSHCN services and have served as lead agencies in HRSA-funded projects, such as efforts to improve the health and well-being of pregnant/postpartum women, and has collaborated to establish school-based health centers.

Title V works closely with WIC, Title X/Family Planning, Part C, Child Care (all overseen by the BFH/Title V MCH Director). Title V and Title X has strategically worked to set priorities, goals, objectives, and identify linkages between MCH and Reproductive Health/Family Planning. Significant progress has been made related to reproductive health and family planning with new activities, resources, and interventions in place. MCH works directly with WIC and Child Care on shared priorities (e.g., breastfeeding, oral health, smoking cessation) and both the State WIC and Child Care director are part of the MCH Coordination Team and KMCHC.

State Health Department Programs and Local MCH Programs

The BFH and MCH programs work closely with the Bureau of Health Promotion, specifically on chronic disease risk reduction, tobacco cessation, injury prevention (e.g., Safe Kids Kansas), and opioid use. MCH staff have been active in working to help develop/ implement the state's injury prevention plan, particularly around safe sleep, adolescent driving safety, preventing and addressing Adverse Childhood Experiences (ACEs), and substance abuse prevention.

Title V works with the Bureau of Epidemiology and Public Health Informatics and co-locates two MCH Epidemiologists with the BFH team. Collaboration has resulted in implementing PRAMS, launching maternal mortality review, and enhancing birth defects surveillance. Epidemiologists serve lead roles with the Perinatal Periods of Risk Analysis, Fetal and Infant Mortality Review processes, local public health system assessments, and the state health needs assessment.

Partnership with the Bureau of Community Health Systems supports development, training, capacity building, and systems development among the MCH workforce. Including the annual Governor’s Public Health Conference that focuses on public health resources and supports and includes a pre-conference and track specifically for those working in MCH.

Title V and Medicaid (housed in the KDHE Division of Health Care Finance) are dedicated to collaborating, particularly as it relates to addressing disparities among Medicaid beneficiaries. An area of focus has been the Medicaid-linked birth data set and areas where measures and programming align, such as disparities in prenatal care and birth outcomes. Title V also assists Medicaid to identify and address reporting and program requirements related to childhood immunization status, live birth weight, well child visits, and chlamydia screening.

Title V supports and works closely with local MCH programs, providing funding support to local MCH through the agency’s aid to local grant process. Technical assistance is provided through a variety of means by state MCH consultants. It has been noted that local programs believe responsive and effective technical assistance are strengths of the Title V program.

Other Public, Private and Governmental Organizations Serving the MCH Population

Title V is a key partner in the Kansas Early Childhood Systems Building Needs Assessment and Strategic Plan, supported by the Preschool Development Grant Birth through Five (PDG B-5) funding. Coordinated by a State Directors Team consisting of key leaders from the Kansas Children’s Cabinet and Trust Fund, Kansas State Department of Education, Kansas Department for Children and Families, and KDHE (Title V MCH Director), opportunities for statewide collaboration has focused on building coordinated systems to support early childhood.

Other key partners and organizations the private associations, foundations, and coalitions, such as: Kansas Hospital Association, Kansas Academy of Family Physicians, Kansas Health Foundation, Kansas United Methodist Health Ministry Fund, Kansas Breastfeeding Coalition, Oral Health Kansas, Child Care Aware, Kansas Child Care Training Opportunities, and Families Together (Family-to-Family Health Information Center), among others.

Other Key Partners (e.g., Tribes, Universities)

KDHE continues its work to build relationships with the four Kansas tribes (Iowa Tribe of Kansas and Nebraska, Prairie Band Potawatomi Nation, Sac & Fox Tribe, and Kickapoo Tribe). KDHE and the tribes collaborate on a Kansas Tribal Health Summit, the latest of which was in 2018 and focused on the status/future of each of the tribes’ community health assessments. Tribal representatives are invited to participate in state and local level efforts, including the Maternal Mortality Review Committee includes a tribal representative. KDHE and Title V are interested in increasing collaboration with the tribes, but response has been inconsistent or lacking.

KDHE works closely in support of public health education, including undergraduate programs at state Regents Institutions and the MPH program at the Kansas University Medical Center. Multiple health professions educators play an active role in development and implementation of the MCH State Action Plan and MCH programs. Multiple faculty members with state universities play active roles on the KMCHC, including a pediatrician who serves as the Council Chair.

Methods Used to Rank Needs and Select Priorities

Data was compiled and reviewed with Title V prior to engaging an expanded stakeholder team (KDHE Bureaus and programs, Medicaid, KS African-American Affairs Commission, KS Hispanic & Latino American Affairs Commission, KS MCH Council, State Early Childhood Directors Team). Through interactive exercises, participants ranked their top five issues, supported with relevant data, to be included as potential priorities. MCH epidemiologists then compiled detailed information around sixteen issues identified through stakeholder meetings. Key themes emerged and guided the selection of the 2021-2025 MCH Priorities.

1. Well-functioning/Holistic Systems of Care: Across all population domains and the state: need for access to high-quality, comprehensive, coordinated, and affordable services.
2. Mental Health: A priority in each community was access to screening, intervention, and referrals. There was discussion about focus or emphasis on “diseases of despair” (e.g., suicide, drug abuse/overdose, and excessive drinking).
3. Healthy Relationships: Interpersonal/domestic violence was identified as a contributor to stress, injury, death and other poor health outcomes.
4. Disparities & Social Determinants of Health: Focus on chronic stress as a contributor to chronic disease, including disparities associated with higher risk factors (e.g., tobacco use, physical inactivity, poor diet/food insecurity). Taking an “upstream” approach will require focus and intentionality with partners and stakeholders to address the needs of the MCH population linked to stressors associated with social determinants of health.
5. Family Strengthening and Supports: All agreed services and supports for families are most beneficial when families are engaged and actively working with program and policy leaders to assure a strengths-based approach to service delivery.

Seven priorities were developed, one for each population domain and two for Cross Cutting/Systems Building. Development of objectives and strategies, alignment with national performance measures (NPMs), adoption of new state performance measures (SPMs), and the creation of evidence-based strategy measures (ESMs) followed. During this process, five NPMs and four SPM’s were selected to cover state needs. The final draft of the 2021-2025 State Action Plan was developed and presented to Title V advisory groups.

With similarities to priorities from the 2016-2020 plan, these new priorities expand on previous work or focus on new/emerging issues. Kansas adopted a stronger focus on holistic, well-functioning, strong systems of care and support for the MCH population and their families. Recent efforts with the early childhood systems (PDG B-5 planning and renewal grants) has set the foundation for more alignment across systems so families can experience seamless service delivery and transitions across systems. Kansas envisions fully-integrated systems of care and the development of policies, systems, and environments that reduce and/or eliminate persistent disparities. The table the follows compares 2021-2025 priorities to those from 2016-2020.

Emerging Issues/Frequently Cited Needs

One issue cited frequently that was not explicitly called out among the selected priorities is inadequate insurance coverage (NPM 15). There are strategies included in the plan to support efforts to improve in this area given ongoing efforts in the state to expand Medicaid coverage and Title V engagement in discussions about enhancing insurance coverage. Examples of this engagement are:

1. State Directors Team for Early Childhood Care and Education (ECCE): The Title V MCH Director is heavily involved in the ECCE systems building work to advance the new “All in for Kansas Kids Strategic Plan.” Several strategies in this plan support policies that contribute to economic security for families, including the adoption of policies to expand covered/billable services for Medicaid, the types of providers who qualify for reimbursement, and the settings where services can be provided.
2. Early Intervention Strategic Plan: The Title V CSHCN Director provided support and guidance for the program where focus was placed on billing structures and practices to find ways to enhance reimbursement for early intervention services.
3. Kansas PSP Workgroup: Public health, Medicaid, child welfare, behavioral health, pediatrics, philanthropic organizations, and families identified gaps and opportunities to improve health outcomes – the proposed policy change was to allow maternal depression screenings to be covered under the child’s Medicaid plan in pediatric care settings. When approved, MCH will support implementation, assist with necessary guidance to providers, and assist in training development.

Factors Contributing to Changes in Kansas’ Priority Needs

Title V’s focus remained on adapting to emerging needs, trends, and newly identified gaps. The following table outlines the factors that provide rationale for the shifts proposed across domains.

Relationship Between Priority Needs and Measures

The Kansas Title V Needs Assessment process focused on identifying and addressing

issues at the state and local levels, and priorities were selected with Title V mission, purpose, and legislation in mind. The top state priority issues that most closely aligned with the national priorities and NPMs were selected.