The Kansas Title V program demonstrates strong commitment to coordinating and collaborating beyond mandated work, addressing emerging and ongoing needs, and remaining focused on quality improvement. Title V goals are infused in, and supported by, the entirety of the work within the Bureau of Family Health (BFH) – across programs, funding sources, resources, and shared infrastructure. This commitment drives development of integrated systems of care and assessment for community level MCH initiatives.

Shared Measurement & Data Monitoring Systems

Data Application & Integration Solutions for the Early Years (DAISEY): BFH has been working with the University of Kansas Center for Public Partnerships & Research (KU-CPPR) since 2015 to: 1) implement and support a secure, HIPAA compliant web-based system (DAISEY); 2) train and provide technical assistance to users to capture MCH services at the individual level and use data to inform MCH practice and service delivery; and 3) provide analytics to improve accountability and continuous quality improvement at the state and local levels. DAISEY supports Title V’s vision for shared measurement and integrated community-level MCH initiatives. Increased data capacity allows the program to demonstrate the impact of coordinated, essential MCH services on improved outcomes. DAISEY is available free to all local grantees and is the required centralized collection system for MCH services.

The DAISEY website was developed at the time of launch to provide a centralized access point for users to find information and resources such as training, printable forms, data dictionaries, user guides, and technical briefs. KDHE and KU staff provide extensive training and technical assistance through webinars, individual phone instruction, on-site training, and recorded navigational videos. A DAISEY helpdesk email is available to provide direct technical support for system users. As of July 2022, there are 1,000 DAISEY users representing 96 grantees and 162 organizations. The DAISEY team completes an annual User Audit to verify all DAISEY users are accurate and still in use.

DAISEY’s data and analytics infrastructure continues to be enhanced, with focus shifting from data collection to using data to drive decisions and quality services. Customized, visual reports in DAISEY allow users and KDHE to review data quality, meet compliance reporting, and implement program improvements through review of clients served, services provided, education provided, and referrals made/completed. DAISEY reports help local agencies and KDHE easily demonstrate the need for MCH services and share the impact of their programs at the community, regional, and statewide levels.

In addition to the extensive TA and support that is provided, a DAISEY Advisory Group was developed in 2017; however, this group did not meet in FY2021 due to the high demand of COVID-19 responsibilities (likely to resume in the coming year). The group is comprised of users representing multiple programs in both rural and urban areas – 22 members currently represent 15 local agencies. Their role is to provide input into local needs regarding data collection/measurement and provide feedback regarding requested form and report changes as well as other technical elements of the DAISEY system. Membership will be reevaluated during this next year to verify members are willing to represent their community in the advisory group.

Input from the KDHE MCH staff is collected throughout the year, and a comprehensive review of DAISEY forms and reports is completed annually to assess for needed changes. Effective July 1, 2022, the following forms were added/updated:

• KDHE Program Visit Form
• MCH Service Form (added new response options to Education and Services provided)
• Pregnancy Maintenance Initiative (PMI) Service Form
• Teen Pregnancy Targeted Case Management (TPTCM) Service Form
• Added a Social Determinates of Health screening form

Typically, staff participate in monthly DAISEY “Deep Dives” to review and discuss data. The team strategizes around topics/focus areas and how to show impact. The MCH team is already discussing the data around the Edinburgh Postnatal Depression Scale and what we are seeing with the positive screens and referrals made.

The DAISEY Data Dictionary is available online. During the pandemic, an additional question was added to the KDHE Program Visit Form for both adult and the infant/child/adolescent encounters. The new question is to determine whether the visit occurred in person or remotely. There are multiple response options to select from: In-Person; Virtual, phone only; Virtual, video chat (Skype, Zoom, Facetime, etc.). KDHE will be able to use this to assess the client encounters.

Integrated Referral & Intake System (IRIS): Title V is a partner with KU to implement IRIS, a web-based community referral system to support best practices in social service referral and coordination among community partners. Its primary purpose is to enable service providers to make, receive, track, and respond to referrals. Data collected will provide insight into what’s working and not working at the local level for families as far as connecting to needed services.

There have been concerted efforts to align systems in public health, early childhood, family supports, behavioral health, and social services at the state and community level. IRIS is an important tool in this work, bridging the technical and adaptive gap between systems to engage individuals and families and get them connected to the services to address their unique and often complex needs. Often local public health is the entry point into the system of care for vulnerable populations, connecting families to needed resources and supports in the community. Additionally, local public health identifies goals and needs based on risk factors for families and connects them to wrap around services. IRIS is an efficient, low cost way for local public health to communicate with other providers, make those connections for families, and close the feedback loop, to ensure that families are connected to the supports they need. It allows other organizations within the IRIS network to see what local public health has to offer and to refer into the public health system as well.

When a system such as IRIS is in place, organizations can start to see a map of their community. They are easily able to recognize what services are available to families and make those connections. IRIS allows organizations to easily track referrals made, to ensure that families do get connected to the services they need. It is hard for a family in crisis to navigate their way through a complicated system, IRIS can help alleviate some of that stress for a family. A referring organization can see if/when services are available, rather than directing a family to a resource that may not be accepting new patients or has eligibility criteria that the family does not meet. That can save many fruitless phone calls and frustration for the referring organization and the family.

Title V supports engagement of local partners in IRIS through messaging and promotion to ensure that IRIS is integrated into new initiatives, especially if providers do not have another means of referring and connecting. We encourage all partnering organizations to be involved in their local IRIS community, it one exists. Meeting communities where they are to assure referral systems that are robust, offer bi-directional referrals and closes the feedback loop are established and working for the community, even if that’s not IRIS. If a system is not in place, Title V encourages the community to adopt IRIS and can offer financial support for communities to adopt IRIS as part of a larger grant or pilot projects. It’s also encouraged for communities to work together collaboratively to develop a plan for start-up and maintenance for long-term sustainability.

The following screenshot provides a snapshot of the impact of IRIS. Total families served through IRIS connections increased from 8,887 to 12,367 and total referrals made increased from 13,489 to 19,212.  42.9% of referrals resulted in successful service enrollment. IRIS is currently utilized across 21 Kansas counties, a reduction from 25 counties the prior year. Four networks elected to transition away from IRIS. These community-led decisions reflect common sustainability challenges related to capacity, resources, and partner engagement. Feedback provided by stakeholders in these communities will inform technical assistance and implementation strategies in the year ahead.

Strategic expansion of IRIS continues. To support a Universal Maternal Community Health Worker pilot, the Kansas City region IRIS network has begun expansion to two neighboring counties (Miami and Leavenworth).  Partners in northwest Kansas envision expanding their IRIS-supported developmental health screening and referral system to an additional nine counties. Technical assistance continues to focus on onboarding high-priority partners such as Department for Children and Families, primary health care, and behavioral health providers to all IRIS networks. Learn more about IRIS online at http://connectwithiris.org/.

MCH Community Check Box (CCB): Monitoring the State Action Plan: Title V has been utilizing the MCH Community Check Box since 2017. The monitoring tool was developed by the KU Center for Community Health and Development (KU-CCHD). CCB captures, characterizes, and communicates state action plan activities/accomplishments. MCH staff input data by completing an accomplishment form which includes questions such as: what group led the activity, when did the activity take place, a brief description of the activity. The activity is then grouped by activity type:

• Development Activity - Training, technical assistance, assessment, planning, design and preparation of materials, input/feedback, and other development activities
• Community/System Change - A new/modified program, policy, or practice in the community/system, includes creating, improving, or expanding programs or initiatives for MCH
• Services Provided - Delivery of information, training, presentation, partnership building event, or direct clinical services
• Resources Generated - Acquisition of financial, human, or material resources that are internal to the initiative (e.g., grant received by the initiative)
• Media (M) - Coverage of the initiative by the media (e.g., news release/story, radio, billboard)
• Dissemination Effort - Conveying information about an initiative (e.g., presentations, publications, social media) to audiences outside the community to be served (county, regional, and/or state levels)
• Other - Activity not described above (e.g., internal planning meeting, draft plan or proposal).

Based on the selection of activity type, additional questions are prompted such as which populations were served and the social determinants of health and national/state performance measures addressed by the activity. The information collected is used for learning, improved collaboration, quality improvement, and monitoring the extent to which state and local partners are building capacity and acting to address the plan priorities and measures. Title V tracks how these activities may be influencing key indicators such as maternal and infant mortality. Sensemaking sessions take place quarterly with the Title V and KU teams.

Quarterly Sensemaking sessions gives staff an opportunity to see the impact of their work. Various data graphs are reviewed, and key targeted questions asked to help staff examine the data on a deeper level to identify what is working, what could be improved and areas for better collaboration. These sessions lead to robust conversation and allow the team to brainstorm ideas for systems improvement. In FFY 23 during each session, the team will look at data beginning from the first quarter of the fiscal year to current, to identify trends and gaps that need to be addressed. In December of 2022, a review will be done on the 2022 fiscal year and, for the first time, include external partners who are also entering in to CCB. This will help the external partner feel more engaged as part of the system and internal staff have a better understanding of the contribution these external partners play. 

Graphs below were created with CCB data and detail the extent to which efforts were focused on priority areas and performance measures, as well as, through what means or essential MCH service for the FFY2021 reporting period.

Key - Community/System Change (CC), Development Activity (DA), Other (O), Resources Generated (RG), Services Provided (SP), Dissemination Effort (DE), Media (M)

Efforts to Improve MCH Data Capacity

ESM Review:  In summer 2022, the Kansas Title V team began reevaluating the state’s MCH evidence-based/informed strategy measures (ESMs) that were selected for FFY 2022. The goal of this initial review was to determine 1) their effectiveness against criteria and national review results provided by Georgetown University’s National Center for Education in Maternal and Child Health (NCEMCH), 2) the degree to which they align with the MCH evidence base, and 3) how well they convey program success and impact. This effort has resulted in an understanding of how Kansas’ ESMs could be strengthened. Additionally, some alternative ESMs were brainstormed, which may better highlight the outcomes of ongoing MCH efforts that align with evidence-based strategies. Additional evaluation of current and prospective ESMs will occur through a contract with the University of Kansas, to conduct a robust evaluation of the state’s MCH State Action Plan and Block Grant.

Block Grant Evaluation: Expanding from the CCB monitoring efforts, the KU-CCHD will serve as the evaluator for Title V/MCH and lead, in collaboration with the Title V Directors and MCH Epidemiologists, the following in the coming year: a) the development of a robust evaluation plan, b) ongoing review and refinement of evaluation questions, c) integration and alignment with the Title V performance measurement framework, d) systematically reflecting on data using the sensemaking protocol, and e) using the information to make adjustments. KU-CCHD will develop a logic model for implementation of the Title V State Action Plan, including outputs/short term outcomes, intermediate term outcomes, and longer term outcomes, while the MCH Epidemiologists will take the lead in identifying the performance measures to be included in the evaluation plan as outlined above.

National Survey of Children’s Health Oversampling: Beginning in 2022, Kansas will sponsor a state oversample within the 2023 National Survey of Children’s Health (NSCH). An additional 13,000 addresses will be sampled in 2023, with data available in 2024 – right on time for inclusion into the next 5-Year Needs Assessment process.