Local MCH Reach

Based on SFY2024 MCH Aid-to-Local applications received 50 of 56 grantees (89%) plan to provide services to the Woman & Maternal population. As related to each objective within Priority 1: 

•       30 of 50 grantees (60%) plan to provide well-woman services 
•       43 of 50 grantees (86%) plan to provide post-partum depression services 
•       42 of 50 grantees (84%) plan to provide prenatal education and support services 
•       32 of 50 grantees (64%) plan to provide pregnancy intention screening services 

Kansas expanded postpartum care for new mothers covered by Medicaid in 2022! The policy change supports healthcare, counseling, and other treatment services to be available for 12-months post-delivery. Kansas Title V is committed to continuing its partnership with Kansas Medicaid Leadership to strengthen available services and supports, offer workforce development opportunities to ensure access to quality care, and promote Medicaid plan benefits with beneficiaries. Further, Kansas Title V remains committed to the continued development and expansion of the Kansas Perinatal Community Collaboratives (KPCC) model and supporting community implementation of the Becoming a Mom® (BaM) prenatal education curriculum. This commitment extends to the development and implementation of additional integration components that allow for the strengthening of particular priority resources, such as the: Well-Woman Visit Integration Toolkit; Reproductive Life Plan (RLP) Workbook; Pregnancy Intention Screening ; Fourth Trimester Initiative (FTI); and LARC resources. These resources will be expanded to include comprehensive screening guidance and tools as well as implementation technical assistance. This will continue to be the primary work for women of reproductive age throughout FY24.

Well-Woman Visit Initiatives

Objective 1.1: Increase the proportion of women program participants receiving a high-quality, comprehensive preventive medical visit.

Title V remains committed to assuring women of reproductive age can receive high-quality, comprehensive preventive well-woman care in their communities. Key priorities in the coming year include the continued expansion of resource development including; Well-Woman Visit Integration Toolkits and promotional materials accompanied by social media kits for local communities.

Well-Woman Visit Integration Toolkits: The KDHE Well-Woman Visit Integration Toolkits for Providers and Communities will continue to be developed and evolve to meet the needs of women and communities. Yearly reviews and updates to materials will be guided by MCH data on maternal morbidity and mortality as well as by feedback from community partners. One such update will be emphasizing training and resources for local programs to provide client centered reproductive goals and counseling. The toolkit will provide support to position sustainable practices at the local level around education on the importance for regular preventative comprehensive care, emphasizing client-centered care, warm handoffs and referral follow-up.

Well-Woman Promotional Efforts: MCH-led promotional efforts around awareness months and weeks (e.g., National Women’s Health Week, Minority Health Month, Black Maternal Health Week) will incorporate messaging related to the importance of the well-woman visit. Promotional materials and social media kits developed will be shared with all Title V and Title X partners as well as other key partners such as the Kansas Maternal and Child Health and Bureau of Family Health Family Advisory Councils. The Woman/Maternal Health Consultant will work to create training opportunities that align with awareness months. In addition, due to the KS extension on postpartum Medicaid, the Women/Maternal Health Consultant will be working to develop public-facing and provider-focused materials on services that can, and should, be utilized in the 12-month postpartum period. These materials will be shared with MCH, Title X and home visiting providers as well as professional networks such as the Kansas Chapter of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists.

Universal Screening Practices: Screening tools are a core component of our well-woman education and training for MCH providers. Providing support to MCH programs for screening implementation and resource and referrals for mental health and substance use disorders will remain a priority. MCH guidance directs local programs to the Kansas specific Perinatal Psychiatric Access line, where any provider seeing Kansas residents will have access to a resource and referral specialist, Perinatal psychiatric specialist, and training/TA for universal screening practices. More information about the Universal Screening Practices can be found in the Cross-Cutting narratives.

The January 2023 Becoming a Mom (BaM) Risk Report enhancement requests included pulling positive response options to any of the pre-screen questions into the BaM Risk Report, identifying for staff any “positive” screen or “at risk” participant, warranting one-on-one follow-up outside the group setting to provide support, brief intervention, and referral to treatment (SBIRT). Overview of the developed workflow guide was provided during the November 2022 in-person training event, where feedback was gathered and integrated. The Screening Workflow Desk Guide https://kdhe.daiseysolutions.org/articles/becoming-a-mom-form-completion-desk-guide-screening-workflow/ has since been updated and TA will be provided again once the report updates become available and data is obtained and reviewed from at least a 6-month period.

Medicaid Policy Improvements: Effective April 1, 2023, continuous coverage Medicaid will end, with an estimated 115,000 individuals losing coverage. However, Kansas was successful in extending the Medicaid postpartum coverage period from 60-days to 12-months post-delivery. This supports access to behavioral health treatment and other preventive care, thus improving health outcomes for both the mother and child. Title V continues to partner with Medicaid on communication and messaging about the expansion, as well as informing opportunities to also expand covered services for women during this timeframe. The Woman/Maternal Health Consultant will develop various iterations of a guide, entitled Mommy Milestones, to serve as a living document complete with best practices for achieving optimal health outcomes. Other versions will include trauma informed, compassionate language for special populations experiencing a non-traditional postpartum period.

Local MCH Agencies: 

• CareArc, a federally qualified health center in Emporia, KS, will increase the percent of woman clients with a wellness visit in the last year from 20%-25%. They will provide education to their staff about the importance of an annual wellness visit and discuss progress toward their goal during monthly meetings. 
• Delivering Change will assess each Woman/Maternal client for a medical home and well visit in the last 12 months. They will provide education to women on the importance of having a well visit annually. In SFY22 97% of MCH clients reported having a well visit in the last 12 months. The target for SFY24 will be 98%. In SFY22 56% of MCH clients received education on the importance of a well woman visit. The target for SFY24 is 65%. Delivering change will maintain their partnership with Konza Prairie Community Health Center to provide bi-directional referral between Konza’s Family Planning Program and Delivering Change’s MCH Program. 
• Pawnee County Health Department will increase the percentage of women receiving education on well woman visits from 5% to 50%. All staff will be trained on the importance of providing well woman education to all MCH clients and how to document that education was provided in DAISEY.  
• Riley County Health Department will have postpartum home visiting clients complete the Reproductive Life Plan and provide education about birth control, inter-conception and preconception health. They will increase the percentage of MCH clients with a well visit in the last year from 95%-96%. 
• Southeast Kansas Multi-County Health Department which serves four counties will begin having their home visitors educate all prenatal and postpartum clients on the importance of annual well woman visits. Currently, only 11 percent of their clients have well woman education documented in DAISEY and their target will be to have 100% of clients receiving well woman education. 

Perinatal Mood and Anxiety Disorder Initiatives

Objective 1.2: Increase the proportion of women receiving education or screening about perinatal mood and anxiety disorders (PMADs) during pregnancy and the postpartum period.

Ongoing partnerships with communities around maternal mental health screenings, treatments, and resources will support our goal to provide opportunities for women to receive education or screening on perinatal mood and anxiety disorders (PMADs) during pregnancy and the postpartum period. Title V intends to continue their previous initiatives, such as:

• Maternal Mental Health Treatment Pilot Project: The pilot with Russell Child Development Center (RCDC) will continue in the coming year and Title V will continue providing instruction and technical assistance to RCDC, including coordination with Kansas Medicaid, to ensure services will be sustained beyond the pilot project period and can be replicated by other early child development centers.
• Kansas Connecting Communities (KCC): KCC will continue to increase statewide access to screening, assessment, and treatment for maternal depression, anxiety, and substance use disorders. KCC is a HRSA Maternal Depression and other Related Behavioral Disorders program that is funded through FFY2023. Title V intends to apply for a new award to continue the essential workforce development opportunities made available by the program. See the Cross-Cutting Plan/Report for more information about these activities.

Local MCH Agencies:  

• Barton County Health Department will launch a monthly postpartum depression support group. This was an area of need identified through resource mapping. The health department’s social worker will attend training to become the group facilitator and will monitor attendance.   
• Butler County Health Department staff will collaborate with their WIC program to screen 85% of pregnant and postpartum clients for PMADS using the Edinburgh Postnatal Depression Screening (EPDS).  This will be an increase from 65%.  
• City-Cowley County Health Department will begin completing the EPDS at all home visits. Currently they are completed at visits up to 6 months postpartum.  
• Clay County Health Department will screen 100% of Becoming a Mom (BaM) and home visiting clients for PMADs. They will also begin screening postpartum parents during the infant’s 2, 4, and 6-month immunization visits.  
• Mitchell County Health Department will begin documenting the PMADs education provided through their MCH program. The target for this year is 85% of clients will have PMADs education documented in DAISEY. Progress toward their goal will be monitored using the DAISEY Education Provided Report. Their goal will be achieved by ensuring all staff are educated on the how to screen for PMADs, document it in DAISEY and provide education and referral based on the score.  

Prenatal Education and Support Services Initiatives

Objective 1.3: Increase the proportion of high-risk pregnant women receiving prenatal education and support services through perinatal community collaboratives.

Kansas Perinatal Community Collaboratives / Becoming a Mom: Title V is heavily invested and committed to expansion of the Kansas Perinatal Community Collaboratives (KPCC) model. This includes the desire to spread to new communities across Kansas, while continuing to remain focused on strengthening the model, targeting and reaching disparity populations, and integrating additional services and support mechanisms for populations at greatest risk. In recent years, the model has organically scaled to include preconception care through pregnancy. In one community, this is being scaled even farther by integration of the early childhood system. Early discussions are occurring for utilizing this model as the foundational framework and basis for the implementation of Help Me Grow across Kansas. This would support a preconception through early childhood (up to age 8), possibly setting the stage for long-term planning on a life course approach to this model.

Based off 2021 BaM State Aggregate Report data and recommendations, as well as BaM/KPCC site input gathered during August 2022 site visits, FY24 work and expansion plans will focus on reaching greater disparity populations. This work will include Title V investments in two key areas:

• Curriculum adaptations/development for use across other ATL program models, service settings and with special populations (I.e. virtual format, low-literacy and non-English speaking immigrant populations, tribal communities, etc.).
• Health Equity Opportunity Projects (HEOP) slated for July 2023 – June 2024.

A Request for Proposals for the HEOP was provided to BaM/KPCC sites in January 2023, with a March 15th submission deadline. Sites were provided guidance on the inclusion of project plans seeking to improve local (and/or state) maternal/perinatal health outcomes, through targeted interventions aiming to reach high-risk disparity populations as well as women identified as high-risk due to chronic health conditions or pregnancy complications. Title V Women/Maternal, Perinatal/Infant and Behavioral Health Consultants will work together, in collaboration with other state partners, to provide TA throughout the project period.

As indicated above, FY2024 work and expansion plans, will also focus on providing TA to local community partners interested in strengthening their existing KPCC collaborations. Lessons learned from this work will help to inform development of a continued expansion approach where communities are identified as high need, based off maternal/perinatal and infant health indicators. These communities will be solicited to engage in KPCC development activities, with the support of KDHE Title V provided guidance and TA. 

Local MCH Agencies:  

• Crawford County Health Department will increase their Becoming a Mom (BaM) class participation by 10% from a baseline of 96 participants in 2021. BaM is known locally as Healthy Beginnings. They currently collaborate with other Health Department Programs, Via Christi Hospital, and local physicians to gain referrals, and will begin working with the WIC program to further increase promotion and referral.  
• Delivering Change will increase their BaM participation by 10% for a total of 60 participants in the coming year. Their navigators are embedded in a local OB/GYN clinic where they will provide prenatal education and enrollment into BaM. BaM will be offered at least every 8 weeks and be facilitated by Delivering Change and other community agencies that serve the prenatal community. BaM serves as an introduction and relationship builder between the participants and community agencies that facilitate the various class sessions.  
• Riley County Health Department will offer BaM in a hybrid (virtual and in-person) format to increase participation by 10%. Between July 1 and December 30, 2022, 72 people participated in BaM. It is estimated that a 10% increase would result in 158 participants in the coming program year. Some activities that will be implemented to increase reach include holding two classes a year on Saturdays, conducting classes virtually and in-person, facilitation of enrollment via a navigator placed at The Women’s Health Group, and a radio advertisement to market to the demographic of focus. 
• Saline County Health Department will expand their Kansas Perinatal Community Collaborative (KPCC) partnerships to achieve increased participation in BaM classes. Last year, they began outreach to McPherson County partners to increase BaM participation among McPherson County residents. There is not a Block Grant-funded MCH program in McPherson County, so this expansion fills a need in the region. This year they plan to expand partnerships to Republic County and offer virtual BaM classes to residents there. In addition, they will engage Salina Regional Health Center Birth Unit Director to facilitate Session 3 (Labor and Delivery) of BaM.    
• University of Kansas School of Medicine-Wichita will provide Baby Talk classes to 350 participants from Sedgwick County which is an increase of 11% from baseline. In addition, they will have 30 participants from neighboring Harvey County, and 30 from other neighboring counties that do not offer BaM. To achieve this, they will promote their BaM classes, known locally as Baby Talk, through community outreach events and referrals made by their home visitor that is embedded in the Wesley Women’s Care Clinic.  

Pregnancy Intention Screening

Objective 1.4: Increase the proportion of women receiving pregnancy intention screening as part of preconception and interconception services.

Reproductive Life Plan (RLP): 2016-2020 data from the KMMRC, has demonstrated that focused evaluation and intentional intervention in the postpartum period should be the primary goal to improve maternal health outcomes. The KPQC’s FTI is a maternal health quality initiative aimed at decreasing maternal morbidity and mortality in our state by intentionally focusing on the immediate postpartum setting through the first year postpartum.

One of the core components of the FTI model of care is ensuring that postpartum persons receive education and access to reproductive life planning services, including Long-Acting Reversible Contraceptives (LARC) devices. Nationally 40% of birthing persons never attend a postpartum appointment thereby missing a key opportunity and touchpoint for reproductive life planning education and conversation. This in turn leads to higher rates of unintended pregnancy, short pregnancy intervals, and higher preterm birth rates; along with missing a myriad of other leading maternal health indicators that impact maternal morbidity and mortality. As part of the FTI postpartum model of care all participating birth facilities will include reproductive life planning as part of their discharge education; and will schedule a postpartum appointment for the birthing person prior to discharge from the FTI facility. Additionally, FTI facilities will work collaboratively with community partners to connect postpartum persons to local community resources that provide low or no cost reproductive life planning services- including LARC devices (Title X programs, safety net clinics, local providers, etc.).

LARC Toolkit: The LARC toolkit is intended to be utilized by Kansas MCH and Title X/Family Planning programs and shared with local partnering providers serving the same population, in an effort to collaboratively develop an adequate system of care. Information in the toolkit is based on sound research and recommendations from The American College of Obstetricians and Gynecologists. Updates to toolkits and education around LARC devices and support for providers will continue to be made available for MCH programs. Preconception health awareness, education, and resources will be provided through evidence-based partners including, the National Clinical Training Center for Family Planning, the Reproductive Health National Training Center, and with direct connection with field representatives from pharmaceutical companies to provide onsite support when needed. 

Medicaid policy related to LARC insertion was submitted as a State Plan Amendment and became effective on January 1, 2023, with the policy finalized, executed and the bulletin published prior to the effective date. This removes the financial disincentive/barrier for hospitals to support placement prior to discharge. However, there is much work that can be done by the MCH team over the next year to help provide clarity with providers on the value of considering placement prior to discharge.

Local MCH Agencies: This is the second year Objective 1.4 was included in the Aid-to-Local application. While many applicants have been asking about pregnancy intention, they hadn’t been monitoring it using DAISEY. Many goals are focused on collecting data around pregnancy intention and referral for services.  

• Butler County Health Department will assess all MCH clients for pregnancy intention using the KDHE Program Visit Form in DAISEY. 80% of those will have appropriate referral forms documented in DAISEY.  
• Community Health Council of Wyandotte County will assess all clients for pregnancy intention and provide reproductive life planning support using My Life, My Plan. Current data shows 80% of clients have been assessed for pregnancy intentions. Client pregnancy intentions will be documented in DAISEY and referrals will be made in IRIS when a need for further services is indicated. They will also distribute reproductive life planning materials at education and outreach events throughout Kansas City.  
• Delivering Change Navigators and the Universal Home Visitor will increase education on reproductive life planning by 15%, for a total of at least 115 clients receiving reproductive life plan education.   
• Pawnee County Health Department will increase their assessment of pregnancy intention from 2% of clients in SFY 2022 to 98% of clients in this grant year. They will assess for pregnancy intention any time there is an MCH visit. They will complete the One Key Question form in DAISEY to monitor this goal. 
• Riley County Health Department will assess all their MCH clients for pregnancy intention. All will be educated on the importance of preconception and inter-conception care. Each client will complete the Reproductive Life Plan at either the 8th month Maternal & Infant visit or 1-month postpartum visit with the MCH nurse. 
• Saline County Health Department will assess 100% of their home visiting clients for their pregnancy intentions and use the One Key Question form in DAISEY to document responses. This will be an increase from 52%.  

Other Women/Maternal Initiatives

Count the Kicks® (CTK) Stillbirth Prevention Initiative: Title V will continue the formal partnership with Healthy Birth Day to continue the CTK campaign to prevent stillbirth through provider and patient education around monitoring fetal movements during the 3rd trimester of pregnancy. This will continue to be provided across the state at no cost to providers, who will have full access to videos and educational materials (including posters, brochures, and appointment cards in English and Spanish). Kansas plans to build on the momentum of the CTK campaign through social media and sharing data and information with the MCH network. The following are examples of planned initiatives:

• Stillbirth Awareness Month: Encourage local MCH agencies to spread awareness in their communities and encourage moms to count kicks. (October 2023)
• Kansas CTK Mobile App: A KS-specific version of the app with four follow-up questions that connect mothers directly with resources in Kansas based on expressed needs and concerns was developed and launched in 2022. Data from this app will be collected and evaluated throughout FY24, and adjustments will be made as deemed necessary in the following contract.
• CTK Toolkit: Distribution of the CTK Toolkit, low literacy materials, and kick counting wrist bands to MCH, home visiting (including Maternal and Child Health Home Visiting), and Teen Pregnancy Targeted Case Management/Pregnancy Maintenance Initiative programs across the state. Utilization of these materials will be monitored throughout the year for discussion and inclusion of material/resource needs in the upcoming contract year.
• CTK Awareness Marketing: Marketing plans include social media, Google display and Apple App Store ads as well as CTK billboards in rural areas of the state.
• Faith-Based Initiative Toolkit: to be piloted with KPCC/BaM Communities. Healthy Birth Day will partner with KPCC communities in reaching out to faith-based organizations, offering a CTK training webinar and resources providing CTK messaging for their parishioners. While CTK resources have been adapted specifically for this audience, it will serve as a great opportunity to begin a partnership with the faith-based communities that will hopefully foster integration of additional programming and resources such as BaM, Safe Sleep Community Baby Showers and breastfeeding support.

MAVIS – Maternal Antiviolence Innovation and Sharing: MAVIS is a five-year cooperative agreement between KDHE and the U.S. Department of Health and Human Services’ OASH/Office on Women’s Health to develop, implement, and sustain interventions to reduce maternal deaths due to violence, specifically homicide and suicide. Between 2016-2018, the second and third leading causes of pregnancy-associated but not related deaths in Kansas were homicide and poisoning/overdose. Substance use disorder and/or mental health contributed to more than half of the deaths. MAVIS initiatives will help address the urgent matter of maternal mortality through collaborative efforts to cross-train and educate providers across the state on perinatal mood and anxiety disorders, domestic violence, and substance use disorders. Partners in this initiative include the Kansas Coalition Against Sexual and Domestic Violence (KCSDV), Kansas Connecting Communities (KCC), Kansas Perinatal Quality Collaborative (KPQC), and Kansas Maternal Mortality Review Committee (KMMRC). Plans for the upcoming grant year include; providing onsite training for interpersonal violence education and awareness to KPQC Fourth Trimester Initiative (FTI) sites, continued training and TA for providers, and data review and analysis based on KMMRC subcommittee decision points and recommendations.