PRIORITY 1: Women have access to and utilize integrated, holistic, patient-centered care before, during, and after pregnancy

NPM 1: Well-woman visit (Percent of women, ages 18-44, with a past year preventive visit)

SPM 1: Postpartum Depression (Percent of women who have recently given birth who reported experiencing postpartum depression following a live birth)

 

 

Local MCH Reach: Based on SFY2021 MCH Aid-to-Local applications received:

• 58 of 67 grantees (87%) plan to provide services to the Woman & Maternal population
• 33 of 58 grantees serving Woman & Maternal population (57%) plan to provide well-woman services

 

 

NPM 1: Well-woman visit (Percent of women, ages 18-44, with a past year preventive visit)

 

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

 

Title V staff will continue to support the promotion of women receiving a well-woman visit annually, by messaging the importance of local MCH agencies partnering with other community agencies to provide on-site assistance for accessing health care coverage in the preconception and interconception periods. Local grantees either offer direct well-woman preventive care or enabling services by providing resources and referrals for annual well-woman visits. The tag line “Every Woman, Every Time” will ensure that all women are assessed for a well-woman visit and educated on the importance of comprehensive annual preventative care at every visit. Primary strategies to increase the number of women receiving an annual well-woman visit include:

• Providing resources and tools to support local health agencies on educating women about the importance of a high quality, comprehensive annual preventive medical/well-woman visit, assessing for insurance coverage, and assisting women to obtain insurance if needed;
• Providing on-site assistance for accessing health care coverage through certified application counselors or Medicaid eligibility workers to ensure coverage before, during and after pregnancy;
• Utilizing peer and social networks for women, including peer or group education models, to promote and support access to preventive care;
• Providing technical assistance to support local health agencies in developing policies and protocols that incorporate women’s goal setting and health screenings to assess for basic needs and health status; and
• Promoting and supporting Medicaid policy change to expand pregnancy coverage through 12 months postpartum and the inclusion of screening for Perinatal Mood and Anxiety Disorders (PMADs) screening as a covered service.

 

This work will be done in alignment and collaboration with the Title X Family Planning program and other state partners. The importance of women’s health and the annual visit will be highlighted at trainings and other events, and associated resources will be distributed at the annual Governor’s Public Health Conference, MCH Home Visiting Regional training, and other appropriate venues as well as online through the Kanas MCH website and social media.

 

Recent activities have focused on the development of a Well-Woman Visit Integrated Toolkit and a Reproductive Life Plan Workbook that will be inclusive of the One Key Question® approach (currently being implemented in Kansas) and existing LARC resources. These resources will be expanded in scope to include comprehensive screening guidance and tools as well as technical assistance related to implementation. This will continue to be the primary work for women of reproductive age throughout FY25.

 

Well-Woman Visit Integration Toolkit: Title V and Title X are collaborating to create a Well-Woman Visit Integration Toolkit. The release is planned for summer 2020. Patient, provider, and community resources will be cited from the American College of Obstetricians and Gynecologists (ACOG), CityMatCH’s Well-woman, Well Communities Initiative, and Office of Women’s Health (guidance from the Women’s Preventive Services Initiative will be incorporated).

 

In addition to these components, there will be supplemental modules added to the toolkit in 2021 that provide in-depth guidance related to:

1. Comprehensive screening: A streamlined prescreening tool is being developed by MCH Title V staff, with a launch date of July 2021. Technical assistance (e.g., 1-on-1 support, webinars, group trainings) will be provided to local partners on how to: administer the screening tool; respond appropriately to affirmative responses; conduct interventions; and identify and adequately complete appropriate referrals. This tool will prescreen for several evidence-based full-length screening tools, including:
   • Substance use – Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST)
   • Tobacco use – ASSIST, Tobacco Use Survey
   • Mental health – Patient Health Questionnaire-9 (PHQ-9) for depression
   • Pregnancy intention – One Key Question (OKQ)
   • Social determinants of health – KDHE Parental Health Screener
   • Intimate partner violence – CUES: Evidence-Based Intervention and Lethality Assessment Program
2. Violence prevention: The Centers for Disease Control and Prevention’s Connecting the Dots violence prevention training will be promoted to local partners and shared via social media and KDHE’s online resource library. In addition, one-on-one technical assistance and training will be provided to partners expressing interest in learning more about how they can incorporate violence intervention strategies into their agency, including the CUES: Evidence-based Intervention and the intimate partner Lethality Assessment Program.
3. Partnerships: A key component of the toolkit’s success will rely on partnerships with allied professionals and community agencies. An additional chapter of the toolkit will focus on educating partner programs about the importance of the well-woman visit, what is included in the visit, resources, etc. Tailored templates for partner programs to distribute to clients will provide an overview of the visit and underscore its importance. Title V staff will conduct a webinar with key programs interested in learning more. Targeted programs include Title X, WIC, PMI, MIECHV and TPTCM.

 

MCH-led promotional efforts around awareness months and weeks will incorporate messaging related to the importance of the well-woman visit. These awareness events include National Women’s Health Week, Minority Health Month, Black Maternal Health Week, and Sexual Assault and Domestic Violence Awareness Month. In 2021, during National Women’s Health Week, the statewide media campaign “Past the Pap…Why an annual preventative visit is more than a pap smear!” will be introduced. Plans are being made for a Governor’s proclamation with signing ceremony to officially recognize Women’s Health Week in Kansas as well as a media release and social media blasts centered on the importance of women receiving an annual well-woman visit. Ideas for celebrating National Women’s Health Week in partnership with the HHS Office of Women’s Health will be shared with all MCH and Family Planning public health network partners as well as other partners representing the medical setting.

 

Peer & Social Networks: Title V staff will continue to support pregnant and new mothers through the Kansas Perinatal Community Collaboratives (KPCC)/Becoming a Mom (BaM). This program allows mothers to connect with one another during this important time and share lived experiences in an authentic and supportive environment. Plans to extend the program past birth are underway, which will provide an opportunity for mothers to share birth stories as well as postpartum struggles – reinforcing a network that can reduce isolation and promote healing and resilience. For women not participating in BaM, Title V staff will vet and promote secure and safe peer support options through social media, training and marketing including those offered through Postpartum Support International (PSI). Title V will also pursue the possibility of adding this as a target population for Supporting You.

 

Medicaid Policy Improvements: In 2019, KDHE and partners convened to engaged in the Center for the Study of Social Policy’s (CSSP) Pediatrics Supporting Parents (PSP) project. The goal of PSP is to explore transformation possibilities in pediatric primary care to promote the social and emotional well-being of young children, the parent-child relationship, and parent mental health. CSSP and Manatt Health developed a set of actionable strategies that can be used to leverage Medicaid to foster social and emotional development through pediatric primary care, Blueprint for Using Medicaid to Finance Changes in Pediatric Care.

 

The Kansas PSP Workgroup, including public health, Medicaid, child welfare, behavioral health, pediatrics, family members, and philanthropic organizations, convened to identify gaps and discuss opportunities to improve health outcomes. The Workgroup’s first priority was a policy change allowing for maternal depression screenings (MDS) to be a covered service under the child’s Medicaid plan and allowable in pediatric care settings. The Workgroup drafted an impact paper highlighting the prevalence of maternal depression, impact on child development, financial impact of untreated maternal depression, national recommendations for standard of care and practice, the role of Medicaid in screening and treatment, and made eight recommendations for Kansas Medicaid’s consideration. They also drafted an MDS policy to establish a payment policy for health care professionals who are Medicaid providers conducting MDS and treatment for the benefit of the Medicaid beneficiaries in Kansas. Approval of this policy further supports the BFH’s guidance to local health agencies to follow American Academy of Pediatrics (AAP)/Bright Futures Guidelines, which includes MDS during well-child visits.

 

The recommendations and proposed policy are pending Kansas Medicaid leaders’ review. If approved, MCH will support implementation by assisting with any necessary guidance to providers, as well as in the development of training materials. The Mental Health Integration Toolkit and Well-woman Integration Toolkit will be updated to reflect this work. The Workgroup will then transition to other identified priorities, including but not limited to: expansion of Medicaid provider requirements to include Home Visitors (and allow for HV to bill Medicaid for MDS they are already doing), expansion of Medicaid pregnancy coverage from 60-days to 12-months postpartum, and enhancing the MDS policy to include all caregivers (e.g., fathers, grandparents, foster parents).

 

Kansas Perinatal Community Collaboratives (KPCC)/Becoming a Mom® (BaM): As part of Kansas Title V’s commitment to the continued development and expansion of perinatal collaboratives utilizing the March of Dimes BaM® prenatal education curriculum, there is continued commitment to the development and implementation of additional integration components that allow for the strengthening of particular priority areas within the curriculum and program delivery model. One area of focus over the next year will include training of BaM sites on the comprehensive integration of personal health plans, including greater utilization of the reproductive life plan (RLP) completed by each woman participating in BaM, and greater familiarity with the OKQ initiative. More information on the RLP can be found in a later section.

 

Once development of the RLP workbook is complete, it will be integrated into the BaM curriculum, either complementing or replacing the current resource “Show Your LOVE – Steps to a Healthier me!” by the CDC. Participants will be encouraged to take their RLP to their provider for discussion during the remainder of their prenatal care and their postpartum check-up. Additionally, during session six of the BaM program, sites will be encouraged to invite a Health Care Exchange Navigator from their community to participate as a guest presenter on the topic of accessing health care coverage following the loss of Medicaid coverage 60 days postpartum. Ideally, this navigator will be available before and after the session to assist participants in navigating the federal insurance exchange and enrolling in an insurance plan that will increase the likelihood of the women receiving annual well-woman exams following pregnancy.

 

Local MCH Agencies: In addition to the Title V proposed strategies outlined previously, local MCH grantee agencies have proposed community-specific approaches to promoting well-woman visits. Some examples include:

• Community Health Center of Southeast Kansas staff plan to work closely with all Kansas Managed Care Organizations (MCOs) incentive programs to maximize the services available, while also working with local foundations to offer incentives for women to access preventative care. The well-woman exam will be incorporated into each participant's individual goals, be available at no "out of pocket" cost and include transportation to the appointment.
• Crawford County plans to increase the number of new patients and clients receiving preventative care by creating an informational flyer/brochure on the importance of annual well-woman visits. Flyers will be mailed to clients one month prior to their visit date and the MCH Navigator will assist with calling patients before their scheduled exam to remind them of their appointment. The flyer will be given to women visiting the health department for services and will be available in the waiting room.
• Wyandotte County will provide comprehensive care during annual well-woman exams. All staff (nurse practitioner, registered nurse, licensed social worker, public health educator) will be provided detailed training on all the components American College of Obstetricians and Gynecologists (ACOG) annual well-woman examination guidelines. Staff will be trained on implementing the evidence-based Smoking Cessation and Reduction in Pregnancy Treatment Program (SCRIPT). The Screening, Brief Intervention and Referral to Treatment (SBIRT) process has been implemented into the Sexually Transmitted Infection Clinic and will be implemented into all prenatal care and well-woman exams.

 

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

 

KDHE BFH was awarded the HRSA Screening and Treatment for Maternal Depression and Related Behavioral Disorders Program Cooperative Agreement funding in October 2018. The funding/project provides the opportunity to increase health care providers’ capacity to screen, assess, treat, and refer pregnant and postpartum women for depression, anxiety, and substance use disorders. This project is titled Kansas Connecting Communities (KCC) and is directed/managed by the BFH/Title V Behavioral Health Consultant. Read more about this project in the Cross-Cutting Report narrative.

 

KCC will continue to work to increase statewide access, using a regional phased approach, to screening, assessment, and treatment for maternal depression, anxiety, and substance use disorders. While grant activities will be focused in the SE KS region for the first 3 years of the award (10/2018 – 09/2021), all resources and capacity building opportunities have and will continue to be made available to the statewide MCH network.

 

Perinatal Provider Consultation Line: A dually-licensed mental health and substance use clinician, with training in perinatal behavioral health, is available weekdays from 8 a.m. to 5 p.m. to assist providers with their perinatal behavioral health questions. Consultation Line staff can help with diagnosis, medication, treatment, patient resources, identifying local referral options, and connecting the calling provider with a clinical psychiatrist for case consultations.

 

Provider Consultation Line Postcard

 

Telehealth Assessment & Treatment Services: In partnership with CKF Addiction Treatment, telepsychiatry assessments, substance use addiction and treatment services are made available to perinatal women. CKF uses technology to complete substance use assessments, provide therapeutic individual services, and facilitate treatment groups to perinatal women regardless of her geographic location in the state or ability to pay.

 

Peer Support Groups: In partnership with Wichita State University’s Community Engagement Institute (CEI), health care practitioners/organizations and interested groups can receive support in the development of peer support groups within their community. CEI manages the Kansas Support Groups website. Individuals can search for support groups by type of group and/or location of group meetings. Support groups can register on the site, so individuals can find and participate in their groups. CEI recently joined the Southeast Kansas IRIS Community; providers can refer patients to CEI who can help identify support groups in their area, as well as help establish groups, if that is the request.

 

Screening App Feasibility Study: KCC will be conducting a perinatal behavioral health screening app feasibility study. Identifying needs is a critical first step to connecting individuals and families with appropriate services. Common perceived barriers include limited time during the patient visit, lack of knowledge and training, fearing negative patient reactions, and feeling uncomfortable discussing substance use. A screening app makes reliable, validated screening tools available to the general public, overcoming some of these barriers and empowering individuals and families to engage in the process of identifying and understanding their own needs. A questionnaire will be sent out to gain consumer input.

 

Integration Toolkits: KCC and Title V will continue to promote the Perinatal Mental Health Integration and SBIRT Toolkits. These valuable resources are still underutilized and MCH, KCC, KPQC, and other interest groups will focus on promotion during this grant year. Promotional flyers were developed to aid in this effort. These can be found in Supporting Documents.

 

KCC Trainings: Several training opportunities will be made available in the coming year.

• Postpartum Support International’s (PSI) Frontline Provider Training. This webinar-style training is designed to equip frontline healthcare providers with the skills necessary to assess patients for perinatal mental health complications and provide treatment with medication or connect individuals with additional resources and care.  The training will be made available to 80 participants (e.g., nurses, family practice physicians, physician assistants) in September 2020. Following completion of the PSI webinar trainings, participants can engage in a peer-to-peer learning opportunity facilitated by PSI Kansas staff.
• Every Mom Thrives! Regional Training Event. This free training focuses on building skills to implement mental health and substance use screening, referral, and treatment support into participants’ organizations. Designed for everyone who works with perinatal women including medical providers, public health, administrative staff, and social workers and is facilitated by Melissa Hoffman, DNP, APRN, PMHNP-BC, and Christina Boyd, LSCSW, LCAC. There have been two trainings to date, with a third being planned for FFY2021.
• KCC Project ECHO Series. Through partnership with the KU Medical Center, KCC offered training and case-based learning using the Project Extension for Community Healthcare Outcomes (ECHO). Utilizing video-conferencing technology for collaborative education, participants can hear form experts as mentors and share their expertise across a virtual network, linking interdisciplinary specialty team with multiple primary care clinicians. The model has proven to help provide better access for patients in rural and underserved communities, reduce treatment disparities, and promote consistency in care and practice. The KCC Project ECHO Series includes four one-hour sessions on various topics related to perinatal behavioral health. The third KCC Project ECHO Series will be held in Spring 2021.

 

• Screening, Brief Intervention, and Referral to Treatment (SBIRT) Online Learning Collaborative. As a process that can effectively identify risk and intervention of substance use, the BFH is promoting SBIRT and encouraging other to apply this same model to any behavior risk, including perinatal mood and anxiety disorders. The first “Implementing SBIRT into Practice in Communities across Kansas” training series will be held June 2020. The online learning series will provide instruction over six weeks and will include content related to utilization and implementation of SBIRT services. This will be an interactive learning environment with opportunity for questions, interaction, and networking with others in the state. Participants will be exposed to strategies to reduce stigma related to substance use; introduced to the components of SBIRT and creative ways to leverage technology in the administration of these services; and provided strategies for implementing SBIRT with patients. Future online learning collaboratives will be planned based on participant’s feedback from this first training series.
   

Communities Supporting Perinatal Behavioral Health Community Collaborative: There is great interest in the expansion of KCC, and BFH is seeing a demand for additional perinatal behavioral health trainings from local MCH programs. To meet this need, BFH will facilitate a Community Collaborative from July 2020-June 2021, to provide an opportunity for five local MCH agencies to partner with the BFH to receive targeted technical assistance and 1:1 guidance to obtain recognition as a Community Supporting Perinatal Behavioral Health. The goal is for MCH agencies to implement perinatal behavioral health screenings, brief interventions, and referrals to treatment into clinical practice that meets both benchmark standards. Once a participant completes both benchmarks, they will be recognized as an “MCH Leader in Perinatal Behavioral Health” for communities supporting perinatal behavioral health.

 

Framework for the Community Collaborative & Recognition Awards

 

Addressing perinatal behavioral health and improving health outcomes is much grander than screening. BFH developed a list of components to serve as guidance for local agencies to enhance their programs. Becoming an “MCH Benchmark Leader in Perinatal Mental Health,” includes screenings, brief interventions, and referrals to treatment for perinatal mood and anxiety disorders. Similarly, becoming an MCH Benchmark Leader in Perinatal Substance Use requires implementation of perinatal substance use screenings, brief interventions, and referrals to treatment, as well as level 1 and level 2 components.

 

Paternal Postpartum Depression (PPD): Perinatal depression affects about 1:7 women (14.7% according to the 2018 Kansas PRAMS Surveillance Report); however, many are surprised to learn that 10% of dads experience PPD, and prevalence can increase up to 50% when the mother is also experiencing perinatal depression. A 2005 study found that depression in fathers during the postnatal period was associated with adverse emotional and behavioral outcomes in children aged 3.5 years, and an increased risk of conduct problems in boys; these effects remained even after controlling for maternal and paternal depression (Ramchandani, et al.). While more research is needed to determine the full impact of paternal depression on child development, it is reasonable to conclude there would be an adverse impact.

 

It is important for providers to understand the symptom and onset differences between paternal and maternal depression to increase identification and early interventions. For example, women endorse 4 symptoms at significantly greater rates than men: stress, crying, sleep problems, and loss of interest or pleasure in things they usually enjoy; men endorse anger attacks/aggression, substance abuse, and risk-taking behavior due to depressive symptoms at significantly higher rates than woman. Preliminary research suggests that the onset of paternal depression occurs much later in the postpartum period than maternal depression. In fact, findings suggest the rate decreases from birth to 6-weeks post-delivery, but then steadily increases throughout the postpartum period. As with maternal depression, paternal depression is a treatable condition and men do recover. Therefore, clinicians are encouraged to screen for depression in fathers, particularly during the first year postpartum, as early identification, intervention, and treatment can improve the quality of life for the father and family, as well as decrease the risk for emotional and behavioral problems in his children (Scarff, May 2019).

 

BFH developed a Paternal PPD Package that will be used in conjunction with the Perinatal Mental Health Integration Toolkit. BFH promoted this in recognition of International Father’s Mental Health Awareness Day (June 22, 2020). Contents will be used to increase provider awareness about the prevalence of paternal PPD, educate about the symptoms and how they differ from perinatal depression, serve as guidance for implementing paternal screenings into their clinic workflow, and offer programming considerations. The toolkit includes resources for fathers who might be experiencing PPD. An infographic was created for fathers to help increase awareness and offer guidance on how and where to access treatment services and supports. The infographic is currently being reviewed by Geared Up Dads, a fatherhood initiative in Geary County. Consumer feedback will be used to make necessary changes before making the resource available to all local MCH agencies.

 

Local MCH Agencies: Many MCH agencies provide PMAD screenings during visits with pregnant and/or postpartum women using the Edinburgh Postnatal Depression Scale (EPDS). Case managers from the Pregnancy Maintenance Initiative (PMI) and the Teen Pregnancy Targeted Case Management (TPTCM) will screen clients using the EPDS to help identify woman experiencing or at-risk of experiencing PMADs. Several MCH agencies are taking advantage of technical assistance to create innovative ways to screen more women by implementing screenings during infant immunization appointments.

• Coffey County will provide the EPDS on all 2, 4, 6, & 12-month immunization appointments and make referrals as needed. They continue meeting with the Mental Health Collaborative Resource Team to improve access to care. MCH staff will meet with local primary care providers to discuss postnatal depression and the screening tool, in hopes that they will implement them at their agencies.
• Delivering Change will screen all clients, at a minimum, twice during the antepartum period and twice during the postpartum period for utilizing the EPDS.
• Dickinson County prenatal education clients will be screened for PMAD using the EPDS during sessions 3 and 6 as well as postpartum. All clients with positive screens are referred to a community mental health center (CMHC) and/or their primary care physician for further evaluation and care.
• Hamilton County utilizes the MCH Home Visitor who uses the EPDS at every home/clinic visit for both prenatal and postpartum women. The home visitor provides educational materials that address substance use during pregnancy and within the household. MCH staff provide clients with educational materials that address nutrition, good health hygiene, dental care, sleep practices, and having a medical home.
• Nemaha County Community Health Services has a PMAD Screening Policy that assures the MCH nurse universally screens every pregnant and postpartum woman (through one-year post-delivery) served using the EPDS. Repeat screening is administered according to the policy, as the client remains engaged in MCH Services, WIC, and/or the Breastfeeding Clinic. The EPDS is recorded in DAISEY and documents referrals on all positive screens. A referral is made to the client's primary health care provider or CMHC. The MCH nurse follows up by phone call to the client and if needed, the health care provider. MCH staff work with providers and agencies across the community to ensure an adequate system of care is in place. Staff also provide educational resources on PMAD and information on available mental health services to every pregnant and postpartum woman served by the agency.
• Wichita Children’s Home, who provides residential maternity care to pregnant and parenting teens to give them and their babies a healthy start and will screen PMI/TPTCM clients for mental health and substance use. Program staff are trained in trauma informed care to provide trauma sensitive direct care services. A biopsychosocial assessment is completed for each client and referrals are made according to identified needs.

 

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

 

KPCC/BaM: As mentioned in the Women/Maternal report narrative, resources for regional and statewide implementation of KPCCs utilizing the MODs BaM curriculum have been under development over the past several years to ensure both growth and sustainability of the initiative. Phase 2 of the website development that includes redesign and expansion of the public Perinatal Community Collaboratives website as an access point to introductory information about the initiative has been completed. This will allow interested communities to explore the initiative and engage in conversations with community partners on their own timeline, utilizing TA resources provided online. This approach is hoped to better meet the needs of local communities who are interested in enhancing perinatal services, while reducing burden on Title V staff, which will improve expansion and sustainability efforts long term.

 

Revisions to the private BaM website are ongoing, intended to provide additional training and implementation resources for communities once they are ready to begin implementation. Enhancements to the resources include online training webinars for program coordinators and group facilitators. These resources will continue to be expanded upon as additional technical assistance needs are identified. Additional training webinars will also be developed as new integration toolkits are made available. Promotional material templates will also be expanded to include materials for provider outreach, as well as additional “getting started” resources and other materials developed and shared by existing sites. All efforts are aimed at decreasing burden on new sites embarking upon implementation and existing sites facing staff turnover.

 

Conversations continue with clinical service providers in rural southwest Kansas to identify local issues and needs for the region around the KPCC model and BaM implementation. This region has a significant Hispanic population, many of whom are undocumented and/or uninsured. Four counties provide the bulk of clinical services for women of child-bearing age in the region, requiring pregnant women to travel for services, including BaM prenatal education. Virtual implementation has been piloted in the Northcentral region of the state and is an option available for this region as well, however there is interest in possibly adapting the model in other ways that will better lend itself to access by this largely rural population. Continued conversations with local stakeholders are planned for early FFY21.

 

A KPCC infographic was developed to aid communication and recruitment, planned for the coming years, for new communities among existing MCH local grantees to showcase the impact of the KPCC model and BaM programming in existing communities.

 

KDHE’s Title V commitment to this model is greater than just increasing the number of KPCC who implement the BaM program, as our updated objective hopefully demonstrates. Rather than a primary focus on expansion of the model indicated by the number of sites, it is our desire to strengthen the model, targeting and reaching a greater disparity population, and integrating additional services and support mechanisms for populations at greatest risk. Plans for this work are in early stages but will focus on targeted outreach and potential funding opportunities for sites who develop disparity specific marketing and implementation plans that will engage these high-risk populations to a greater degree than have historically been reached. Additionally, work is already in progress to develop a postpartum session as an add-on to the already existing BaM prenatal education series, creating an additional touch-point opportunity following the birth of the baby. This will provide an environment of support for these new families, while giving a booster dose of education on several postpartum and infant care topics as well as infant development, creating an opportunity for very real conversations with parents that hopefully will begin to identify and address the real barriers to healthy maternal and infant care behaviors (e.g., safe sleep practices, breastfeeding, postpartum/inter-conception self-care activities).

 

Objective: Increase the proportion of women receiving pregnancy intention screening as part of preconception and inter-conception services.

 

According to the 2020 Title V MCH Needs Assessment community survey, approximately 44% of women said that reproductive health and family planning access was a concern. Title V will continue, and expand, work related to pregnancy intention through the following strategies:

• Increase consumer/family and provider awareness about the importance of preconception and inter-conception care, counseling/planning, and pregnancy intention screening by utilizing social media, infographics, data briefs, and partner networks.
• Provide resources and education specific to preconception and inter-conception care to providers in support of quality services and comprehensive visits during these critical periods.
• Increase the number of local health agencies utilizing evidence-based pregnancy interventions including One Key Question, support implementation into practice through virtual skills building sessions and increase provider capacity to implement pregnancy intention screening into their practice.

 

Local MCH Agencies: PMI/TPTCM Case managers will assure clients have access to holistic

services and supports through coordinated and comprehensive care, include preconception and inter-conception care. They will utilize external partnerships and internal agency programs to help clients access any service that promotes healthy, full-term pregnancies. In addition, one of the common goals among all SFY21 grantees is to help clients increase self-sufficiency and reduce negative outcomes. Participants will receive assistance to set personal and professional goals according to the eight life domains: empowerment, key relationships, health, daily living, financial, parenting, education/training and employment. All PMI/TPTCM participants will receive RLP education, to support family stability through completion of basic education, vocational, and health goals prior to subsequent pregnancies.

• Unified Government of Wyandotte County plans to utilize OKQ to track pregnancy intent of all TPTCM enrolled clients. Each client will complete a birth plan. Medically accurate education will be used by providing and counseling each client with a contraception handout from Reproductive Access. A contraception kit will be used as a hands-on tool to demonstrate each method to clients.
• Barton County Health Department will provide annual training on OKQ to their staff and refer TPTCM clients to contraceptive services provided by family planning programs, OB-GYNs, or other health care providers. One of the goals is to discuss and implement OKQ with each intake and review semi-annually for each TPTCM participant.

 

Reproductive Life Plan (RLP) Workbook: The development of an RLP Workbook is ongoing. Several collaborative work group meetings have occurred between KDHE and local agencies in the metro Kansas City area, including the Wyandotte Health Council, Unified Government of Wyandotte County (Local Public Health Department), and Vibrant Health Care (FQHC) to develop a comprehensive RLP workbook for use across agencies and sectors of the health care system in our state. The workbook consists of the following sections:

• Your Future
• Your Choice
• Your Health Now
• The Skin You’re In
• Inner Health
• Healthy Checklist

 

The workbook is being designed with the intention of using the tool in a variety of settings where providers have varying degrees of opportunity to work through the workbook with a woman. For example, a case management or home visitation service provider can be revisited over the course of several visits for completion, reflection, and progress monitoring, whereas only targeted sections of the workbook might be completed by a provider in a medical or Title X clinic. Use of the workbook can be customized by each type of service provider but does provide standardized tools and a consistent approach for encouraging women of reproductive age to set life and health goals during a well-woman visit on an annual basis.

 

The workbook has been tested in a variety of settings including physician offices, safety net clinics, home visiting with parent educators, health department clinics, peer to peer conversations, and a barber shop. The responses were overwhelmingly positive, with an appreciation of the contraceptive devices and effective rates, space to plan/think/take notes, and the reflections on health. Some constructive feedback included: the length of the booklet, the number of notes pages, pictures do not reflect all populations intended or served, and there is nothing about the men/fathers in the woman’s life. Work will continue in the upcoming year to finalize the workbook and create training and technical assistance for local MCH agencies wishing to incorporate the workbook into their practice.

 

Preconception Guide: In collaboration with the Bureau of Disease Control & Prevention, Title V staff created a Prenatal Syphilis Screening, Staging, Treatment, and Monitoring for Congenital Syphilis guide for women’s health providers. This resource provides clinical guidance related to screening before and during pregnancy along with information about what questions should be asked of the patient related to their pregnancy intention. The guide will be shared and promoted to all local partners throughout the plan period and included as part of the Well-Woman Toolkit.

 

Long Acting Reversible Contraceptives (LARC): Title V will continue our collaboration with Title X and other state partners to increase access to LARCs for women, including continued implementation of the LARC Integration Toolkit (described in more detail in the Women/Maternal Report narrative). There are plans to recruit physicians for a LARC Preceptor Network (peer support) which will allow trained physicians to serve as preceptors for newly trained providers that need experience.

 

Title V plans to host LARC “lunch and learn” online events where organizations can call in for a short didactic session about a specific LARC topic (e.g., LARC myths, educating about LARCs) followed by a Q&A session where participants can discuss LARC cases and get expert and peer advice. Title V and Title X have offered three such programs to date and will continue to offer technical assistance to organizations around LARC and assist identifying innovative ways to overcome barriers they may have to offering or referring for LARC.

 

One Key Question®: To support broader MCH women’s reproductive health goals, full implementation is underway of the One Key Question® (OKQ) Initiative, property of Power to Decide, in partnership with Title V and Title X clinics. Title V is currently working with Power to Decide to be the first state to pilot their online training module which will enable ongoing learning and growth of the program despite current restrictions on meetings and conferences. In addition, the online format will increase the number of potential attendees significantly, allowing for the inclusion of additional community partners and service providers. The goal is to pilot the online curriculum in the summer of 2020 and rollout full cohort implementation by fall 2020.

 

 

Other Women/Maternal Activities

 

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. A new mailing will go out to all providers in counties with high still birth rates to promote CTKs and sharing the impactful story of a Kansas mom, Deanna Cummings, who saved her baby with CTK. In the upcoming year, a CTKs webinar targeted at midwives and doulas in Kansas will be offered and a new CTKs magnet will be added to the list of educational materials that Kansas providers can order for free. Stillbirth Awareness Month (October 2020) will provide opportunity to encourage local MCH agencies to spread awareness in their communities and encourage moms to count kicks. Learn more about CTK, view materials, and access Deanna’s story online at: http://www.kansasmch.org/countthekicks.asp.