Based on SFY2025 MCH Aid-to-Local applications received 52 of 56 grantees (%) plan to provide services to the Perinatal/Infant population. As related to each objective within Priority 1:

• 37 of 56 grantees (66 %) plan to provide comprehensive annual well woman/preventive services
• 46 of 56 grantees (82 %) plan to provide education and/or screening for perinatal mental health conditions
• 45 of 56 grantees (80 %) plan to provide prenatal education and support services
• 36 of 56 grantees (64 %) plan to provide pregnancy intention screening

 

Well-Woman Visit Initiatives

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

 

Well-Woman Visit Integration Toolkits: The KDHE Well-Woman Visit Integration Toolkits for Providers and Communities will continue to be developed 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. The Woman/Maternal will work to develop an Action Alert for local grantees which will pull information from the Toolkit and develop a 3-page resource for how to promote the value and importance of well woman visits.

 

Well-Woman Promotion 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 Council. The Woman/Maternal Health Consultant will develop Well-Woman promotion cards to be shared with partners across the state. Additionally, the Woman/Maternal Consultant will work with the Perinatal Community Health Worker and Doula organizations to provide promotional materials and education.

 

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.

 

Medicaid Policy Improvements:  During FY25, the Title V MCH Director will participate in a workgroup with other Bureau of Family Health leaders and leaders from Kansas Medicaid. The intent of this group is to develop a strategic plan for future investments that both public health/Title V and Medicaid should be making to advance maternal and infant health in Kansas. Members of the Title V team will be asked for ideas and suggestions on how to advance maternal and infant health in the state based on their areas of expertise and knowledge of community needs.

 

Local MCH Agencies: The following are examples are local MCH grantee agencies plans toward Objective 1.1 during the plan period.

• City-Cowley County Health Department plans to include annual well-woman care and education in the pre-birth curriculum for all home-visiting recipients and pregnancy education visits. During the initial visit, home-visiting prenatal recipients will be asked about their last well-woman exam date. To reinforce education, we will also promote resources within KDHE's “Well-Woman Visit Toolkit: For Providers” document and the Reproductive Health National Training Center (RHNTC) website. Prenatal care and well-woman exams will be referred to local primary care providers (PCP). After the birth, referrals for well-woman care will be made to the Family Planning Program or the individual's PCP, if applicable.
• Jefferson County Health Department MCH home visiting nurse will continue to screen all of our MCH clients for a recent well woman visit at every MCH visit. The MCH home visiting nurse will also continue screening all of our MCH clients for adequate health insurance and for a primary care provider. Lack of adequate health insurance and/or lack of a primary care provider can be barriers for our clients in receiving annual well-woman services and other preventive services. The KDHE MCH flyer “Schedule Your Well Woman Exam Today” with information regarding the importance of regular exams and screenings will be reviewed at every MCH visit and a copy of the flyer will be sent home with every client.
• Northeast Kansas Multi-County Health Department will educate clients on the importance of annual well woman exams regardless of need for a pap. We will implement a reminder system to notify clients of their annual exams to encourage them to schedule an appointment. Our staff will receive training from our clinic NP/MD on services and education to provide clients based on age, risk factors, and previous health history.

 

Perinatal Mental Health

Objective 1.2: Objective 1.2: Increase the proportion of women receiving education or screening about perinatal mental health during pregnancy and the postpartum period.

 

Kansas Connecting Communities (KCC): Perinatal behavioral health disorders, including mental health and substance use conditions, are the most common complication of pregnancy and childbirth and are a leading cause of maternal mortality and morbidity. These disorders present during pregnancy through the first year following childbirth and affect the health and wellbeing of the entire family unit. Potential consequences include reduced ability to care for oneself or one’s infant, developmental delays for the infant, and impaired bonding between the mother and the infant. Despite the prevalence and impact, these disorders often go undiagnosed and untreated.

 

KDHE Bureau of Family Health (BFH) was re-awarded HRSA’s Screening and Treatment for Maternal Mental Health and Substance Use Disorders (MMHSUD) program in October 2023. The Kansas Program, Kansas Connecting Communities (KCC) has four overarching goals: 1) Maintain, expand, and enhance a diverse interdisciplinary Perinatal Behavioral Health Team (PBHT); 2) Increase the number of providers trained in perinatal behavioral health, including screening, brief interventions, treatment/referral to treatment, and follow-up support, including providers who predominately serve individuals who experience health disparities; 3) Increase utilization of real-time psychiatric consultations and care coordination support services, especially utilization by providers who serve individuals who experience health disparities (e.g., race, ethnicity, socioeconomic, Medicaid, rural or frontier); and 4) Develop a robust communications plan to increase provider enrollment and utilization of all KCC program components as well as with key stakeholders for program sustainability.

 

Oversight will continue to be provided by the KDHE BFH, which manages the state’s Title V MCH Program. The BFH will ensure the program aligns with the MCH vision and is collaborative to maximize efficiencies, awareness, and system impact. The BFH will contract with the University of Kansas Medical Center Research Institute for the establishment of the PBHT for training and consultation, the University of Kansas Center for Public Partnerships and Research for KCC coordination and evaluation activities, and the Postpartum Support International (Kansas Chapter) for additional training components.

 

To achieve program goals, the KCC Team will support providers within a statewide network though three main program components: education (robust multimodality training program), consultation (Consultation Line), and resources and referral support.

 

For the purposes of this program, ‘provider’ is used to reference frontline health care practitioners and public health providers, which includes, but is not limited to, obstetrician and gynecologists, family medicine physicians, pediatricians, psychiatrists, nurse practitioners, physician assistants, certified nurse midwives, doulas, mental health and substance use clinicians/counselors, social workers, and care coordinators, including home visitors and community health workers.

 

Through collaboration with these providers, KCC promotes early identification, referral to resources, and treatment for pregnant and postpartum individuals with anxiety, depression, and substance use disorder(s) across the state, particularly those who reside in the rural mental health professional shortage areas. With an effective outreach strategy and through its main program components, KCC will improve timely access to quality care in rural and frontier communities, especially for uninsured, underinsured, and low-income families.

 

KCC and Title V will continue promotion of the sustained training resources, such as:

• Perinatal Behavioral Health Screening and Intervention Role Play Videos: Through funding and support of the MAVIS initiative and collaboration with KCC, a series of videos have been developed to help providers and clinics implement screening and brief interventions. These role play videos were created with the guidance of KCC’s clinical consultant team to offer guidance and shared language, specifically for behavioral health concerns with perinatal patients. Videos can be used individually to build skills or integrated into organizational policy for ongoing training of staff. Additional information on implementing perinatal behavioral health screenings can also be found in the toolkits or by reaching out to the Provider Consultation Line. An accompanying perinatal behavioral health screening video resource guide was also developed to be used along with the videos. The videos include:
  • Screening Tool Overviews for the ASSIST (adult substance use), CRAFFT 2.1N (adolescent/young adult substance use), EPDS (perinatal depression and anxiety), GAD-7 (anxiety), and PHQ-9 (depression) (5 videos)
  • Introducing a mental health and substance use screening (2 videos)
  • Responding to a patient who does not want to be screened (1 video)
  • Discussing a high risk, moderate risk, and low risk screening result for both mental health and substance use (6 videos)
  • Responding to a crisis (1 video)
• Perinatal Support Group Guidebook has been developed through collaborative work between Wichita State University Community Engagement Institute with contributions from the PSI-KS. The guidebook has been developed to provide information and guidance for those looking to start a perinatal support group. Too often, there is a recognized need and a desire to provide support for this population, but a lack of guidance around how to make this desire a reality. The guidebook provides practical tips and ideas to consider for creating and maintaining a support group, specifically for the perinatal experience. Individuals can search for peer support groups in Kansas by topic and location at supportgroupsinkansas.org or connect to the Provider Consultation Line for perinatal specific resources. Further, KCC developed a perinatal peer support online training module for Certified Peer Supports (mental health), Peer Mentors (substance use disorder), and Parent Peer Specialists (parents of children with behavioral health challenges) in Kansas. These peer professionals are required to complete Kansas Certified Peer Specialist training to bill Medicaid for services provided. The perinatal peer support training was added as an optional training to the curriculum in 2023. KCC and Title V will continue promoting its availability throughout this Plan period.
• MCH Integration Toolkits have been created through the work of many state and local partners with shared interest in providing coordinated and comprehensive services to women before, during, and after pregnancy. KCC and Title V will facilitate an annual review with subject matter experts and make updates to the Perinatal Mental Health Toolkit and Perinatal Substance Use Toolkit.

 

In addition to ongoing activities for the sustained resources, KCC will continue its robust offering of various workforce development opportunities related to perinatal mental health.

• Kansas Moms In Mind (KMIM) Case Consultation Clinics: The treatment and management of perinatal behavioral health disorders, especially comorbidities, can be a nuanced process. The KMIM Consultation Clinic Series will offer physicians and other providers the opportunity to connect with peers and build their knowledge on a variety of topics related to perinatal behavioral health. Each clinic will feature a brief didactic and collaborative case review. These clinics are designed to build the confidence and knowledge of frontline providers to manage perinatal behavioral health conditions. Providers are encouraged to bring questions and examples from their own practice for discussion. Note: These clinics are intended to provide evidence-based education and support from trained professionals. Decisions around medication in the perinatal period should always involve an individual risk benefit analysis and discussion with the pregnant person and their partner/family about treatment options, especially concerns for the fetus or baby. Participants are encouraged to call the Provider Consultation Line for individual case consultations with the KCC perinatal psychiatrist.
• Bi-Monthly Training Webinars: In partnership with the PSI-KS, live, virtual training opportunities will be made available. Past training topics have included racial equity, LBGTQ+, biopsychosocial assessments, perinatal substance use disorders, infertility, maternal morbidity and mortality, and peer support. Future topics will be selected in collaboration with the PBHT and KCC partners, with priority given to topics identified through feedback from training attendees. These one-hour trainings are intended for all perinatal provider types. As part of this webinar series, “advanced training” opportunities will also be identified. These two-hour trainings will be intended for licensed physicians and clinician who are listed with the Kansas Maternal Mental Health Provider Directory. The advanced trainings will help enhance quality perinatal mental health treatment service provision (e.g., “Advanced Assessment of Perinatal Mood and Anxiety Disorders;” “Recognizing, Understanding, and Treating OCD During the Perinatal Period”). Session topics will be decided in collaboration with the PBHT and KCC partners, as well as based on feedback from training attendees, inquiries to the Consultation Line, and the Directory questionnaire responses. Three, live, virtual “advanced trainings” will be made available annually, in addition to three, live, virtual one-hour trainings.
• Training Scholarships: Also, in partnership with PSI-KS, KCC will offer, administer, and manage scholarships for PCPs to cover registration costs for external trainings, such as those offered by PSI Central, Centimano Counseling, and Mass General. The PSI-KS Board of Directors will identify quality evidence-based trainings that will expand provider competency in perinatal mood and anxiety disorders. This includes, but is not limited to, trainings that included on the approved list as part of the Perinatal Mental Health Certification (PMHC) process. PSI-KS will develop scholarship criteria prioritizing providers in all geographic regions who work with vulnerable populations (e.g., low-income, uninsured/underinsured). Scholarship recipients will complete a pre/post self-efficacy survey to measure knowledge, skills, and confidence changes based on the training.
• Ad Hoc Training Requests (In-Person and Virtual): KCC will coordinate with the PBHT, solicit feedback from PCPs, and use data collected through Consultation Line inquiries to identify training topics and will develop a training listing. The listing of available training topics will be promoted through PCP networks, as part of KCC Network outreach, and published on the KCC website. These trainings are intended to be live, either in-person or virtual, and delivered for an entire organization, clinic, and/or program staff. The KCC team will maintain a master training curriculum that incorporates best-practice guidelines and culturally and linguistically appropriate standards. When a training request is received, the KCC Team will complete a perinatal behavioral health screening/treatment implementation checklist to determine training content. The developed checklist will follow the universal screening guidelines (e.g., select a validated screening tool, adopt a universal screening policy, program workflow development, identify a local system of care to enhance the referral process, bill for screening services provided, etc.). Members of the PBHT will identify which trainings they would like to facilitate, and training coordination will occur accordingly. Already identified training topics include overview of maternal mental health and substance use disorders, screening for perinatal behavioral health risk using the SBIRT process, using motivational interviewing and other person-centered approaches when implementing universal screening practices, developing organizational and program specific screening and referral algorithms/workflows, and building local referral networks and refining referral process mapping. All trainings will include an overview of available resources (e.g., Consultation Line, Perinatal Mental Health Toolkit, Perinatal Substance Use Toolkit, National Maternal Mental Health Hotline).

 

KCC and PSI-KS will continue activities to promote, vet, and enhance the Kansas Maternal Mental Health Provider Directory. PSI-KS has developed an application to collect information from Kansas providers with special training or expertise in the perinatal period. The application requires providers to share their demographic information to help make referrals for people who prefer to see providers with the same identity as them (e.g., gender identify, race/ethnicity, language), as well as treatment provision (e.g., professional role/provider type, certifications, catchment area, availability of telehealth services, accepted insurance types, years of experience treating perinatal populations). As part of the vetting process, PSI-KS assesses the qualifications, experience, and continuing education needs of the PCPs completing the application. The Directory is shared between the KCC Social Worker as a resource for provider inquiries and with PSI-KS Support Coordinators who triage calls from perinatal individuals seeking support to ensure both perinatal providers and individuals can receive referral options to a behavioral health treatment provider with perinatal specific training.

 

Maternal Depression Screening: The KanCare Maternal Depression Screening (MDS) policy became effective January 1, 2021 to reimburse for up to three screenings during the prenatal period under the mother’s Medicaid ID and for up to five screenings during the 12-months postpartum period under the child’s Medicaid ID. The policy was updated thereafter allowing reimbursement to occur when non-licensed professionals, like home visitors and community health workers, administer screenings under the supervision of a licensed professional. With the KanCare Postpartum Medicaid Extension, the MDS policy was reviewed, and the limitations on number of screenings was lifted effective July 2022. Title V updated the MDS Medicaid Billing and Policy Guidance, as well as the MDS Medicaid Billing and Policy Guidance for Part C Programs, as part of the Perinatal Mental Health Toolkit. The guides are intended for healthcare providers treating perinatal women and for pediatric providers who administer MDS during the postpartum period. It outlines allowable screening tools, approved provider types, approved places of service, the procedure codes, and documentation requirements for MDS service reimbursement, as well as training opportunities and case consultation support available to providers through the KCC program.

 

Through the KCC program, several handouts were created to promote and increase awareness on the importance of universal screening practices, the KanCare MDS policy, and availability of psychiatric case consultations made available through the program’s toll-free provider consultation line. This will continue to be used to increase awareness of the policy.

 

 

Maternal Depression Screening Billing Quality Improvement: In partnership with KDHE Division of Health Care Finance (Kansas Medicaid), Title V completed an analysis of MDS claims submitted in the first three years of the policy change (2021-2023). In summary, over 12,000 individuals have been screened for depression during pregnancy or 12-months postpartum period. Of these, 23% were billed under the mother’s Medicaid ID and 77% were billed under the child’s Medicaid ID.

 

On average, each individual was screened twice (24,824 MDS claims were processed from 2021-2023).

 

Following trends in 2021 and 2022, 2023 MDS services were predominantly provided by physicians and billed under the Child’s Medicaid ID (70%).

 

 

Based on findings, several opportunities for quality improvement have been noted: 1) to increase education on recommendations from various professional organizations on screening recommendations (e.g., ACOG recommends screening for perinatal depression and anxiety at the initial prenatal visit, later in pregnancy, and at the postpartum visit; AAP recommends screening for maternal depression by 1-month and at the 2, 4, and 6-month pediatric visits; PSI recommends screening for perinatal mental health disorders at the first prenatal visit, at least once in the second trimester, at least once in the third trimester, at the first postpartum visit, at the 6 and/or 12-months in OB and primary care settings, and at the 3, 9, and 12-month pediatric visits); and, 2) to increase education with prenatal care providers about the availability of Medicaid reimbursement for MDS services provided, potentially clarifying that MDS is not packaged in the maternity global fee.

 

KCC and Title V will develop strategy aligning with these quality improvement opportunities. If successful, there should be an increase in number of screening claims submitted for each Medicaid member, and there should be an increase in number of MDS claims submitted under the mother’s Medicaid ID. The MCH Behavioral Director will continue partnering with Kansas Medicaid to complete an annual analysis of MDS claims and identify additional quality improvement opportunities.

 

In review of Kansas PRAMS Reports, it was noted that self-reported anxiety symptoms were more prevalent than depression prior to pregnancy and during pregnancy. During this Plan period, Title V will partner with Kansas Medicaid to conduct research on other state’s coverage of perinatal anxiety screenings and explore possibly of developing a perinatal anxiety screening policy for Kansas.

 

 

Local MCH Agencies: The following are examples are local MCH grantee agencies plans toward Objective 1.2 during the plan period.

• Crawford County Health Department will continue to screen prenatal and postpartum clients using the Edinburgh Postnatal Depression Scale (EPDS) during the Healthy Beginnings Prenatal (BAM) as well as by home visitors. Home Visitors will screen using the EPDS at least once during pregnancy and once postpartum. Results will be recorded in DAISEY. All participants of the Healthy Beginnings Prenatal Classes will be given the screening at least two times during the series of classes with results recorded in DAISEY. Referrals will be made if needed during the appointment. The health department has a "fast track" referral system in place with Crawford County Mental Health if a person is in crisis. For those that are not in crisis referral is made to their physician or a mental health professional.
• Seward County Health Department will education and/or screening for perinatal mental health conditions is completed on all of the MCH participants. The program nurses evaluate all of the clients by using the EPDS. To improve the client outcomes, a Social Worker is available to see the clients when a referral is needed. Evaluations are completed more than once during the pregnancy and after the delivery to assure the patient has not had any negative changes in her mental state.
• Saline County Health Department will continue to improve upon the data accuracy for the maternal mental health screenings, as documentation will be added under client notes in DAISEY as to why a screen was not provided. Additionally, education provided will be noted during this encounter. Postpartum screens will also be provided to all consenting mothers who are enrolled in the Incredible Babies Parenting program. All MCH staff will participate in maternal mental health trainings to enhance knowledge base of maternal mental health. Additionally, to expand our program outreach for this objective, we will collaborate with our local law enforcement to provide MCH services to Incarcerated women prenatally or newly postpartum.

 

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.

 

KPCC/BaM/ Expansion: 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 historically marginalized 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 a number of communities, this is being scaled even further 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 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 2022 BaM State Aggregate Report data and recommendations, as well as BaM/KPCC site input gathered during August-October 2023 site visits, FY25 work and expansion plans will focus on individual community need. 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.).
• Expansion of BaM program service area through regional and state partnerships, and multi-jurisdictional agreements.

 

FY2025 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 under supported, 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.

 

HEOP Project: As shared in the FY23 Report narrative, much success has come from KPCC/BaM Health Equity Opportunity Projects. While the current funding period comes to an end July 2024, efforts have been underway to sustain further development and continuation of these successful projects. While one project’s continuation plans are being incorporated into their SFY25 MCH ATL application, another project has been assisted by state Title V Perinatal/Infant Health Consultants to engage in conversation and possible sustainability planning through partnership with the Bureau of Health Promotion. While this conversation is in its infancy, it is hopeful that this highly successful project will be sustained throughout FY25, as well as possible replication in other BaM/KPCC communities. Additionally, the state Title V team stays committed to the continuation and completion of curriculum adaptation efforts that have been underway and advancing throughout FY24.

 

Local MCH Agencies: The following are examples are local MCH grantee agencies plans toward Objective 1.3 during the plan period.

• Barton County Health Department will continue to provide BaM educational sessions to enhance partnerships/collaborations with community partners to help teach these sessions. We plan to do more advertising/promotion of these classes to help increase participation. We will target area OB providers. We will also promote to the public by way of social media, promoting BaM on our radio show and in our Barton County Health Department newsletter. We will request to be a speaker at a Central Kansas Partnership meeting (there is an educational session prior to the business meeting each month). We will measure success by increasing our attendance at BaM sessions. We will continue to provide education to clients as they come in for M&I clinic visits, these clients are scheduled at least once a trimester but generally every other month. Clients meet with the social worker, nurse, dietitian and home visitor during these visits.
• Delivering Change will enhance prenatal education and support services through continued development and extension of interest and enrollment into BaM Prenatal Education Classes, facilitated by Delivering Change, along with providing direct prenatal education and support services through direct navigation to all clients. The goal is to increase Becoming A Mom participation by 15-20%, along with offering 100% of prenatal MCH clients prenatal care education/support services as indicated in DAISEY MCH service form. Delivering Change Navigation will continue to be embedded into the local OB/GYN office, allowing Navigators/Universal Home Visitor to meet with every prenatal woman throughout her pregnancy. Navigators will continue to meet with women at her initial prenatal visit, offering education about prenatal education and support services, specifically BaM Prenatal Education Classes, available to them during their pregnancy. Both pregnant women and fathers/male support person(s) are encouraged to enroll into BaM Prenatal Education and Becoming A Dad classes during pregnancy. Throughout the pregnancy journey, navigators continue to meet with prenatal women to offer continual individualized education and supports surrounding pregnancy, along with encouraging Becoming A Mom enrollment and participation. BaM series will be offered every 6-8 weeks, with classes being taught by content area experts and community agencies. Through these interactions, this ensures that participants are receiving expert education, along with recognition of staff within community programs.
• Shawnee County Health Department will continue to offer Baby Basics utilizing the Becoming a Mom® curriculum 5 times in the grant period. We are expanding this service by adding 2 Spanish speaking Baby Basics classes utilizing the Becoming a Mom® Spanish curriculum. We are currently recruiting Spanish speaking volunteers to teach the classes. We will be offering a Breastfeeding Basics class to prenatal and postpartum women this grant year. This class will be held at the Shawnee County Health Department monthly, alternating afternoon and evening classes. We will be offering the Baby Basics utilizing the Becoming a Mom® curriculum sessions online. Our MCH RN's will be offering one-on-one breastfeeding support services as needed in the home once our team has completed the necessary trainings. The woman will need to call the Shawnee County Health Department and request a visit. We are improving this service by placing enrollment and information cards in the local OB offices and through direct mailings of WIC clients. We are enhancing this service by advertising the Baby Basics utilizing the Becoming a Mom® curriculum on targeted Facebook posts. Adding the Facebook posts and placing cards in the OB office initiative will be complete during the grant period. We will be measuring this objective by asking those who enroll how they heard of this class.

 

Pregnancy Intention Screening Initiatives

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

 

Pregnancy Intention Screening: 2016-2020 data from the Kansas Maternal Mortality Review Committee demonstrated that focused evaluation and intentional intervention in the postpartum period should be the primary goal to improve maternal health outcomes. The KPQC Fourth Trimester Initiative (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 Reversable Contraception (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 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. 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.

 

Local MCH Agencies: The following are examples are local MCH grantee agencies plans toward Objective 1.4 during the plan period.

• Butler County Health Department will ask all pregnant and postpartum women at each MCH visit, “Do you or your partner wish to become pregnant in the next year?” In addition to ensuring this question is asked at each visit, we are committed to improving the referral process in DAISEY.
• Northeast Kansas Multi-County Health Department will screen for pregnancy intention using the DAISEY form. We will implement specific education for our nurses to provide based on the screening as well as identifying resources to offer based on client responses. Educational guidance will be determined and provided to staff during the first quarter of the reporting period.
• Southeast Kansas Multi-County Health Department plans to enhance the pregnancy intention screening service for all postpartum clients by providing Home Visitors with comprehensive training on conducting pregnancy intention screening, utilizing validated tools, and guiding appropriate referrals and education based on screening outcomes. The screening process will be tailored to be culturally sensitive, acknowledging the diverse beliefs and values of the served populations to foster trust and accuracy in responses. Integration of pregnancy intention screening into routine postpartum visits will become standard, normalizing discussions around family planning and ensuring consistent screening for all clients. Clear and accurate education and counseling will be offered based on screening results, providing information on contraception options, family planning resources, and preconception counseling for informed decision-making.

 

Other Women/Maternal Initiatives

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

 

Digital Education and Outreach: Using Google Display ads and geofenced social media campaigns, CTK will encourage expectant parents in Kansas to download the CTK app and continue fetal movement monitoring conversations with their providers. Ads and Campaigns will raise awareness of special interest topics such as syphilis infection prevention and counting with multiples.

 

Stillbirth Awareness Month: Title V will encourage local MCH agencies to spread awareness in their communities and encourage moms to count kicks.

 

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 continue to be collected and evaluated throughout FY25, and adjustments will be made as deemed necessary.

 

CTK Wristbands: Following the success of the wristband initiation with Home Visiting teams in 2023, Title V is building upon that effort by making the wristbands widely available to interested providers. A letter campaign will introduce the wristbands to clinics and hospitals, and bundles of wristbands will be placed on the CTK KS website for ordering.

 

Finally, CTK will host one educational webinar for all grantees during the grant year.

 

Maternal Anti-Violence and Information Sharing (MAVIS): MAVIS is a five-year cooperative agreement between KDHE and 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 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), the Kansas Perinatal Quality Collaborative (KPQC), and the Kansas Maternal Mortality Review Committee (KMMRC). Plans for the upcoming year include expanding training for interpersonal violence education and awareness to doulas and community health workers across the state, continued training and TA for providers, and data review and analysis based on KMMRC decision points and recommendations brought about by Social Determinants of Health determination tool.

 

Alliance for Innovation on Maternal (AIM) Health Capacity Award: In September 2023, KDHE was awarded a 4-year funding opportunity from the Health Resources and Services Administration (HRSA) for the implementation of the Alliance for Innovation on Maternal (AIM) Health patient safety bundles.

 

The AIM program is a national, cross-sector commitment designed to lead in the identification, development, implementation, and dissemination of maternal (patient) safety bundles for the promotion of safe care for every U.S. birth and assist with addressing the complex problem of high maternal mortality and SMM rates within the United States. The mission of AIM is to support best practices that make birth safer, improve the quality of maternal health care and outcomes, and save lives. Maternal safety bundles address topics commonly associated with health complications or risks related to prenatal, labor and delivery, and postpartum care.

 

Through AIM Capacity funding Kansas will increase the number of hospitals, and other birthing facility settings implementing patient safety bundles; increase the number of bundles being implemented and/or sustained by birthing facilities; support the fidelity of bundle delivery; and promote effective data collection and reporting.

 

Kansas formally enrolled as an AIM state in October of 2021 and have been implementing the Postpartum Discharge Transition (PPDT) patient safety bundle, in Kansas known as the Fourth Trimester Initiative (FTI). In FY25, Kansas plans to complete implementation of the PPDT bundle, and to select a new AIM bundle for implementation. Bundle selection will be made by the KPQC Advisory Committee based on maternal health data from the KMMRC, PRAMS, other state level maternal health data sources and MHI MHTF recommendations.

 

State Maternal Health Innovation: In September 2023, KDHE was awarded a 5-year State Maternal Health Innovation (MHI) grant through the Health Resources and Services Administration (HRSA). The purpose of the MHI grant is to reduce maternal mortality and severe maternal morbidity (SMM) by supporting state-led demonstrations focused on improving maternal health and addressing maternal health disparities through quality services, a skilled workforce, enhanced data quality and capacity, and innovative programming. The MHI work will engage public health professionals, providers, payers, and consumers by developing and convening a state-led Maternal Health Task Force (MHTF). The MHTF will review state-specific maternal health data and then implement innovations to improve health outcomes, develop state-specific plans that will guide maternal health efforts, and enhance measurement of maternal health outcomes.

 

To ensure alignment and to avoid duplication of maternal health related efforts, the Maternal and Perinatal Initiatives Consultant, who coordinates the KMMRC and KPQC (including the AIM Capacity Award), will help to supervise the MHI Program Coordinator.

 

In FY25, KDHE will develop a MHTF and create a draft strategic plan, integrating health equity into evaluation plans. KDHE initiated with the Office of Vital Statistics linking birth certificates (mothers) with Medicaid claims and delivery hospital discharge records for 2017-2022 to support the AIM state surveillance measures – specifically the readmission data and the postpartum appointment. Additionally, the linked data will be used to explore/quantify potentially preventable SMM.

 

Universal NPM: Postpartum Visit

A) Percent of women who attended a postpartum checkup within 12 weeks after giving birth and B) Percent of women who attended a postpartum checkup and received recommended care components.

 

According to the Kansas Pregnancy Risk Assessment Monitoring System (PRAMS), 92.1% of Kansas residents with a recent live birth in 2022 reported attending a postpartum checkup (95% confidence interval [CI]: 89.8%-93.9%). Moreover, 79.0% attended the postpartum checkup and received recommended care components (95% CI: 75.6%-82.0%).

 

Fourth Trimester Initiative (FTI): All FTI enrolled facilities schedule a postpartum appointment for the birthing person prior to discharge from the FTI facility. This will continue throughout FY25. Title V staff will work to identify ways that follow through on the postpartum visit could be tracked to help support its work on the universal NPM of postpartum visit. Through these efforts, Title V intends to identify potential best practices that could be expanded to grantees and other MCH partners throughout the state.

 

Planning Year: Beyond the current work around postpartum visit occurring at FTI sites, the Title V team will continue to review current data on attendance at the postpartum visit to understand where the state is currently at. Additionally, the Title V Needs Assessment will be utilized to understand the potential barriers to attending the postpartum visit. A thorough review of this information will be used to help the Title V team determine plans for future years.