Local MCH Reach

Based on SFY2023 MCH Aid-to-Local applications received: 39 of 55 grantees (71%) plan to provide services to the Child population. As related to each objective within Priority 3:

• 35 of 39 grantees (90%) plan to provide developmental screening services
• 24 of 39 grantees (62%) plan to provide activities and programs that support the interests, healthy development, and learning of children
• 21 of 39 grantees (54%) plan to provide quality, comprehensive annual preventive services

Developmental Screening Initiatives (Objective 3.1)

Title V will continue to partner with other early childhood agencies, including the Kansas State Department of Education (KSDE), Department for Children and Families (DCF), and Kansas Children’s Cabinet & Trust Fund (KCCTF), to focus on children’s developmental health and emphasize the importance of early and ongoing developmental screening. Title V is dedicated to assisting communities in creating seamless and coordinated systems that connects families to local services and resources. In addition to partnering around the ASQ screening and data utilization, Title V will build MCH capacity to support the Help Me Grow Kansas Connected Families, Connected Communities vision; facilitate access to available resources through the statewide 1-800-CHILDREN helpline; and support coordinated, two-way referrals with other providers offering community-based services through use of the Integrated Referral and Intake System (IRIS) at the community level.

Provider & Parent Education/Training: In the coming year, developmental screening will be incorporated into the Becoming a Mom (BAM) curriculum for the Kansas Perinatal Community Collaboratives (KPCCs) across the state. The Child and Perinatal/Infant Health Consultants will work together to introduce an overview on developmental screening into Session 5 – Newborn and Infant Care. Families located in the 20 BAM/KPCC communities that enroll and attend this session will receive the one-page fact sheet and their own full set of developmental milestone activity cards and a developmental screening passport. All of these resources will be available in both English and Spanish. Ongoing discussions and planning to include more detailed information about developmental screening, recommended screening tools used, screening results, and the referral process/connection for early intervention services in a future Session 7 of the BAM curriculum are currently taking place.

Development Milestone Cards & Passports: Title V will continue to disseminate the Developmental Screening Passports previously created through the Early Childhood Comprehensive Service (ECCS) grant for MCH programs’ use with families. Home visitors, early childhood educators, and health care providers will be encouraged to utilize these resources which can be found on the Kansas Help Me Grow website.

All Bridges Care Coordinators will share information with the families in the program about the importance of developmental screening and help link them to the appropriate resources in their area to complete a developmental screening on their child. Care Coordinators provide families with the developmental passport and share the Developmental Milestone Cards regularly. As more cards and passports are needed at Bridges locations across the state these are provided to them upon request at no cost. The KS-SHCN care coordinators will use these resources with up to 60+ families across the state. As new Bridges sites are developed in FY23 additional trainings will be held to encourage ASQ screenings and the use of the passports and postcards. All bridges and SHCN care coordinators will receive training on how to do an ASQ during the FY2023 year.

Coordination and Referrals: Title V will continue to encourage MCH agencies to place the 1-800-CHILDREN logo/weblink on their agency website, show clients how to use the 1-800-CHILDREN app, update their agency information in the statewide resource directory as needed, and promote the 1-800-CHILDREN helpline on their social media platforms and at community events. As the resource becomes more widely known, Title V anticipates an increase in the amount of calls and service connections in their counties. For communities that utilize The Integrated Referral and Intake System (IRIS) an uptick in referrals and linking families and children to needed resources is expected.

There are opportunities through several of these projects to collect information/data around social determinants of health such as housing/food insecurity, mental health needs, community and educational needs. Upon identification of the client/family need an Action Plan is collaboratively developed with the family to address those needs. Care coordinators from both Bridges and SHCN closely monitor progress and update the Action Plan as needed.

Utilizing Statewide ASQ Data: Through successful discussions and planning strategies with Brookes Publishing, strong ASQ hubs have been established and are monitored by the local Kansas Early Childhood Developmental Services (KEDS - formerly Infant Toddler Services/ITS). A variety of partnering programs include USDs, WIC, Head Start, home visiting, Children’s Cabinet, licensed childcare, and Part B. Partners will continue to be added in the development to consolidate multisector development screens into one statewide hub account. Technical assistance will continue to be provided to local MCH agencies on how to access the statewide ASQ Enterprise and guidance for documentation of developmental screenings and referrals into the shared data measurement system, DAISEY. During SY 23, the SHCN/Bridges program staff will receive training on how to conduct, document and submit ASQ screenings into the local Infant Toddler Hubs across the state.

Local MCH Agencies: Local agencies will continue to provide developmental screening at least once a year to children they serve. Local MCH agencies will continue to provide required ASQ screenings during KanBeHealthy (KBH) well child visits. Local agency activities are highlighted below:

• Barton County: Plans to increase the number of times "child development" is chosen as an education topic. Will provide education about developmental milestones during home visits and support use of the developmental screening passport and milestone cards. Are pursuing a new partnership with Sunflower Early Education as a referral source for children whose developmental screening scores indicate the need for intervention.

• Shawnee County: Screen 100% of MCH infants and children served using the ASQ-3 and ASQ:SE2. Refer all screens that are not within normal range or if a parent has concerns for further evaluation through our Kansas Early Childhood Services (KEDS - formerly Infant-Toddler Services/ITS) network. Follow up with parents to ensure further evaluation took place. Distribute and educate clients on the CDC Milestone Moments booklet or website. The Bright Futures Toolkit is a resource for MCH home visiting staff. Bright Futures handouts are distributed to families. Assure that all MCH staff are signed up for use of the online KDHE MCH Toolkit.
• Lawrence-Douglas County:  Will administer ASQ and ASQ:SE screenings for 70% of children in the home visiting program. All child development screens that indicate potential for delay are referred to local tiny k services and results are sent to the child's primary care provider. Home visitors and staff will offer the families assistance in contacting tiny k and offer a joint visit with all parties. Additionally, Growing Great Kids curriculum and ASQ child activities will be shared with the parents to educate and promote techniques parents can use with their children to strengthen the developmental area of concern.
• Pawnee County: Will increase the number of developmental screenings provided during the year by attending “school entry screening days”. They will search the state database when youth come in for immunizations to see if they are due for a well child exam and schedule if parents approve.

• Southeast Kansas Multi-County Health Department: Increase the percentage of appointments with a child developmental screening that are completed from 58% to 80%. This will be tracked using Appointment Plus Software. Screening tools will be mailed to families ahead of time as a strategy for completing screenings.

Healthy Activities for School-Aged Children (Objective 3.2)

Partnerships with local school districts and the Bureau of Health Promotion have stalled due to staffing shortages, but this objective will become a strong focus in the coming year. Efforts to align statewide messaging around child health initiatives will be valuable. Local communities will receive guidance on healthy campaigns (e.g., Move Your Way, Let’s Move; Turn a Page-Touch a Mind; Dolly Parton’s Imagination Library), farmer’s market resources, and other food programs that are available.

Through the CDC Workforce Development grant funds related to the COVID-19 pandemic, the Bureau of Family Health is supporting the expansion of school-based health services in seven school districts in Southeast and Southwest Kansas, including the provision of behavioral health services at each location. The goal is for each school district to have services established and self-sustaining by the end of the grant period in summer of 2023, ensuring the provision of behavioral services through and expanded clinical workforce in areas that are currently designated as Health Professional Shortage Areas.

Inclusive Playgrounds: Many play areas are not inclusive for children with disabilities who also need to be physically active. Holding true to the BFH belief that “children with special health care needs (CSHCN) are children first and foremost,” our focus will be on assisting communities and schools with understanding how they can make playgrounds accessible for all children. Title V will engage communities and partners to think broadly about making safe and accessible play areas for children in their communities, schools or daycares by offering mini grants to assist them in accessing inclusive playground equipment. Communities, schools and childcare facilities can complete a call for proposal to apply for funding but will need to have a 50% match to be considered for funding support. Title V will identify key partners who can provide technical assistance and establish guidance on adapting play equipment for children with mobility and sensory needs to communities and schools. MCH local agencies will be prioritized to receive these resources and supports as they become active in ensuring that ALL children are able to enjoy community spaces.

Local MCH Agencies: Local agencies are increasing access to activities and programs that support a child’s interests, healthy development and learning through individual education and referrals during clinic visits and group education and services in community settings such as schools and festivals. Most local agencies working on this objective are increasing access to nutrition, physical activity, immunizations and child passenger safety. Local agency activities are highlighted below:

• Community Health Center of Southeast Kansas: Will connect children to health promotion activities and programs after calculating BMI and counseling parents when a child is under or over-weight. Connection will be to YMCA scholarships, onsite fitness room and onsite professional nutrition education. Will use targeted social media posts about children’s health topics, enrollment in Dolly Parton’s Imagination Library, and information about Turn A Page Touch a Mind.
• Linn County Health Department: Will promote the use of the community’s new splash pad to encourage more physical activity among children. They will also promote health through developmental screenings by providing educational material about health ranging from hand washing to physical activity. The WIC nurse will provide educational materials from the CDC, Be Active Kids, and Kids Health during appointments. They will have "Funshine Days" during the summer and incorporate fun activities that can be done outside to stay active along with education on how to stay cool during the summer. They will hold an outreach event with the schools to promote good handwashing.
• Nemaha County Community Health Services: Will become the lead for Nemaha County Safe Kids Coalition. An application will be submitted to the National Safe Kids Coalition and the first Safe KidsEvent will be held once it is approved. The coalition will include local safety partners such as EMS, fire, and police departments.

Well-Child Preventive Services (Objective 3.3)

In May 2022, Kansas submitted the HRSA TPEC (HRSA-22-141) application to expand the existing holistic care coordination (HCC) and early childhood systems work. The proposed project, Health Education, Access, and Referrals to Transform Systems (HEARTS) Project would serve rural and urban communities across Kansas by developing a network to create, establish, and sustain Early Childhood Development (ECD) Resource Hubs, supporting increased access, reduced barriers, and more coordinated services for high-risk/underserved families with children prenatal-to-five years old (P-5). The HEARTS Project would strive to improve (1) equitable access to a continuum of ECD services in child health care provider (CHCP) settings, and (2) the capacity of the CHCP workforce to deliver high-quality ECD services that address the holistic needs of children and families. Primary goals of the project include:

• Establishing a network of ECD “Resource Hubs” to ensure all families have the full range of services and supports they need across their community (aligned with the HMG implementation efforts)
• Expand access to HCC services for high-risk and underserved families and children (building from existing effort to provide HCC technical assistance for public and primary care settings)
• Provide training, education, and technical assistance to CHCP on the continuum of ECD services, such as developmental promotions and prevention; surveillance and screening; care coordination and linkage; and early interventions (primary focus for HMG)
• Engage in systemic policy change to ensure adequate financial strategies to ensure sustainability for a continuum of ECD services

Proposed grant activities include training, education and outreach for providers and partners on the continuum of ECD services (e.g., early developmental promotion/prevention, community resources, quality preventive health services for children), coordination of community-level intake and referrals, family engagement and supports, screenings (e.g., development, behavioral health, social determinants, special health care needs/disability), provision of HCC services, continuous quality improvement, and policy change.

Family engagement and parent empowerment is at the core the HEARTS Project. ECD experts will provide services in collaboration with the family and providers. In partnership the KDHE Family and Consumer Partnership and Family Resource Centers, technical assistance will be provided to ECD expert and medical practices on how to implement strategies to help the identify barriers to care, family needs, and partner with families to make lasting change within the clinics. This project will build the early childhood system infrastructure and co-develop a roadmap and guidance for CHCP settings to integrate an ECD expert as a member of the health care team.

If Kansas is not a recipient of the funding available under HRSA-22-141, Title V will be working to implement many of these components and efforts, it will just take much longer and require a shift of funding priorities. However, this is in line with the spread/scale efforts for the KPCC’s.

Local MCH Agencies: Local agencies will Increase the proportion of MCH program participants, 1 through 11 years, receiving a quality, comprehensive annual preventive services by asking and documenting if a child is up-to-date on their well exam, educating about the importance of regular well-exams, and providing well exams or referring to a provider based on the desires of the family. Local agency activities are highlighted below:

• Community Health Center of Southeast Kansas: Have a goal of all children in the MCH program having access to comprehensive Well-Child/Preventive Care Services which are provided, regardless of ability to pay, at 15 full-service sites throughout seven counties. MCH staff will work with the Population Health team to identify children who have not had a Well-Child visit in the past two years and contact them for an appointment providing support (transportation, translation, etc.) as needed.
• Northeast Kansas Multi-County Health Department: Will form a partnership with Northeast Kansas Community Action Program to ensure that all children that attend their program are receiving their KBH and developmental screenings to identify any potential needs as well as referring families to specialists, PAT, etc.
• Reno County Health Department: Have a goal to serve as many children in this grant year as the last, 77. Their experienced APRN will complete KBH exams using recommended tools. They will create a succession plan to prepare for when she retires.

Other Activities Related to Children’s Developmental Health

Early Childhood Systems Building: As one of four state agencies involved in the early childhood systems building initiative, KDHE will continue to serve as the lead to carry out the below projects under the plan.

• Bridges: Helping families navigate systems after early intervention services have ended to help bridge transition gaps identified by the needs assessment.
• Holistic Care Coordination: Establishing models of holistic, coordinated care in primary care settings across the state to support child development and growth for all children but especially those who have a special health care need.
• Family Engagement and Leadership: Strengthening family voices in leadership through development and learning, program and policy advisory roles, and engagement.
• Peer to Peer Supports: Expanding peer to peer support and information sharing opportunities for families in Kansas.
• Child Care Systems Improvement: Increasing capacity of the child-care system and assuring equitable access to high-quality early childhood care and education programs.

Each of these initiatives are aligned with the Title V State Action Plan. Plans for the coming year for Bridges can be found in the CSHCN Plan narrative and for the Holistic Care Coordination, Family Engagement and Leadership, and Peer to Peer Supports in the Cross-Cutting Plan.