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Kansas Maternal and Child Health
Service Manual
Bureau of Family Health
Kansas Department of Health and Environment
Revised January, 2012
KDHE Mission: To Protect the Health
and Environment of all Kansans
Contributions
Appreciation is extended to the members of the Children & Families Section staff, those
who provided consultation and technical assistance, reviewers and all others who
assisted in the preparation of this document.
Children & Families Section Staff:
Jamie Klenklen, BPA, MCH Administrative Consultant, Kansas Department of
Health & Environment
Joseph Kotsch, RN, BSN, MS Perinatal Consultant, Kansas Department of
Health & Environment
Jane Stueve, MS, BSN, RN, Child and School Health Consultant, Kansas
Department of Health & Environment
Consultation and Technical Assistance:
Anita Poland, RN
Barber County Community Health Department
Janis Goedeke, ARNP, Administrator
Crawford County Health Department
John Hultgren, Administrator
Dickinson County Health Department
Diana Rice, Administrator
Edwards County Health Department
Ashley Goss, Administrator
Finney County Health Department
Darlene Lindskog, RN, MCH Nurse
Finney County Health Department
Mary “Midge” Ransom, PhD, Director
Franklin County Health Department
Rebecca Teegarden, HSHV
Kingman County Health Department
Sondra Hone, RN, BSN, Administrator
Mitchell County Health Department
Carolyn Muller, RN, Interim Administrator
Montgomery County Health Department
Teresa K Starr, Administrator
Neosho County Health Department
2
Sandra Schwinn, RN
Pottawatomie County Health Department
Jeanne Ritter, RD, LD, WIC/Child Health Coordinator
Reno County Health Department
Neita Christopherson, RN, BSN, MCH Program
Reno County Health Department
Marci Detmer, RN, BSN, Administrator
Rice County Health Department
Karen Sattler, RN, Administrator
Scott County Health Department
Teresa Fisher, RN, BSN, MCH Outreach Team Leader
Shawnee County Health Agency
Susan E Wilson, BGS, Program Director
Healthy Babies ~ Sedgwick County Health Department
Melanie Vogts, RN, BSN, Program Head-Child Health/KSHS
Unified Government Public Health Department
Medical Review:
Secretary Robert Moser, MD
Kansas Department of Health & Environment
Dennis Cooley, MD
President, Kansas Chapter AAP
John Evans, MD, FACOG, Perinatologist, Maternal-Fetal Medicine
Stormont-Vail Health Care
Special Acknowledgement:
Linda Kenney, MPH, Director Bureau of Family Health, Kansas Department of
Health & Environment for her vision, support and leadership throughout the
development of this manual and continuing implementation of the Kansas Ma
Former Staff Acknowledgement:
Appreciation is extended to these former staff members of the Children and
Families Section who shared their insights and provided consultation in the
development of this manual.
•
Ileen Meyer, RN, MS Director of Children & Families Section, Kansas
Department of Health & Environment Maternal and Child Health Program
•
Brenda Nickel, RN, BSN, MS Child and School Health Consultant, Kansas
Department of Health & Environment
3
Preparation of the Manuscript:
Carrie Akin, Administrative Specialist, Kansas Department of Health &
Environment
Penny Hulse, Sr. Administrative Assistant, Kansas Department of Health &
Environment
Table of Contents
100 - Overview of Maternal and Child Health (MCH) Services in Kansas ............... 12
101
Bureau of Family Health Mission...................................................................... 13
102
Bureau of Family Health Services Philosophy.................................................. 13
103
History of MCH in Kansas ................................................................................ 13
104
MCH Grants ..................................................................................................... 13
105
MCH Services .................................................................................................. 14
106
Qualified Workforce.......................................................................................... 15
107
MCH Goal and Standards ................................................................................ 15
108
References: ...................................................................................................... 26
150 - MCH BACKGROUND .......................................................................................... 27
151
Title V Block Grant to States ............................................................................ 28
152
Maternal and Child Health ................................................................................ 28
153
MCH (Title V) Funding ..................................................................................... 29
154
State 5 – Year Needs Assessment .................................................................. 29
155
MCH Performance and Accountability ............................................................. 30
156
MCH Performance Measures ........................................................................... 30
157
Criteria for MCHB Performance Measures ....................................................... 31
158
18 National Performance Measures (2010) ..................................................... 31
159
6 MCH Outcome Measures .............................................................................. 32
160
Kansas 10 State Performance Measures (2015) ............................................. 32
161
MCH 10 Essential Services .............................................................................. 33
162
Local Core MCH Public Health Services for the Perinatal Population .............. 36
163
Local Core MCH Public Health Services for Children and Adolescent
Populations ...................................................................................................... 37
164
Local Core MCH Public Health Services for Children and Youth with Special
Health Care Needs .......................................................................................... 38
200 - Social Determinants of Health in Kansas ........................................................ 39
201
Description of Social Determinants .................................................................. 40
202
Resources ........................................................................................................ 40
250 - Guidelines for Bright Futures® and the Medical Home Model........................ 42
251
Description of Medical Home ........................................................................... 43
252
Program Goal and Outcome Objectives for MCH 2015 ................................... 43
253
Bright Futures® and the Medical Home Model ................................................. 43
254
Medical Home Defined ..................................................................................... 43
255
Resources ........................................................................................................ 44
256
References ....................................................................................................... 44
300 - MCH Administrative Manual .............................................................................. 45
301
Grant Applications ............................................................................................ 46
302
Contracts and Subcontracts ............................................................................. 46
303
Contract Revisions ........................................................................................... 47
304
Budgets ............................................................................................................ 48
305
Documentation of Local Match ......................................................................... 49
306
Financial Accountability .................................................................................... 49
307
Fiscal Record Retention ................................................................................... 51
308
Narrative/Progress Reports .............................................................................. 51
309
Inventory or Capital Equipment ........................................................................ 51
310
Income ............................................................................................................. 52
311
Data Collection ................................................................................................. 54
312
Schedule .......................................................................................................... 55
313
Monitoring ........................................................................................................ 56
350 - Guidelines for Records Management ............................................................... 58
351
Scope of Records Management ....................................................................... 59
352
Statutes and Laws for Records Management .................................................. 59
353
Resources ........................................................................................................ 59
400 - Maternal and Infant Health ................................................................................ 62
401
Program Description ........................................................................................ 64
402
Multidisciplinary Health Professional Team ...................................................... 64
403
Program Purpose ............................................................................................. 65
410 - Guidelines for Outreach and Family Support: Home Visiting and the Kansas
Healthy Start Home Visitor (HSHV) Services ................................................... 65
411
Description of Services .................................................................................... 65
412
Eligibility for Services ....................................................................................... 66
413
Program Philosophy, Goals and Objectives ..................................................... 66
414
Supervision Standards and Provision of Services ............................................ 67
415
Qualifications of Supervisors ............................................................................ 67
416
Responsibilities of Supervisors ........................................................................ 67
417
Qualifications of Home Visitors ........................................................................ 68
418
Making a Home Visit ........................................................................................ 68
419
Responsibilities of Home Visitors ..................................................................... 69
420
Community Collaboration and Local Coordination ........................................... 69
421
Healthy Start Home Visitor Services Pamphlets .............................................. 70
6
422
Orientation and Training Standards ................................................................. 70
423
Initial Training for Healthy Start Home Visitors ................................................. 70
424
Continuing Education ....................................................................................... 71
425
Provision of Services ........................................................................................ 71
426
Provision of HSHV Services Algorithm ............................................................. 72
427
Confidentiality................................................................................................... 72
428
Administrative Information and Documenting Services .................................... 73
429
Documentation of Visits for the Client’s Permanent Health Record ................. 73
430
Client Encounter Data ...................................................................................... 73
431
Evaluating Outreach and Family Support Services .......................................... 74
432
MCH Client Satisfaction Survey Card .............................................................. 74
433
Do’s and Don’ts of Successful Home Visitation................................................ 75
434
Federal Healthy Start Programs Serving Kansas ............................................. 75
435
References ....................................................................................................... 76
440 Preconception Health ........................................................................................ 77
441
Access to Health Care ..................................................................................... 77
442
Sexually Transmitted Infections (STI) .............................................................. 77
443
Intimate Partner Violence ................................................................................. 78
444
Alcohol, Tobacco and Other Drugs .................................................................. 78
445
Nutrition ............................................................................................................ 79
446
Physical Health and Oral Health Status ........................................................... 79
447
Physical Activity ............................................................................................... 80
448
Cultural Competence ....................................................................................... 80
449
Emergency Planning ........................................................................................ 81
450
General Preconception Health Resources ....................................................... 81
460 Prenatal Health ................................................................................................... 82
461
Access to Health Care ..................................................................................... 82
462
Prenatal Screening Tests ................................................................................. 82
463
Genetic Screening............................................................................................ 83
464
Risks, Warning Signs and Hazards .................................................................. 83
465
Sexually Transmitted Infections (STI) .............................................................. 84
466
Intimate Partner Violence ................................................................................. 84
467
Alcohol, Tobacco and Other Drugs .................................................................. 84
468
Nutrition ............................................................................................................ 85
469
Physical Health and Oral Health Status ........................................................... 85
470
Physical Activity ............................................................................................... 85
471
Cultural Competence ....................................................................................... 86
7
472
Emergency Planning ........................................................................................ 86
473
Immunizations .................................................................................................. 86
474
Labor and Delivery ........................................................................................... 87
475
General Prenatal Health Resources................................................................. 87
460 Postpartum Health ........................................................................................... 882
481
Access to Health Care ..................................................................................... 88
482
Common Considerations .................................................................................. 88
483
Sexually Transmitted Infections (STI) .............................................................. 89
484
Intimate Partner Violence ................................................................................. 89
485
Nutrition ............................................................................................................ 89
486
Physical Activity ............................................................................................... 89
487
Cultural Competence ....................................................................................... 90
488
Emergency Planning ........................................................................................ 90
489
Immunizations .................................................................................................. 90
490
Mental Health Considerations .......................................................................... 90
491
General Postpartum Health Resources............................................................ 91
492
Breastfeeding ................................................................................................... 91
493
Sudden Infant Death Syndrome (SIDS) ........................................................... 92
494
Safe Haven: Newborn Infant Protection Act ..................................................... 92
500 Infant Health.......................................................................................................... 93
501
Access to Health Care ..................................................................................... 93
502
Parent-Infant Bonding ...................................................................................... 93
503
Infant Mental Health ......................................................................................... 94
504
Newborn Screening.......................................................................................... 94
505
General Infant Care.......................................................................................... 95
506
Growth and Development ................................................................................ 95
507
Infant Nutrition .................................................................................................. 96
508
Oral Health ....................................................................................................... 96
509
Safety and Security .......................................................................................... 97
510
Emergency Planning ........................................................................................ 97
511
Immunizations .................................................................................................. 97
512
General Infant Health Resources ..................................................................... 98
550 - Guidelines for Child and Adolescent Health.................................................. 100
551
Purpose for Child and Adolescent Health Services ........................................ 101
552
Leading Health Indicators for Children and Adolescents................................ 101
553
Settings for Service Provision ........................................................................ 101
8
554
Medical Home Program Goal and Outcome Objective ................................... 101
555
Standard of Practice for Health Supervision of Infants, Children and
Adolescents ................................................................................................... 102
556
Components of Health Assessments ............................................................. 103
557
Resources ...................................................................................................... 103
558
References ..................................................................................................... 106
600 - Adolescent Health and Development ............................................................. 107
601
Adolescent Health .......................................................................................... 108
602
Adolescent Brain Development ...................................................................... 108
603
Adolescent Development and Health ............................................................. 109
604
Alcohol, Tobacco and Other Drugs (ATOD) ................................................... 110
605
Dental Care .................................................................................................... 113
606
Injury .............................................................................................................. 114
607
Mental Health ................................................................................................. 115
608
Nutrition and Physical Activity ........................................................................ 118
609
Sexual Health ................................................................................................. 119
610
Teen Pregnancy ............................................................................................. 120
611
Violence ......................................................................................................... 121
612
Youth Development........................................................................................ 121
613
Youth Engagement ........................................................................................ 123
650 - Guidelines for Children and Youth with Special Health Care Needs (CYSHCN) 125
651
Defining Children and Youth with Special Health Care Needs (CYSHCN) .... 126
652
Individuals with Disabilities Act (IDEA) ........................................................... 126
653
Resources ...................................................................................................... 126
654
References ..................................................................................................... 127
700 - Guidelines for School Health Services .......................................................... 128
701
School-Age Populations ................................................................................. 129
702
Federal Laws to Consider when Providing Health Services in School Settings
....................................................................................................................... 129
703
Delivery of School Health Services ................................................................ 129
704
Definition of School Nursing ........................................................................... 130
705
Services Provided by School Nurses ............................................................. 130
706
Health Care Plans, Accommodations and Special Education ........................ 130
707
Collaborative Partners.................................................................................... 131
708
School Health Policies, Statutes and Regulations.......................................... 131
709
Kansas Statutes and Regulations Addressing School Health ........................ 131
710
School Health Statutes and Regulations in the Kansas Nurse Practice Act ... 132
711
Confidentiality and School Health Records .................................................... 132
9
712
Resources ...................................................................................................... 133
750 - MCH Resources for Practice ........................................................................... 134
751
General State of Kansas Resources .............................................................. 135
752
Child Abuse and Neglect ................................................................................ 135
753
Childhood Diseases, Infections and Immunizations ....................................... 137
754
Children and Youth with Special Health Care Needs ..................................... 137
755
Confidentiality and Protection of Health Information ...................................... 138
756
Dental and Oral Health ................................................................................... 138
757
Disabilities and the Law ................................................................................. 139
758
Emergency and All-Hazards Preparedness ................................................... 139
759
Health Literacy ............................................................................................... 140
760
Health Screenings and Assessment .............................................................. 141
761
Maternal and Child Health Resources............................................................ 142
762
Mental Health and Behavioral Needs ............................................................. 142
763
Nutrition Assistance Programs ....................................................................... 142
764
Parenting Skills .............................................................................................. 143
765
Public Health Resource Manual ..................................................................... 144
766
Safety ............................................................................................................. 144
767
Sudden Infant Death Syndrome (SIDS) ......................................................... 144
800 - Appendix ........................................................................................................... 145
10
Forward
The Maternal and Child Health (MCH) Services Manual reflects a commitment of the
Children and Families Section, Bureau of Family Health (BFH), Kansas Department of
Health and Environment (KDHE), to promote the KDHE mission: To protect and
improve the health and environment of all Kansans.
This manual was developed specifically for use by entry level MCH/KDHE grantees in
the public health workforce.
100 - Overview of Maternal and Child Health
(MCH) Services in Kansas
Table of Contents
101 - Bureau of Family Health Mission
102 - Bureau of Family Health Services Philosophy
103 - History of MCH in Kansas
104 - MCH Grants
105 - MCH Services
106 - Qualified Workforce
107 - MCH Goal and Standards
108 - References
12
101 Bureau of Family Health Mission
The mission of the Bureau of Family Health is to provide leadership to enhance the
health of Kansas’s women and children through partnerships with families and
communities.
102 Bureau of Family Health Services Philosophy
Holistic health services and health promotion for children, youth and their families
should be made available and accessible through integrated systems that promote
individualized, family-centered, community-based and coordinated care. These services
are founded on sound theoretical and evidence-based principals within current standard
of health practices. Gaps and barriers to essential services must be identified and
addressed in a delivery model that sustains broad based efforts for the promotion and
maintenance of optimum health.
103 History of MCH in Kansas
A legislative mandate created the Kansas Division of Child Hygiene in 1915 “that the
general duties of this Division of the State Board of Health shall include the issuance of
educational literature on the care of the baby and the hygiene of the child, the study of
the causes of infant mortality and the application of preventive measures for the
prevention and suppression of the diseases of infancy and early childhood.” These
original charges have served as the framework for the Kansas Maternal and Child
Health program which has evolved over the last 94 years and are an integral
component of our present services.
The Kansas Maternal and Child Health Service was organized as a bureau in 1974
when legislation established a Department of Health and Environment with a secretary
of cabinet status in the Governor’s office to replace the original Board of Health.
104 MCH Grants
Through MCH grants, local agencies increase access and participation in prenatal care
services, increase first trimester enrollments in prenatal care services and facilitate
access to comprehensive prenatal and postnatal healthcare and follow-up services for
the mother and infant up to one year post delivery. Health, psychosocial and nutrition
assessments are provided through a collaborative effort between public health and
private medical providers. In addition, reproductive health, STD testing and treatment,
pediatric health services including well-child visits and immunizations, reduction of
unintentional and intentional injuries in children, high-risk infant follow-up, smoking
cessation efforts, perinatal mood disorders and identification and referral for substance
abuse. Clients have access to multi-lingual translator services and a culturally oriented,
multidisciplinary health professional team, including, at a minimum, a physician,
registered nurse (including clinicians, practitioners and/or nurse midwives), registered
dietitian and licensed social worker, on site and/or through referral to the appropriate
professional(s) within the community or grantee’s service area.
Local MCH grantees should make every effort to inform clients of the services available
from Medicaid and HealthWave. The local agency staff assists clients in completing the
Kansas Medical Assistance Program application. It is expected that through these
enrollment efforts there will be a reduction in the need for primary care resources and
that these resources will be redirected to other MCH system development and support
activities.
13
105 MCH Services
Interventions emphasize the reduction of risks (e.g. substance use/abuse; late or no
prenatal care; environmental and psychosocial stressors; nutritional needs; and family
violence and abuse) associated with poor pregnancy outcomes (e.g. premature
labor/delivery, low birth weight and infant death) and improvement in quality of life for
the mother, infant and family. Services include, but are not limited to the following and
are available during the first year post-delivery and beyond if indicated:
• Reproductive health services including
o Preconception counseling and referral as indicated
o Linkage to early comprehensive prenatal medical care
o STD testing and treatment
o Link to genetic counseling services
o Pregnancy testing, counseling and referrals as indicated
• Care coordination including
o Supplemental food and nutrition programs such as Women, Infants and
Children (WIC) nutrition program and the Commodity Supplemental Food
Program (CSFP)
o Healthy Start Home Visitor services
o High-risk infant case management
o Child health and safety information
o Community resource linkages
• Risk reduction & counseling including
o General health screens/assessments and treatment linkage
o Tobacco, alcohol and substance use cessation
o Healthy weight counseling
o Domestic violence referral assistance
o Identification of perinatal mood disorders
o Depression screening with mental health service linkage
o Prenatal classes
o Parenting classes
• Pediatric health services including
o Well-child health assessments
o Immunizations
o Child development and mental health screening
o Reduction of unintentional and intentional injuries
o Healthy weight guidance
o Parenting education with anticipatory guidance
o Mental health screening and referral as indicated
Enhanced services are available through the Well Women's Health Care and Family
Planning Program for pre-pregnancy counseling, infertility option education and annual
health screenings. The Well Women’s Health Care and Family Planning program
constitutes primary care for many of the clients served. A complete health history is
taken on each client followed by a physical assessment that may include a Pap smear,
urinalysis, screening for anemia, hypertension and abnormal conditions of the breast
and cervix as indicated. Pregnancy testing and appropriate counseling is available.
Information regarding early and continuous prenatal care is provided if the pregnancy
test and/or exam findings are positive for pregnancy.
Local family planning clinics also offer a variety of contraceptive methods including
abstinence. Instruction concerning effectiveness, proper use, indications/precautions,
14
risks, benefits, possible minor side effects and potential life threatening complications of
contraceptive methods is provided. Screening and treatment for sexually transmitted
diseases are a part of the initial and annual visits. Immunization status is routinely
addressed.
106 Qualified Workforce
Local agencies must recruit and retain qualified public health professionals to assure a
workforce that possesses the knowledge, skills and attitudes to meet unique MCH
population needs. Credentials of licensure and certifications must be current and in
good standing. Prior professional MCH service experience is helpful. Orientation to
providing MCH services is required for all staff hired to provide MCH services.
The Core Public Health Competencies are a set of skills desirable for the broad practice
of public health, reflecting the characteristics that staff of public health organizations
need as they work to protect and promote health in the community. The competencies
are designed to cover the essential services of assessment, policy development and
assurance. www.health.gov/phfunctions/public.htm
107 MCH Goal and Standards
The following MCH goals and standards are the framework for services to women and
their families. Each community has unique health needs and priorities. Each MCH
grantee must determine the needs of their community through a local needs
assessment process and assure that consideration is given to address health priorities
for Kansas.
Goal: Maternal and Child Health (MCH) services enhance the health of Kansans in
partnership with families and communities.
Standard 1: Community Needs Identification
Specific MCH program services provided by local agencies are to be determined by the
local grantees in collaboration with community partners/stakeholders of the MCH
population using information from a community need and resource assessment as a
basis for coordination, planning and evaluation.
•
Rationale:
An important element of public health infrastructure is the ability of local health
departments to assess and monitor the health of their community, to disseminate
timely information and to identify emerging threats.
The community assessment includes a current demographic, cultural and
epidemiological profile of the community to accurately plan for and implement
services that respond to the cultural and linguistic characteristics of the service
area. Public health professionals must effectively address health disparities of
racial/ethnic populations assuring services are culturally and linguistically
accessible during health priority setting, decision-making and program
development. Ensuring access to services based on community and regional
needs facilitates the provision of care to all childbearing women, their infants,
children, adolescents and families.
15
To learn more about community assessments, go to:
o Center for Disease Control and Prevention Assessment Initiative 1
www.cdc.gov/ncphi/od/AI/assessment.htm .
o Healthy People 2010. “Healthy People in Healthy Communities: A
Community Planning Guide Using Healthy People 2010.”2
www.healthypeople.gov/Publications/HealthyCommunities2001/default.ht
m
•
Local agency grantees:
o Identify, define and prioritize specific interventions addressing the specific
health care needs of the community.
o Ensure ongoing community involvement in the planning, implementation
and evaluation of the program.
o Ensure involvement of representatives of the cultural, racial, ethnic,
gender, economic and linguistic diversities within the community.
o Provide educational materials and services in a manner and format that
best meets cultural, linguistic, cognitive, literacy and accessibility needs of
the community.
o Move toward full compliance with the four mandated Culturally and
Linguistically Appropriate Service standards (CLAS).
www.omhrc.gov\\assets\\pdf\\checked\\finalreport.pdf
o Establish or maintain a committee of community partners/stakeholders
that advises on community MCH health issues.
o Work with other local, state and federal entities in the community to
develop a network of complementary services.
o Make every attempt to employ staff that is representative of the population
being served.
o Build systems of coordinated health care within your community and/or
region.
o Provide Translation/Interpreter services or have bilingual staff available
Standard 2: Infrastructure
Public health infrastructure is maintained to protect MCH population's health and safety,
provide credible information for better health decisions and promote good health
through a network of partnerships that works to achieve measureable improvements in
operational efficiencies and most importantly, to improve the quality of available health
care.
•
Rationale:
Public health infrastructure is defined as a complex web of practices and
organizations, public and private, governmental and nongovernmental entities
that provide services to the MCH population.
An important element of public health infrastructure is the ability of local health
departments to assess and monitor the health of their community, to disseminate
timely information and to identify emerging threats.
The client record and data system facilitates systematic, service integrated
documentation of care coordination and any direct service provided to all MCH
1
CDC Assessment Initiative http://www.cdc.gov/ncphi/od/AI/assessment.htm
Healthy People in Healthy Communities: A Community Planning Guide Using Healthy People 2010
http://www.healthypeople.gov/Publications/HealthyCommunities2001/default.htm
2
16
clients. A systematic, integrated method for documentation of assessments,
referrals, follow-ups and care coordination provided is the basis for an initial
client specific plan of care, need for modifications of the care plan and evaluation
of expected outcomes. Documentation should indicate evidence of health,
nutritional and psychosocial assessments and interventions, to include health
promotion, anticipatory guidance and risk-appropriate education.
Documentation serves as:
• Legal protection for the client and the health care provider
• Evidence of the client's response to care and recommendations
• Evidence of informed consent
• Communication methodology between providers
• A method for the evaluation of service methodologies through chart review
and quality assurance
Internet access, electronic collection of data and linkages between local, state
and federal data systems are important to data collection, analysis and program
evaluation activities.
•
3
Local agency grantees:
o Employ adequate staff members to address the identified needs of the
population to be served in the community.
o Establish written fiscal management policies and procedures that include,
but are not limited to: payment of debts, payroll, record keeping, auditing
and receivables/expenditures.
o Utilize sound accounting and business practice.
o Develop and implement the Disaster Response Framework with an explicit
emphasis on addressing the immediate and long-term physical and mental
health, educational, housing and human services recovery needs of
pregnant women, children and adolescents.
o Establish and implement reporting and billing systems including a sliding
fee scale for all clients receiving MCH billable services.
o Obtain income information from every client, document and updated at
least annually. The client’s income is used to determine the amount to be
charged for services or supplies on a sliding fee schedule of discounts.
o Establish and implement a sliding fee scale of discounted charges. Scale
must include at least four levels of reduced billing using the federal
Poverty Guidelines of income and number of people in the family. This
scale meets the low income guidelines for those who are eligible for free
or reduced charges for billable services. For information on Federal
Poverty Guidelines 3 go to http://aspe.hhs.gov/poverty/
o Establish a written fee collection policy which will be applied consistently
for all clients. The policy will include a list of reasonable efforts made to
collect outstanding client balances. Under no circumstances shall client
confidentiality be jeopardized.
o Utilize electronic data collection of client encounters and submit data
electronically to KDHE via KIPHS public health software, WebMCH
internet-based program associated with the KSWebIZ immunization
registry, or create a detailed flat file for electronic submission of required
Federal Poverty Guidelines http://aspe.hhs.gov/poverty/.
17
client visit record (CVR) encounter data elements utilizing an alternate
data collection software system.
o Provide adequate automation of data transmission systems to ensure
direct and timely communication to KDHE.
o Notify KDHE of any issues, concerns or questions regarding the MCH
program.
Standard 3: Outreach
Services are available for all women, children and adolescents; however, outreach
methods are employed to identify and reach the targeted low income and most at-risk
for poor outcomes in the MCH population to encourage their participation in MCH
program services and link them into Medical Home systems of care.
•
Rationale:
Poor outcomes are consistently related to selected risk factors that include
demographic, health, socio-economic and other barriers to care. Because each
community has unique socio-demographic factors, system factors, client factors,
health and environmental factors, outreach methods must be tailored to each
community. Barriers to MCH care must be identified and addressed with specific
strategies.
A priority should be placed on identifying and serving:
• Pregnant adolescents
• Families exposed to tobacco smoke in the household
• Families in which substances are used or abused
• Families exposed to violence and physical abuse
• Families that have a member with mental health issues
• Women and children at health, nutritional, or psychosocial risk and/or
experiencing barriers to care (e.g. financial, lack of providers)
• Families with a potential for not entering into and/or complying with health
care recommendations
• Those at risk for poor health outcomes
•
Local agency grantees:
o Review the service area data for who is and who is not accessing care;
communicate with hospitals, school and local medical providers; establish
linkages between SRS and other social, religious and community service
agencies; advertise program services; and develop referral systems and
strategies to create linkages to needed care.
18
o Provide direct outreach and family support from Kansas Healthy Start
Home Visitors or community health outreach staff to pregnant women at
high risk. Projects must ensure that the pregnant women and mothers with
infants have ongoing sources of primary and preventive health care and
that their basic needs (housing, psychosocial, nutritional and educational
and job skill building) are met.
o Utilize the Pregnant Women’s Medicaid that is sent to the local health
department monthly by KDHE to outreach high risk pregnant women.
o Demonstrate through staff job descriptions the designation of outreach
responsibilities to specific staff members.
o Provide home visits and other outreach methodologies in reaching
targeted pregnant women and mothers with infants eligible for MCH
service provision. See Healthy Start Home Visitor Services, page 69.
Standard 4: Care Coordination
Care coordination of services is provided to pregnant women, mothers and their infants,
children, adolescents and their families in accessing resources and reaching optimal
health outcomes.
•
Rationale:
Care coordination is a series of logical and appropriate steps and interactions
within service networks geared towards maximizing the opportunity for a client to
receive needed services in a supportive, timely and efficient manner. Care
coordination assures that parents understand the need to follow through with the
recommended referrals resulting from health screenings and assistance is
provided to reduce barriers in their accessing those services.
Nurses and social workers are particularly suited to provide care coordination
and case management to high risk pregnant women, children and their families.
Both nursing and social service embodies several elements of case
management: It is complex, highly interactive, facilitates client’s self-care
capability, teaches clients to navigate the health care systems and provides
environments which assist clients to gain or maintain health and promotes
efficient use of community resources.
Case management is a collaborative process of assessment, planning,
facilitation and advocacy for options and services to meet an individual’s health
needs through communication and available resources to promote quality, costeffective outcomes. The case manager serves as a liaison between the client,
the physician, other providers and the insurer/payer to identify what services
might also be needed and assists to coordinate all services and resources
necessary to promote the best level of well being and enhance communication
between all parties including the insurance company or health care payer.
Many families are unfamiliar with how to navigate the health care and community
service systems. Care Coordinators and Case Managers help families feel more
comfortable accessing services by modeling how to make appointments and get
needed services by phone, assure that they arrive at their appointed time and
reinforce that they follow the care instructions provided by the medical provider.
19
•
Local agency grantees:
o Work with local prenatal medical care providers to assure early entry (first
trimester) into early and adequate prenatal care.
o Use the results of the Comprehensive Health Risk Assessment as a
template to link families with available resources to address their identified
needs.
o Assist families to find solutions to barriers in accessing services (e.g.
telephone service, skill in appointment scheduling, transportation, time-off
work from employment to attend the appointment, fuel in car, tires inflated,
valid driver’s license, access to public transportation, etc.,)
o Reinforce and assess client understanding of provider’s recommendations
or care and treatment instruction following appointment.
o Teach families how to navigate the healthcare systems and use resources
available to them, including how to make appointments and keep
appointments, cancel appointments, understand their fiscal responsibilities
and how to complete any financial responsibilities in order to maintain
continued care.
Standard 5: MCH Service Team
MCH clients access a multidisciplinary team with expertise in health, nutrition and
psychosocial assessment and receive brief intervention with referral and linkage to the
provision of the required services based on the individual client's identified
problems/needs. Follow-up after referral to ascertain completion of health care services
improves utilization of available community resources to strengthen and support families
and their communities.
•
Rationale:
The MCH Service Team, a multidisciplinary compassionate, respectful and
innovative team, consists of three core areas: health, nutrition and psychosocial
care and support. The team, using an integrated approach to address these
components, completes a comprehensive assessment; brief intervention 4
including health education and risk reduction counseling; and initiate connection
with appropriate health and human services and links to resources, as indicated
by the assessment and family’ choice. The individual components of care should
not be provided in isolation, but collaboratively planned and provided. Risk
assessment, health promotion and development of a plan of care, early
intervention and linkage into systems of care with follow-up are activities that
should increase detection and/or prevention of risk factors that could negatively
affect the outcomes of the pregnancy for women, infants, children, adolescents
and family life.
4
Brief Intervention is defined here as recognizing a problem, or potential problem, as soon as possible
and mitigating the harm that the problem will cause. It includes creating opportunities to raise awareness,
share knowledge and support a person in thinking about making changes to improve their health.
20
•
Local agency grantees:
o Show evidence that the agency employs or contracts for MCH services
from staff with expertise in health, nutrition and psychosocial areas to
provide such professional expertise for assessment, evaluation and
facilitate client entry into the system of care for the three core areas.
o Show evidence that new hires receive orientation and that all staff are
given periodic on-going and annual professional development
opportunities regarding Title V concepts and services. Make revisions to
job descriptions as applicable.
o Provide staff with required training and opportunities to acquire
professional competencies to meet the needs of their MCH clients.
o Provide an initial nutrition (basic nutrition services) and on-going nutrition
assessments (at least one per trimester and one post partum) to all
pregnant women with referral to a registered/licensed dietitian if
determined to be nutritionally at high risk.
o Provide nutritional assessments and provide guidance to all children,
adolescents and their parents with referral to registered/licensed dietitian if
determined to be nutritionally at high risk.
o Provide an initial psychosocial screen for depression, ATOD use and
family violence on all new clients with on-going assessments (at least
once per trimester and once postpartum) until discharge to all pregnant
women, with referral to a licensed social worker for additional assessment
and interventions based on individual risks.
o Provide developmental and psychosocial assessments, ATOD exposure
and child abuse or maltreatment assessment of all children and
adolescents. Provide anticipatory guidance regarding health and safety
issues to all children, adolescents and their parents with referral to a
licensed social worker for additional assessment and interventions based
on individual identified risks.
Standard 6: Family-Centered Care
Provide MCH services with a family-centered focus of care and develop a Family Care
Plan (FCP) with the family in collaboration with the MCH team.
•
Rationale:
The family is defined as a “unique social group involving generational ties,
permanence and a concern for the total person, heightened emotionality, care
giving, qualitative goals, an altruistic orientation to members and a primarily
nurturing form of governance.” A family can be comprised of many different
configurations, not just a husband, wife and children. Vulnerable families are
those families who are unable to take full responsibility for a healthy lifestyle due
to poverty, substance abuse, mental illness or other factors. Children in these
families are susceptible to a high risk environment for detrimental behaviors.
These families should be supported by professionals through education,
assessment, intervention and follow up.
21
The FCP clearly defines the family’s goals, service content, frequency and
duration and responsibilities of the MCH team and the family in working toward
meeting the goals. The FCP is a working document, produced collaboratively by
program staff and the family members, that contains the agreed upon MCH
services. At a minimum the FCP should:
• Identify appropriate frequency of primary care visits within a Medical Home for
all family members/talking points that involve the family in their own care
• Identify the family’s social, emotional and physical health goals including
breastfeeding and nutrition, physical activity level and family activities
• Recognize each family is on an ever-changing journey of life-long learning
that begins with pregnancy and birth continuing through adulthood, where the
cycle starts again.
• Recognize what affects one member of the family impacts other members of
the same family in some way. Each family exists in the context of a greater
community and fosters these communities as resources for supports and
services.
•
Local agency grantees:
o Respect that every family has their own unique culture and MCH honors
the values of each family’s neighborhood, community and extended family
o Tailor support and services to each family to meet its own unique needs
and circumstances
o Work as equal partners with each family and with the people and service
systems in the family’s life
o Assist families in identifying a Medical Home that consists of a provider for
and a payer for any services rendered by the provider
o Inform of and assist families through the completion of the Medicaid and
HealthWave application process
Standard 7: Health Risk Assessment and Screening
Families served by the MCH program receive a complete and comprehensive health
risk assessment that includes family health history.
•
Rationale:
Gathering a family health history is the first step toward personalized preventive
health care. Targeted prevention approaches consist of identifying people at
increased risk of disease who can be offered more intensive intervention than is
recommended for the general population. Assessment of risk followed by
information/education and early intervention with regard to smoking, tobacco and
drug use, alcohol consumption, physical exercise, healthy eating and
management of weight, hypertension, diabetes and asthma are cost-effective
interventions.
22
The purpose of the Comprehensive Health Risk Assessment is to provide the
early identification of health needs and to link families to available community
services to prevent or mitigate poor health and/or developmental outcomes.
Population-based education and health promotion activities are instrumental in
reducing chronic diseases.
Bright Futures, 3rd Edition Guidelines5, the curriculum incorporates standards of
care recommended by AAP, CDC, Medicaid and other government and
professional organizations. Bright Futures is a set of principles, strategies and
tools that are theory based and systems oriented that can be used to improve the
health and well-being of all children through culturally appropriate interventions
that address the current and emerging health promotion needs at the family,
clinical practice, community, health system and policy levels.
•
Local agency grantees:
o Develop an approved screening process for all participants and refer to
other programs/funding sources as appropriate.
o Develop a working relationship with other programs to ease the referral
process for clients.
o Develop a referral system with effective follow-up for all screenings.
o Screen families for the use of Alcohol, Tobacco and Other Drugs (ATOD)
and provided education about the associated risks.
o Educate families about depression; provide screening and referral to
appropriate mental health providers.
o Educate families about health and safety in the home and community.
o Educate families about interpersonal violence; provide screening and
referral to community support and protective services.
o Educate parents and assess families for child abuse and neglect and
report suspected child abuse and neglect to Social and Rehabilitation
Services (SRS) appropriately.
Standard 8: Education and Prevention
Health education, anticipatory guidance and preventive health instruction and services
are available to families.
•
5
Rationale:
Basic to health education is a foundation of knowledge about the interrelationship
of behavior and health, interactions within the human body and the prevention of
diseases and other health problems. Experiencing physical, mental, emotional
and social changes as one grows and develops, provides a self-contained
"learning laboratory." Comprehension of health promotion strategies and disease
prevention concepts enables clients to become health literate, self-directed
learners and establishes a foundation of leading healthy and productive lives.
rd
Bright Futures, 3 Edition Guidelines
http://brightfutures.aap.org/3rd_Edition_Guidelines_and_Pocket_Guide.html
23
Prenatal health education should be included as a part of the comprehensive
plan of prenatal care coordination. This education should encourage a woman
and her support systems to participate in and share the responsibility for health
promotion and understand pregnancy as a normal state. Health education
enables a woman to learn the warning signs and symptoms of impending
preterm delivery.
Critical strategies to improve the health care provided children and adolescents
are to meet parents' informational needs and elicit their concerns in a systematic,
standard way. A primary component of well-child care is anticipatory guidance
and parental education (AGPE). Bright Futures Anticipatory Guidance Cards help
"cue" health professionals and families to review key developmental goals for
children and adolescents: confidence, success in school, responsibility and
independence. Other topics range from safety and healthy eating to fitness and
family relationships 6. The most reliable and valid approach to measure whether
parents informational needs are being met is to ask parents directly.
•
Local agency grantees:
o Adjust the level of and approach to providing health education to the
client’s need, current level of knowledge and understanding, utilizing
sensitivity to social, cultural, religious and ethnic resources, family
situation, coping skills, literacy level and economic background.
o Provide general health education for all of the MCH population. Provide
additional education for those with specific medical, nutritional and
psychosocial conditions and identified health risks.
o Provide reproductive health education and link family members’ access to
reproductive, primary and pediatric medical care and other community
services.
o Provide reproductive health education and counseling regarding the
benefits of birth spacing and information about STI/HIV prevention.
o Provide breastfeeding education and support services.
o Provide nutrition education and support services
o Inform and assist local business and industries in the community to
become workplace breastfeeding friendly.
Standard 9: Medical Home
Every pregnant woman, child/youth and family is assisted to establish and utilize a
Medical Home for access to basic primary health care.
•
6
Rationale:
The American Academy of Pediatrics (AAP) introduced the medical home
concept in 1967, initially referring to a central location for archiving a child’s
medical record. In its 2002 policy statement, the AAP expanded the medical
home concept to include these operational characteristics: accessible,
continuous, comprehensive, family-centered, coordinated, compassionate and
culturally effective care. A medical home is not a building, house, or hospital, but
rather an approach to providing comprehensive primary health care.
http://brightfutures.aap.org/3rd_Edition_Guidelines_and_Pocket_Guide.html
24
In a medical home, a physician or medical provider works in partnership with the
family/patient to make sure that all of the medical and non-medical needs of the
patient are met. Through this partnership, the doctor can help the family/patient
access and coordinate specialty care, educational services, out-of-home care,
family support and other public and private community services that are
important to the overall health of the pregnant woman, child/youth and family.
The public health role is to assist individuals and families without identified
medical homes. Families will be assisted in selecting a medical home, applying
for insurance and securing payer assistance for which they may qualify. Families
will be taught to navigate the health care system and partner with physicians and
medical providers to assure that all available community resources are known
and utilized appropriately.
It is important to let the medical home doctor or other primary care provider know
about any medical or health related services the individual is receiving. The
medical home provider needs to know this in order to provide comprehensive
primary care, advice to the family, assure care coordination and serve as the
central repository for all medical and health related records for the individual and
family.
•
Local agency grantees:
o Convene a county-based Medical Home Leadership Group of physicians,
medical providers and community public and private resource partners.
o Develop community resource lists and package them in formats appealing
to busy medical offices
o Work with local community and regional medical providers to accept
individuals and families into primary health care services and to serve as
their medical home.
o Assist uninsured individuals and families to complete the
Medicaid/HealthWave application.
o Problem-solve situations with families that many doctors' offices do not
have the time or knowledge to do.
o Serve as care coordinator for high risk families.
o Provide direct medical services only if there are no medical providers in
the region.
o Coach and encourage families to ask questions, document symptoms,
voice their needs and priorities, provide feedback and otherwise develop
an effective medical home partnership with the primary care provider and
other health care providers.
o Educate families about early intervention and school and community
services.
o Support medical homes by providing or assisting to provide care
coordination and family support and education. Public Health staff is often
the single best source of up-to-date information about what services are
available locally and the exact steps needed to access them.
25
108
•
•
•
•
•
•
•
•
•
•
References:
American Academy of Pediatrics (AAP) www.aap.org/
American Academy of Family Physicians (AAFP)
www.aafp.org/online/en/home.html
American College of Obstetricians and Gynecologists ACOG) www.acog.org/
Association of State and Territorial Health Officials (ASTHO) www.astho.org/
Bright Futures, Georgetown University, promoting and improving the health,
education and well-being of the children and adolescents and their families.
www.brightfutures.org/
Center for Disease Control and Prevention (CDC) www.cdc.gov/
Children, Youth and Families Health Services Manual, KDHE, Jan. 1993, First
Edition. Vol. 1, 2 & 3.
Maternal and Child Health Bureau (MCHB) www.mchb.hrsa.gov/
National Academy for State Health Policy (NASHP) www.nashp.org/index.cfm
National Association of County and City Health Officials (NACCHO)
www.naccho.org/topics/infrastructure/index.cfm
26
150 - MCH BACKGROUND
Table of Contents
151 - Title V Block Grant to States
152 - Maternal and Child Health
153 - MCH (Title V) Funding
154 - State 5 Year Needs Assessment
155 - MCH Performance and Accountability
156 - MCH Performance Measures
157 - Criteria for MCHB Performance Measures
158 - 18 National Performance Measures (2006)
159 - 6 MCH Outcome Measures
160 - Kansas 9 State Performance Measures (2005)
161 - Core Public Health Services Provided by MCH Agencies
162 - Local Core Public Health Services for the Prenatal Population
163 - Local Core Public Health Services for Children and Adolescent Populations
164 - Local Core Public Health Services for Children and Youth with Special Health
Care Needs
165 - MCH Essential Public Health Services
166 - Essential Public Health Services to Promote Maternal and Child Health in America
27
151 Title V Block Grant to States
Title V of the Social Security Act is one of the largest Federal block grant programs with
“states and territories program[ming] their MCH investments to meet their specific needs
. . . [conducting] surveys and analyze data to determine where they can have the most
impact and need the most resources to address MCH problems and challenges”
(AMCHP, 2010, p. 4). It leads the nation in ensuring the health of all mothers, infants,
children, adolescents and children and youth with special health care needs.
To learn more about the history and general overview of the block grant, please refer to
the referenced publication:
Association of Maternal and Child Health Programs (AMCHP). (2010). 75 years of the
Title V maternal and child health block grant: celebrating the legacy, shaping the future.
AMCHP.ORG: Washington, DC. www.amchp.org/AboutTitleV/Documents/Celebratingthe-Legacy.pdf
152 Maternal and Child Health 7
Maternal and Child Health (MCH) is “the professional and academic field that focuses
on the determinants, mechanisms and systems that promote and maintain the health,
safety, well-being and appropriate development of children and their families in
communities and societies in order to enhance the future health and welfare of society
and subsequent generations” (Alexander, 2004).
MCH public health is distinctive among the public health professions for its lifecycle
approach. This approach integrates theory and knowledge from multiple fields including
human development, as well as the health of women, children and adolescents. MCH
professionals are from diverse backgrounds and disciplines, but are united in their
commitment to improving the health of women and children. However, to meet this
ambitious goal, it is essential that MCH professionals work with a broad group of other
professionals and organizations.
The MCH program is required by law to serve as a gap-filling provider for families
served through the Medicaid program. A partnership exists between the Maternal Child
Health Services and Medicaid to serve high risk families. The Maternal and Child Health
(MCH) Services Block Grant and Medicaid, authorized by Title V and Title XIX of the
Social Security Act (SSA), serve complimentary purposes and goals. Coordination and
partnerships between the two programs greatly enhance their respective abilities,
increase their effectiveness and guard against duplication of effort. Such coordination is
the result of a long series of legislative decisions that mandate the two programs to
work together.
Interagency Agreements (IAAs), required by both Title V and Title XIX legislation, serve
as key factors in ensuring coordination and mutual support between the agency that
administers the two programs. The Division of Health Care Finance at KDHE
coordinates with the Title V MCH program to ensure mutual support of programs and
services for Medicaid eligible children and families. The IAA exists between the Title V
MCH program and the Kansas Medicaid program to receive the contact information of
pregnant Medicaid women to enable MCH services to extend outreach and family
support to this high-risk population.
7
Adapted from the Introduction to MCH 101 in-depth module at the HRSA MCH Timeline.
www.mchb.hrsa.gov/timeline/.
28
153 MCH (Title V) Funding
The Maternal and Child Health Bureau (MCHB) 8 within HRSA administers the Maternal
and Child Health Services Block Grant (Title V). Every year Kansas joins other states
and territories in submitting an application to the Maternal and Child Health Bureau
(MCHB) of the Health Resources and Services Administration (HRSA) for MCH funding.
Applications for funding must include:
• Needs assessment and priorities
• Measurable outcomes
• Budget accountability
• Documentation of matching funds
• Maintenance of efforts
• Public input
Each state receives an amount based on the proportional number of children in poverty
according to the U.S. Census. As poverty levels improve or worsen within states,
funding amounts to states fluctuate. “Federal investment is matched by the state or
territory . . . [with] every four dollars in federal funding appropriated by Congress . . .
match[ed] three dollars with state revenue” (AMCHP, 2010, p. 4). Accountability for
funds and outcomes measures is part of the Title V Information System (TVIS) available
at https://perfdata.hrsa.gov/MCHB/TVISReports/default.aspx.
In Kansas, Title V funds are primarily distributed to county health departments or local
agencies to provide services for mothers and children. The amount is calculated using a
funding formula. Each year the recipient health departments complete a plan that
indicates how they will use the funding to address documented MCH needs within their
community. To assist agencies in the planning process, the state provides county
specific data from the Office of Health Assessment in reports and analysis. The Kansas
Information for Communities (KIC) allows data users to perform special analyses by
county, sex, race, age group and in many instances Hispanic origin
www.kdheks.gov/hci/index.html. State MCH program staff with expertise in various
aspects of MCH is available to provide technical assistance as needed.
154 State 5 – Year Needs Assessment
Every five years, Kansas completes an in-depth MCH needs assessment and prepares
a grant to receive federal Title V funding. For the next four years, an annual grant is
submitted to MCHB providing an update on progress made and plans for the coming
year based on the selected goals and priorities.
During the fall of 2009 and spring of 2010, over 60 Expert Panelists participated in MCH
2015 and identified priority needs for each of the three MCH population groups:
Pregnant Women and Infants, Children and Adolescents and Children and Youth with
Special Health Care Needs. “MCH 2015 brought together health care professionals,
families and other leaders to work on ways to improve the health of Kansas women and
children. . . Ten priorities were selected for the five year period 2011 through 2015”
(MCH2015, 2010, no page number). The goals and priority needs identified by the
Expert Panelists are as follows:
8
Maternal and Child Health Bureau. www.mchb.hrsa.gov/about/overview.htm
29
GOAL: To enhance the health of Kansas women and infants across the
lifespan
1. All women receive early and comprehensive health care before, during
and after pregnancy
2. Improve mental health and behavioral health of pregnant women and new
mothers
3. Reduce preterm births (including low birth weight and infant mortality)
4. Increase initiation, duration and exclusivity of breastfeeding
GOAL: To enhance the health of Kansas children and adolescents across
the lifespan
5. All children and youth receive health care through medical homes
6. Reduce child and adolescent risk behaviors relating to alcohol, tobacco
and other drugs
7. All children and youth achieve and maintain healthy weight
GOAL: To enhance the health of all Kansas children and youth with special
health care needs across the lifespan
8. All CYSHCN receive coordinated, comprehensive care within a medical
home
9. Improve the capacity of YSHCN to achieve maximum potential in all
aspects of adult life, including appropriate health care, meaningful work
and self-determined independence
MCH2015 represents only the first steps in a cycle for continuous improvement of
maternal and child health. Between 2010 and 2015, actions and strategies will be
implemented, results will be monitored and evaluated and adjustments will be made as
necessary to continue to enhance the health of Kansas women, infants and children.
The process will be repeated beginning in 2014 to plan for actions and strategies for
2015-2020. To view the complete MCH 2015 Final Report and results, go to
www.datacounts.net/mch2015/default.asp
155 MCH Performance and Accountability
MCH Programs are accountable for continually assessing needs, assuring that services
are provided to the MCH population and developing policies consistent with needs.
MCH public health professionals are accountable to the public and to policymakers to
assure that public dollars are being spent in a way that is aligned with priorities. Some
of the factors for which MCH is accountable include: the core public health functions
outlined by Centers for Disease Control and Prevention National Public Health
Performance Standards Program (NPHPSP)9; collecting and analyzing health data;
developing comprehensive policies to serve the MCH population; and assuring that
services are accessible to all.
156 MCH Performance Measures
A number of tools and measures have been developed to measure performance and
document accountability. The MCHB uses performance measurement and other
program evaluation to assess progress in attaining goals, implementing strategies and
addressing priorities. Evaluation is critical to MCHB policy and program development,
program management and funding. Findings from program evaluations and
9
Centers for Disease Control and Prevention (CDC). (9 December 2010). 10 essential public health
services. www.cdc.gov/nphpsp/essentialServices.html
30
performance measurement are part of the ongoing needs assessment activities of the
Bureau.
At the state level, the MCHB performance and accountability cycle begins with a needs
assessment that includes reporting on health status indicators. Analysis of these data
and other information leads to the identification of priority needs. MCH performance and
outcome measures are developed to address those needs and resources are allocated.
Program implementation, ongoing monitoring and evaluation follow.
Currently the MCH Program reports on 18 National Performance Measures, 9 State
Performance Measures, 6 Outcome Measures, 16 Health Systems Capacity Indicators
and 11 Health Status Indicators. Federal MCH Program staff, states and other grantees
jointly developed these consensus measures. In addition to the national performance
measures, states develop and report on state priority needs and performance
measures. Results of all measures can be found in the Title V Information System
(TVIS) at http://mchb.hrsa.gov/training/performance_measures.asp
157 Criteria for MCHB Performance Measures
State MCH Performance measures must be relevant to major MCHB priorities,
activities, programs and dollars. The measures should be prevention focused, important
and understandable to MCH partners, policymakers and the public with logical linkage
from the measure to the desired outcome.
Performance measures help to quantify whether:
• Capacity was built or strengthened
• Processes or interventions were accomplished
• Health status was improved
158 18 National Performance Measures (2010)
1. The percent of screen positive newborns who received timely follow up to
definitive diagnosis and clinical management for condition(s) mandated by their
State-sponsored newborn screening programs.
2. The percent of children and youth with special health care needs age 0 to 18
whose families partner in decision-making at all levels and are satisfied with the
services they receive. (CYSHCN Survey)
3. The percent of children and youth with special health care needs age 0 to 18 who
receive coordinated, ongoing, comprehensive care within a medical home.
(CYSHCN Survey)
4. The percent of children and youth with special health care needs age 0 to 18
whose families have adequate private and/or public insurance to pay for the
services they need. (CYSHCN Survey)
5. The percent of children and youth with special health care needs age 0 to 18
whose families report the community-based service system are organized so
they can use them easily. (CYSHCN Survey)
6. The percentage of youth with special health care needs who received the
services necessary to make transitions to all aspects of adult life, including adult
health care, work and independence. (CYSHCN Survey)
7. Percent of 19 to 35 month olds who have received full schedule of age
appropriate immunizations against Measles, Mumps, Rubella, Polio, Diphtheria,
Tetanus, Pertussis, Haemophilus Influenza, Hepatitis B.
8. The rate of birth (per 1,000) for teenagers aged 15 through 17 years.
31
9. Percent of third grade children who have received protective sealants on at least
one permanent molar tooth.
10. The rate of deaths to children aged 14 years and younger caused by motor
vehicle crashes per 100,000 children.
11. The percent of mothers who breastfeed their infants at six months of age.
12. Percentage of newborns that have been screened for hearing before hospital
discharge.
13. Percent of children without health insurance.
14. Percentage of children, ages two to five years, receiving WIC services that have
a Body Mass Index (BMI) at or above the 85th percentile.
15. Percentage of women who smoke in the last three months of pregnancy
16. The rate (per 100,000) of suicide deaths among youths age 15-19.
17. Percent of very low birth weight infants delivered at facilities for high-risk
deliveries and neonates.
18. Percent of infants born to pregnant women receiving prenatal care beginning in
the first trimester.
159
1.
2.
3.
4.
5.
6.
6 MCH Outcome Measures
The infant mortality rate per 1,000 live births
The ratio of the black infant mortality rate to the white infant mortality rate
The neonatal mortality rate per 1,000 live births
The postneonatal mortality rate per 1,000 live births
The perinatal mortality rate per 1,000 live births, plus fetal deaths
The child death rate per 100,000 children aged one through 14
160 Kansas 10 State Performance Measures (2015)
Kansas-specific measures reflect local concerns that arise from a state needs
assessment, required and completed every five years.
1. Percent of women in their reproductive years with adequate information and
supports to make sound decisions about their health care (text4baby)
2. Percent of women who report cigarette smoking during pregnancy (birth
certificate)
3. Percent of live births that are born preterm <37 weeks gestation (birth certificate)
4. Percent of infants exclusively breastfed at least six months
5. Percent of children who receive care in a medical home as defined by the AAP
(National Survey of Child Health)
6. Percent of students who had at least one drink of alcohol on at least one day
during the 30 days before the survey (Youth Risk Behavior Survey)
7. Percent of [WIC] children who are overweight (PedNSS)
8. Percent of CYSHCN who receive care in a medical home as defined by the
American Academy of Pediatrics (AAP) (National Survey of Child Health)
9. CYSHCN whose doctors usually or always encourage development of age
appropriate self management skills (National Survey of Children and Youth with
Special Health Care Needs)
10. Percent of CYSHCN families that experience financial problems due to the child's
health needs (National Survey of Children and Youth with Special Health Care
Needs)
32
161 MCH 10 Essential Services
The MCH program has identified 10 essential services that serve as the guide for
services to families:
1. Assessment and monitoring of maternal and child health status to identify and
address problems.
2. Diagnosis and investigation of health problems and health hazards affecting
women, children and youth.
3. Information and education to the public and families about maternal and child
health issues.
4. Mobilizing community partnerships between policy makers, health care providers,
families, the general public and others to identify and solve maternal and child
health problems.
5. Providing leadership for priority setting, planning and policy development to
support community efforts to assure the health of women, children, youth and
their families.
6. Promotion and enforcement of legal requirements that protect the health and
safety of women, children and youth and ensuring public accountability for their
well-being.
7. Linking women, children and youth to health and other community and family
services and assure quality systems of care.
8. Assuring the capacity and competency of the public health and personal health
work force to effectively address maternal and child health needs.
9. Evaluation of the effectiveness, accessibility and quality of personal health and
population-based maternal and child health services.
10. Support for research and demonstrations to gain new insights and innovative
solutions to maternal and child health related problems.
www.amchp.org/programsandtopics/CAST-5/Documents/MCH.pdf
33
MCH Services Pyramid
MCH federal, state and other professionals developed the MCH Pyramid to provide a
conceptual framework of the variety of MCH services provided through the MCH Block
Grant. The pyramid includes four tiers of services for MCH populations. The model
illustrates the uniqueness of the MCH Block Grant, which is the only federal program
that provides services at all levels of the pyramid. These services are direct health care
services (gap filling), enabling services, population-based services and infrastructure
building services. Public health programs are encouraged to utilize their funding to
provide more of the community-based services associated with the lower-level of the
pyramid and to engage in the direct care services only as a provider of last resort.
MCHB/OSCH
Revised 10/1/99
34
•
Direct Health Care Services
Direct health care services are generally delivered “one on one” between a
health professional and a patient in an office, clinic or emergency room setting.
Basic services include what most consider ordinary medical care: inpatient and
outpatient medical services, allied health services, drugs, laboratory testing, x-ray
services, dental care and pharmaceutical products and services. State Title V
programs may support services such as prenatal care, child health (including
immunizations and treatments or referrals), school health and family planning, by
directly operating programs or by funding local providers where gaps exist in
communities related to these services. For CYSHCN, these services include
specialty and subspecialty care.
•
Enabling Services
Enabling services are defined as services that allow or provide for access to and
the derivation of benefits from the array of basic health care services. Enabling
services include transportation, translation, outreach and respite care, home
visiting health education, family support services (e.g., parent support groups,
family training workshops, nutrition and social work) and purchase of health
insurance, case management and coordination of care with Medicaid, State
Children’s Health Insurance (SCHIP) and WIC. These kinds of services are
especially necessary for low-income, disadvantaged and geographically or
culturally isolated populations and for those with special and complicated health
needs.
•
Population-Based Services
Population-based services are defined as services that are developed and
available for the entire population of the state, rather than in a one-on-one
situation. Disease prevention, health promotion and statewide outreach are major
components. Common among these services are newborn and genetic
screening, lead screening, immunizations, oral health, injury prevention, outreach
and public health education. Population-based services are generally available
for women and children regardless of whether they receive care in the public or
private sector or whether or not they have health insurance.
•
Infrastructure Building Services
Infrastructure building services are defined as those services that are directed at
improving and maintaining the health status of all women and children by
providing support for development and maintenance of comprehensive health
service systems, including standards/guidelines, training, data and planning.
Needs assessment, coordination, evaluation, policy development, quality
assurance, information systems, applied research, development of health care
system standards and systems of care are all contained within the infrastructure
umbrella.
35
162
Local Core MCH Public Health Services for the Perinatal Population
•
Direct Services
o Provision of Perinatal Care Services (gap-filling)
•
Enabling Services
o Medicaid/HealthWave Information and Outreach
o Translation and Transportation Services
o Prenatal Care/Resources, Referrals and/or Care Coordination
o Client Health Education regarding Breastfeeding, Seat Belts,
Immunization, Prenatal Weight Gain and Smoking Cessation
•
Population-Based Services
o Public Education/Social Marketing Campaigns related to Prenatal Weight
Gain, Smoking Cessation and other Health Behaviors
o Unintended Pregnancy Prevention Projects
o Breastfeeding Promotion Campaign
o Medicaid/SCHIP Countywide Outreach
o Emergency Preparedness
•
Infrastructure Building
o Community Needs Assessment, Planning and Evaluation
o Policy Development
o Monitoring and Quality Assurance
o Coalition Leadership and Collaboration
o Perinatal Periods of Risk Analysis
o Prenatal/Prenatal Plus/PRAMS Data Collection and Analysis
o Training Providers and Professionals
36
163 Local Core MCH Public Health Services for Children and Adolescent
Populations
•
Direct Services
o Well Child Care for Uninsured Children (gap filling)
o Immunization Clinics (gap filling)
•
Enabling Services
o Health Education regarding Breastfeeding, Seatbelts, Immunization,
Smoking Cessation, etc.
o Medicaid/HealthWave Information and Eligibility
o Translation Services
o Transportation Health Care Resources, Referrals and/or Care
Coordination
o Client Health Education re: Pregnancy Prevention, Fitness, Nutrition,
Motor Vehicle Safety, Immunizations, Substance Abuse
•
Population Based Services
o Breastfeeding Promotion Campaign
o HealthWave County-wide Outreach
o Public Education/Social Marketing related to Child Abuse Prevention,
Injury Prevention, Importance of immunizations
o Car Seat Safety Checks
o Working with Schools to improve Nutrition, Fitness and Health Education
o Emergency Preparedness
•
Infrastructure Services
o Community Needs Assessment, Planning and Evaluation
o Policy Development
o Quality Assurance (working with private immunization providers and child
care providers)
o Coalition Leadership and Collaboration
o Collaborate with School Health Team and Early Childhood Specialists to
identify and plan to address unmet community needs
o Monitoring and Quality Assurance
o Training MCH staff, Parents and Community Professionals
37
164 Local Core MCH Public Health Services for Children and Youth with Special
Health Care Needs
•
Direct Services
o Provision of Specialty Care in HCP Specialty Clinics (gap filling)
o Diagnostic Services in Diagnostic and Evaluation (D&E) Clinics (gap
filling)
•
Enabling Services
o Family Advocacy and Support
o Health Consultation for Medical Home, Specialty Care, Transition to Adult
Health Care, Early Intervention and School Services.
o Individual and Family Care Coordination Services Health Care Resources,
Referrals and Care Coordination for CYSHCN, Families and Providers
o Medicaid/HealthWave Information and Outreach
•
Population Based Services
o Follow-up of Newborn Hearing Screening
o Tracking and monitoring for Children and Youth with Special Needs
(CYCSN) Medicaid/HealthWave+/Supplemental Security Income (SSI)
Outreach
o Public and Provider Education – Medical Home, Newborn Hearing
Screening, Early Vision Screening, Developmental Screening (including
mental and emotional)
o Training Families, Community Partners and Providers
o Emergency Preparedness
•
Infrastructure Services
o Community Needs Assessment, Planning & Evaluation
o Interagency Leadership and Collaboration – Medical Home, Community
Systems, Early Intervention, Insurance, EPSDT, Respite, Diagnostic and
Evaluation (D&E) Services, Developmental Screening and Transition to
Adult Health
o Assist State in Development of Information Systems
o Health Care Program (HCP) uses the Clinical Health Information Record
of Patients (CHIRP) Data Collection and Local Data Analysis
o Monitoring and Quality Assurance
38
200 - Social Determinants of Health in Kansas
Table of Contents
201 - Description of Social Determinants
202 - Resources
39
201 Description of Social Determinants
The resources we have available throughout our lives from pre-birth to old ageeducation, family income, jobs we hold-influences the quality of our lives and our health
outcomes. Community, family, neighborhood, and school environments shape our early
development. Along with the work environments we enter as adolescents and young
adults, these factors continue to influence the way that adulthood and old age unfold
("Reaching for a Healthier Life: Facts on Socioeconomic Status and Health in the US"
John D. and Catherine T. MacArthur Foundation Research Network on Socioeconomic
Status and Health).
These determinants of health (often referred to as social determinants of health) are a
combination of many factors that affect the health of individuals and communities.
Where we live, learn, work and play has considerable impact on health although most of
our funding is concentrated on health care services (access and use).
www.healthequityks.org/health_determinants.html
202 Resources
Access to Health Care/Insurance
Kansas Association for the Medically Underserved (KAMU)
This agency promotes access to high quality, culturally sensitive, comprehensive
and cost-effective primary health care services for the medically underserved in
the state, regardless of an individual's ability to pay. Resources for primary care
providers, including data and practice resources can be found at
www.kspca.org/index.php?option=com_content&view=article&id=80&Itemid=37
Kansas Action for Children (KAC). Kansas KIDS COUNT Data.
KAC provides Kansas data for the Annie E. Casey KIDS COUNT Databook,
published annually. Kansas specific data can be found at
www.kac.org/kac.aspx?pgID=886
KDHE Center for Health Equity.
Reports on this site utilize the best available knowledge to point to concrete steps
that can be taken to improve health. www.healthequityks.org/index.html
Health Insurance Coverage
HealthWave 19 (Medicaid)/HealthWave 21(State Children’s Health Insurance
Program (SCHIP)
Medicaid and HealthWave qualifications and applications are available on the
website for The Division of Health Care Finance: www.kdheks.gov/hcf/
Housing/Assistance Programs
Temporary Assistance for Needy Families (TANF) or the Successful Families
Program
Successful Families is an employment support program for families with children
funded by a federal block grant (Temporary Assistance to Needy Families or
TANF) and state maintenance of effort funds. Besides providing basic cash
benefits for support and maintenance, services provided include job readiness
training, job retention training, subsidized employment, structured job search,
vocational education, intensive case management, work experience and
community service placement, on-the-job training, job coaching, job development
40
and placement, mentoring, and job skills training.
www.srs.ks.gov/agency/FingertipFacts/Pages/EES/SuccessfulFamilies.aspx
Income and Employment
Kansas Works
KANSASWORKS - your best source for posting and finding jobs in the state of
Kansas. Whether you're looking for that perfect job, that perfect employee or
information on an industry or workforce, KANSASWORKS is for you. Search and
apply for jobs across the state at KANSASWORKS.com.
Kansas Social and Rehabilitation Services (SRS)
This site provides links to services, office locations and applications.
www.srs.ks.gov/Pages/Default.aspx
Nutrition Assistance Programs
Family Nutrition Program (FNP), Kansas State University
This program offers nutrition education for Kansans of all ages that receive or are
eligible to receive food assistance. FNP is implemented by Kansas State
Research and Extension with the sponsorship of SRS and U.S. Department of
Agriculture (USDA). www.humec.ksu.edu/fnp/
Food Stamps or Supplemental Nutrition Assistance Program (SNAP), U.S.
Department of Agriculture (USDA)
As of Oct. 1, 2008, Supplemental Nutrition Assistance Program (SNAP) is the
new name for the federal Food Stamp Program. SNAP offers educational
resources for families on obtaining food and using foods. Food Assistance and
Nutrition Program, provided by the USDA provides Food Stamp benefits for lowincome households who qualify. It also provides education on food preparation
and nutrition to these families. This program is meant to provide low income
households with access to a healthy, nutritious diet and serves as the first line of
defense against hunger. Contact the SRS hotline at 1-888-369-4777 for
information. www.srs.ks.gov/services/Pages/FoodAssistance.aspx
Kansas Nutrition and WIC Services
This program administers one USDA funded program, the Special Supplemental
Nutrition Program for Women, Infants and Children (WIC). This program provides
nutrition education and supplemental foods to income eligible Kansas women
who are pregnant, postpartum or are breastfeeding. Services are also provided
to infants and children. www.kansaswic.org/
The Economic and Employment Support (EES) Food Assistance
Formerly known as the Food Stamp Program, the Food Assistance Program
serves as the first line of defense against hunger. It provides crucial support to
elderly households, low-income working households, other low income
households including those unemployed or disabled and to households
transitioning from welfare to work. Food assistance customers can spend their
benefits to buy eligible nutritious food and plants and seeds to grow food for their
household to eat.
www.srs.ks.gov/agency/ees/Pages/Food/FoodAssistance.aspx#program
overview.
41
250 - Guidelines for Bright Futures® and the
Medical Home Model
Table of Contents
251 - Description of Medical Home
252 - Program Goal and Outcome Objectives for MCH 2015
253 - Bright Futures® and the Medical Home Model
254 - Medical Home Defined
255 - Resources
256 - References
42
251 Description of Medical Home
The American Academy of Pediatrics definition of a medical home combines place,
process and people. It is not a building, house or hospital, but rather an approach to
providing comprehensive primary care. A medical home represents an approach to
pediatric health care in which a trusted physician partners with the family to establish
regular ongoing care. www.aap.org
252 Program Goal and Outcome Objectives for MCH 2015
Families need to have a regular source of healthcare in a medical home to receive
services that are family-centered, community-based, collaborative, comprehensive,
flexible, coordinated and culturally competent and developmentally appropriate. With a
medical home, early identification and intervention for children may improve health
outcomes. Therefore, the goal for child health is for children and their families to have
an identified Medical Home that consists of a provider as a regular source of care and
an identified payer source. www.datacounts.net/mch2015/cyshcn.asp
253 Bright Futures® and the Medical Home Model
The Kansas Maternal and Child Health program encourages providers to utilize the
American Academy of Pediatrics periodicity schedule, Recommendations for Preventive
Pediatric Health Care and Bright Futures: Guidelines for Health Supervision of Infants,
Children and Adolescents as guides for provision of health services. The guidelines
describe Bright Futures as:
“A set of principles, strategies and tools that are theory-based, evidence-driven
and systems-oriented that can be used to improve the health and well-being of all
children through culturally appropriate interventions that address their current
and emerging health promotion needs at the family, clinical practice, community,
health system and policy levels” (Hagan J.F., Shaw J.S., & Duncan P.M., 2008,
p. ix).
254 Medical Home Defined
The Medical Home concept in Kansas was adopted by the State legislature by passing
Sub. SB 81 (New Section 13) which defined the medical home in statute:
“Medical home means a health care delivery model in which a patient establishes
an ongoing relationship with a physician or other personal care provider in a
physician-directed team, to provide comprehensive, accessible and continuous
evidence-based primary and preventive care and to coordinate the patient’s
health care needs across the health care system in order to improve quality and
health outcomes in a cost effective manner” (KHPA, 2008).
43
255 Resources
American Academy of Pediatrics Kansas Medical Home
This site is specific for Kansas and includes contacts, resources and initiatives
related to the concept of a Medical Home to assist with meeting the special
health needs of children and their families.
www.medicalhomeinfo.org/states/state/kansas.html
American Academy of Pediatrics’ National Center of Medical Home Initiatives for
Children and Youth with Special Healthcare Needs
Resources and information regarding Medical Homes is available including links
to state-level and national initiatives. www.medicalhomeinfo.org/ .
Kansas Health Policy Authority (KHPA)
KHPA’s mission states, “KHPA shall develop and maintain a coordinated health
policy agenda that combines the effective purchasing and administration of
health care with promotion oriented public health strategies.” KHPA is
responsible for coordinating a statewide health policy agenda that incorporates
effective purchasing and administration with health promotion strategies,
including publicly funded programs (Medicaid, State Children’s Health Insurance
Program and Medikan) and the State Employee Health Benefits Plan
(SEHBP). An important component of this agency’s work revolves around the
Medical Home Concept. www.khpa.ks.gov/default.htm
256
References
Hagan J.F., Shaw J.S., & Duncan P.M. (2008). Bright Futures: Guidelines for
Health Supervision of Infants, Children and Adolescents, Third Edition. Elk Grove
Village, IL: American Academy of Pediatrics.
44
300 - MCH Administrative Manual
Fiscal/Grant Management
Table of Contents
301 - Grant Application
302 - Contracts and Subcontracts
303 - Contract Revisions
304 - Budgets
305 - Documentation of Local Match
306 - Financial Accountability
307 - Fiscal Record Retention
308 - Narrative Reports
309 - Inventory or Capital Equipment
310 - Income
311 - Data Collection
312 - Schedule
313 - Monitoring
314 - Evaluation
45
301 Grant Applications
The Aid-To-Local grant process within the Kansas Department of Health and
Environment (KDHE), the Bureau of Community Health Systems (BCHS) together with
the Bureau of Family Health solicit proposals at the community level for several different
programs. The Maternal and Child Health (MCH) program is the only program
discussed in this manual.
In January of each year, the Grant Application Guidelines and Grant Reporting are
available on the BCHS website: www.kdheks.gov/doc_lib/index.html.
•
Instructions - Access how to assemble the Aid-To-Local Grant at:
www.kdheks.gov/doc_lib/MaternalAneChildHealthServices.html
•
Match - Local matching funds must be equal to or greater than 40 percent of the
grant funds requested and awarded. Local program revenues may be utilized to
meet the match requirement.
•
Local MCH Services - Applicants should adhere to a service plan that utilizes 50
percent of the funds for services to pregnant women and infants and 50 percent
for children and adolescent services.
•
Submission Instructions:
Electronically submit the grant application no later than March 15 to Patricia
Behnke [email protected]
Kansas Department of Health & Environment
Bureau of Community Health Systems
Curtis State Office Building
1000 SW Jackson Ave, Suite 340
Topeka, KS 66612
•
Continuation Grants: Highest priority is to continue funding of local agencies
that demonstrate progress toward specific objectives, meet program
requirements and participate in education updates. A second priority is to provide
funding equal to at least 90 percent of the previous year’s award and to allocate
the remaining 10 percent based on performance/need data.
•
New Grants: Awards for new projects are subject to the availability of funds and
community needs assessment.
302 Contracts and Subcontracts
Contracts are issued for one-year periods based on review of the application, contract
agency performance and compliance with both general and special conditions of the
contract.
• Universal Contract
KDHE Aid-To-Local Program
1. Disclose personal health information (PHI) to the State Agency as requested
or as required by law [45 C.F.R. 165.512(b)] unless disclosure is prohibited by
the Health Insurance Portability and Accountability Act (HIPAA).
2. Comply with all relevant federal requirements.
46
3. Comply with statutes, rules and regulations pertaining to public health,
including but not exclusively K.S.A. 65-101 et seq.
4. The Local Agency, its agents or subcontractors, shall provide services which
have meaningful access to persons with Limited English Proficiency (LEP)
pursuant to Title VI of the Civil Rights Act [(42.U.S.C. 2000d et seq.) and 45
C.F.R. 80.3(b)].
•
Contract Attachment #17
Specific guidelines to MCH grant requirements.
•
Notice of Grant Award Amount and Summary of Program Objectives.
Grantee will be asked to submit a revised final budget for the amount awarded.
Awarding Funds
The key criteria for funding consideration will be proposals based on children in poverty
per county.
Subcontracts
Contract agencies may subcontract a portion of the project activity to another entity.
If a contract agency exchanges personnel services with another entity, a written legal
agreement describing the exchange is required. This agreement may be written as a
memorandum of understanding (MOU) or a memorandum of agreement (MOA). At a
minimum, the agreement should address the scope of work to be performed, assurance
of qualified personnel, financial exchange, reporting requirements and time period. Both
parties (contract agency and subcontractor) must review the subcontract annually.
303 Contract Revisions
All parts of the Title V MCH related programs grant application are a part of the contract
between a contract agency and the department. This includes budget, grant objectives,
narrative and reported data. Any program changes require a written revision to the
application.
A request for approval of program changes must be submitted in writing to the Bureau
of Family Health, Children & Families section and approval must be granted before
changes are implemented. The request should indicate what portion of the narrative or
budget will be changed along with justification.
Adjustments - An adjustment is a written request from the grantee to KDHE if there is a
10 percent or more variance in the line item of the current budget. The deadline is June
20 to process the budget adjustment by June 30.
Routine Adjustments - Adjustments less than 10 percent of a line item may be made
within the budget without prior approval. This includes moving less than 10 percent of
the total budget amount for a program within the budget, revisions to the “other funds”
categories and changes in a single category of personnel of less than .20 FTE.
Examples of routine adjustments include replacing one full-time nurse with two part-time
nurses or adjusting time between two programs.
Routine adjustments must be made in the approved budget. Notify the Bureau of Family
Health by submitting a cover letter with applicable narrative outlining the change on the
47
budget form. Year-end expenditures will be compared against the revised line item
amount.
Amendments - A request to prepare a contract/attachment and/or amendment is in
order when an actual increase or decrease to the grant award amount is made. These
are usually done by KDHE depending on funding.
Process
The process for requesting a grant application revision is as follows:
1. The agency will send an e-mail or letter to the assigned lead consultant for
the agency outlining what they wish to change, the justification for doing so
and supporting documentation.
2. The lead consultant will review the proposed changes and provide feedback
to the supervisor and/or bureau chief.
3. A letter or e-mail will be sent to the agency from the lead consultant, or other
directed staff, to notify the agency of the request status.
4. Upon approval the agency will incorporate the revisions into their plan and
provide the department with the most current version of the plan for their
permanent file.
304 Budgets
Plan to prepare two budgets. The first budget is the amount that it actually costs to run
the MCH program in your agency. It may also include a “wish list” within it. The second
budget or what is called the “Final Budget,” will be completed after you received the
Notice of Grant Award letter with the actual MCH grant amount will be awarded in the
coming fiscal year. You may simply shift the dollar amounts from the grant column to
the local or match column. The “Final” or second budget must be submitted to KDHE by
July 15.
PAYMENTS
#1 - July 1
#2 - October 1
#3 - November 15
#4 - January 1
#5 - February 15
#6 - April 1
#7 - May 15
#8 - on or before June 30
At anytime your agency is not in compliance with the grant requirements, then your
agency may be placed on provisional status and monies will be held until requirements
are met. Reasons to withhold payments or monies include, but are not limited to the
following:
1. Affidavit not received.
2. Semi-Annual Narrative report not received.
3. DATA (due monthly) is not received.
4. A response to a site visit is past due.
5. Healthy Start Home Visitor did not attend a required Statewide Conference.
6. Healthy Start Home Visitor did not attend the required Fall Regional training.
7. Any other requested information is not received.
48
305 Documentation of Local Match
MATCH
• A 40 percent match is required for the MCH grant program.
Non-cash contributions or In-kind donations may be used to meet the required
local match. In-kind or non-cash support may include:
o Personnel time, space, commodities or services.
o Contributions must be given a fair market value and documented in the
local health agency accounting records.
o Costs associated with inpatient care are non-allowable.
Sources that may be used for matching funds are reimbursement for service from
third parties such as insurance and Title XIX, client fees, local funds from nonfederal sources or in-kind contributions. In-kind contributions must be
documented in accordance with generally accepted accounting principles.
Records for tracking match must be made available for review upon request.
•
No supplanting. You cannot use one grant monies to match another federal or
state grant.
Federal funds, with two exceptions, are not allowable as match. Exceptions: (1)
Medicaid dollars received for services provided and (2) Native American Tribes
eligible under P.L. 93-638 may use those federal funds for match. Resources that
are used to match other federal, state or foundation grants cannot be used as
match MCH Grant funds.
306 Financial Accountability
Financial management and accounting procedures must be sufficient for the preparation
of required reports. In addition, the financial operations must be sufficient enough to
trace revenue and expenditures to source documentation as part of a financial review or
audit.
•
•
•
All records and supporting documentation must be available for review.
Accounting records must be supported by source documentation such as
canceled checks, paid bills, payroll, time and attendance records and similar
documents that would verify the nature of revenue and costs associated with the
MCH Grant-funded program.
The accounting system must provide for:
1. Accurate, current and complete disclosure of expenditures
2. Accounting records that adequately identify source of funds (federal, cash
match, in-kind) and the purpose of an expenditure
3. Internal control to safeguard all cash, real and personal property and other
assets and assure that all such property is used for authorized purposes
4. Budget controls that compare budgeted amounts with actual revenues and
expenditures
Fringe Benefits
Personnel whose salaries are supported in part or in full by the MCH contract must
receive the same package of fringe benefits available to other employees of the MCH
grantee.
49
Fringe benefits may only be requested on that portion of the employee’s salary
supported by the MCH contract and must be based on the salary rate specified in the
MCH application.
The fringe benefits provided must be enumerated in the written personnel policies and
in the contract agency’s MCH application. The fringe benefits rate(s), expressed as a
percentage of wages and salaries must be shown in the budget of the approved
contract.
AFFIDAVITS - are due on a quarterly basis.
Please use Affidavit Form # 3. An electronic copy of this form is available at our
website: www.kdheks.gov/doc_lib/index.html.
1. The State Fiscal Year begins on July 1 each year.
2. Affidavits keep a running total of the grant award and match dollars.
3. Agency must spend the grant money and 40 percent match dollars by June
30, the end of the fiscal year.
4. No more than 25 percent of the total grant amount shall be available to the
local agency for the period July 1 through September 30 due to dealing with
two Federal Fiscal years. Therefore, do NOT spend more than 25 percent out
of the Grant section on your 1st quarter affidavit. Any extra money that is
spent must be added to the MATCH section. (See KDHE Notice of Grant
Award Amount & Summary of Program Objectives, #2).
5. Use whole dollar figures in each block.
6. Report the amount collected in the same quarter as it is received.
7. All salary amounts charged must be supported in your agency accounting
records and by the individual employee time sheets.
8. Agency may add together boxes A and B to compute the MATCH.
9. On line item #12 “OTHER” – this must be itemized here. There is no such
thing as “MISC” or “OTHER” categories when it comes to an audit.
10. Be sure that the “other” and “in-kind” amounts listed equal the collected and
monthly expensed funds.
11. On line item #14, Boxes B and C cannot be a negative amount. These should
be zero for July and CANNOT be a negative number. The carry-over balance
is the beginning balance of the next quarter.
12. 50 percent of your grant award should be spent by December 31. In addition
20 percent of your required match amount should be spent by December 31.
Electronically submit Affidavits to Kevin Shaughnessy at [email protected]
Insurance
SCHIP = State Child Health Insurance Program
Other Public Health Insurance includes Tri-Care and Champus
Private health Insurance includes Blue Cross Blue Shield (BCBS)
Other (please specify) - includes donations, Farm Worker Program or Migrate
Education.
Affidavit Reporting Schedule
1st Quarter = July 1 to September 30. Affidavits are due October 15.
2nd Quarter = October 1 to December 31. Affidavits are due January 15.
3rd Quarter = January 1 to March 31. Affidavits are due April 15.
4th Quarter = April 1 to June 30. Affidavits are due July 15.
50
307 Fiscal Record Retention
KDHE
The KDHE Legal Department maintains the record retention schedule. Pursuant to the
Retention Records Schedules (RRS), retention could be between 5-15 years. If it is “Aid
to Counties Program Audit Reports,” the RRS requires that KDHE must retain the
records for five years. After that time records are sent to the archives. For “Federal
Grant Programs Control and Reference Files,” the RRS requires 15 years and after that,
they are sent to the archives.
The KDHE Division of Management and Budget keeps the audits, affidavits, budgets
and authorizations for the same five years then archives them.
County
Each county may be different. Please check with your county legal department and find
out what is required for your county.
308
Narrative/Progress Reports
Semi-Annual Narrative/Progress Reports - two per year are required.
See Grant/Contract Reporting Instructions, Mid-Year Narrative Report Form #3
available at: www.kdheks.gov/doc_lib/index.html.
Narrative/Progress Reports Schedule:
1. July 1 - December 31 are due by January 15
2. January 1 - June 30, end of the fiscal year reports are due by July 15. A
five percent penalty of the total grant award amount will be assessed for
delinquent reports received after August 15
309 Inventory or Capital Equipment
When listing inventory or capital equipment on the budget, the following must be
approved in advance (see page 23 of the Reporting Guidelines booklet):
• Items costing $500 or more
• Items with a useful life greater than one year
• Items purchased from State (grant) funds.
You must justify these items in support of your contract requirement for MCH funding.
You may be required to submit a budget adjustment to re-allocate money from your
approved budget. The deadline is June 20 in order to process the budget adjustment.
Equipment
1. Equipment is defined as any item having a useful life of one year or more and a
unit acquisition cost of $2,000 or more.
2. Items such as office supplies, medical supplies and data system supplies are
excluded from the definition of equipment and thus considered supplies.
3. If any agency desires to purchase equipment that was not approved as part of
the current application budget line item, a letter requesting permission to
purchase must be sent prior to purchasing to:
KDHE, Bureau of Family Health
Children & Families Section
1000 SW Jackson, Ste 220
Topeka, KS 66612
4. MCH funds may not be used to purchase motor vehicles.
51
5. KDHE maintains an inventory of contract agency’s fixed assets and must be
reconciled at least every two years with the contract agency’s inventory.
6. Disposal of property purchased in whole or in part with grant program funds
requires prior written authorization of the Bureau of Family Health. Authorization
for disposal must be obtained regardless of the method of disposal (e.g., sale,
trade-in or junked.)
7. Contract agencies may request in writing to delete equipment from their
inventories if the equipment has been lost, stolen, broken, is obsolete, or no
longer meets the definition of equipment as defined in this policy. The Bureau of
Family Health will return a written approval letter or authorized E-mail.
310 Income
Program Income
Program income means gross income earned by the contract agency resulting from
activities related to fulfilling the terms of the contract. It includes, but is not limited to,
such income as fees for service, cash donations, third-party reimbursement, Medicaid
and private insurance reimbursements and proceeds from sales of tangible, personal or
real property. The requirement of Title V/MCH Block Grant to serve all mothers and
children emphasizes that there are no eligibility requirements established at the federal
level to qualify for services paid by Title V/MCH Block Grant. However, high priority is
placed on services to mothers and children who are under served or low income. To
maximize federal funds to serve the low income populations, it is expected that MCH
Grant-funded programs will determine the health care coverage of persons they serve,
determine coverable services and pursue reimbursement from that source as allowable.
Program income shall be used for allowable costs of the MCH program. Program
income shall be used before using the funds received from the department. Excess
program income may be retained to build a three-month operating capital. Program
income must be used during the current or following fiscal year. A contract agency may
use up to five percent of unobligated program income for special purposes or projects,
provided such use furthers the mission of the MCH program and does not violate state
or federal rules governing the program.
Program income cannot be carried over from year to year. As program income is
earned, it must be utilized to enhance the program, either as cash match or additive,
resulting in a zero balance on the final affidavit of each fiscal year.
Cash Donations
• Cash donations are allowed as optional - but not required - for persons served.
• No person should be denied service from a MCH Grant-funded program for not
offering a cash donation. Donations should not be solicited from an individual
who is covered by Medicaid.
• Cash donations are program income and should be so reflected on the Quarterly
Affidavit. Donations must be re-invested in the MCH Grant-funded program as
cash match or additive.
Other Sources of Funding
The contract agency must develop other sources of financial support for the MCH
program activities, including the following:
1. Recover as much as possible of all third-party revenues to which the contract
agency is entitled as a result of services provided (e.g., private insurance).
2. Garner other available federal, state, local and private funds (e.g., Medicaid).
52
3. Charge clients according to their ability to pay for services provided, based on a
sliding fee schedule. The sliding fee schedule must be based on standardized
guidelines provided by the health department. Any changes from these
guidelines must have prior written approval by the department. Client billing and
collection procedures must be consistent with those established and provided by
the county. Services funded partially or completely by the health department will
not be denied to a person because of his or her inability to pay a fee for the
service. Individual and/or immediate family income and family size are used in
developing the sliding fee schedule.
4. Any changes in funding sources developed or funding sources added during the
contract period must be reported to the department.
Determining Income
Income information will be obtained from every client, documented and updated at least
annually. The client’s income will be used to determine the amount to be charged for
services or supplies. Clients unwilling to provide income information will be charged full
fees for services and supplies.
In order to determine whether a client should be charged the full fee, no fee or a fee
based upon a schedule of discounts, the local agency may request proof of income, but
they may not require it. If a client has no proof of income, but provides a self-declaration
of income, the local agency should accept the self-declaration and charge the client
based upon what has been declared.
Assessment of income is a local agency option, but cannot be a barrier to services. The
local agency may not assess the client at 100 percent of the charge because they do
not have proof of income, as this may present a barrier to the receipt of services or
supplies.
When income assessment is adopted, the local agency will establish a written policy
which will be applied consistently for all MCH clients. The policy must address the
management of income documentation if a client does not have income documentation
at the time of the client’s visit.
Income shall be calculated using the following definitions:
Family and Household are used interchangeably and defined as individuals,
related or non-related, living together as one economic unit. References for this
definition are based on Federal Register, Vol. 45, No. 108, June 3, 1980, Part 59,
Subpart A, Section 59.2 and Federal Register, Vol. 61, No. 43, March 4, 1996,
Annual Update of the HHS Poverty Guidelines, Definitions, Paragraph (c).
Income is defined as total annual gross income available to support a household.
The only exception to using gross income is using net income for farm and other
types of self employment. Income shall include, but is not limited to: wages,
salary, commissions, unemployment or workmen’s compensation, public
assistance money payments, alimony and child support payments, college and
university scholarships, grants, fellowships and assistantships, etc. Income shall
not include tax refunds, one-time insurance payments, gifts, loans and federal
non-cash programs such as Medicare, Medicaid, food stamps, etc.
53
Income for minors who request confidential family planning services must be calculated
solely on that minor’s resources (e.g., wages from part-time employment, stipends and
allowances, etc.). Those services normally provided by parents/guardians (e.g., food,
shelter, etc.) should not be included in determining a minor’s income.
If a minor is requesting services and confidentiality of services is not a concern, the
family’s income must be considered in determining the charge for the services.
The U.S. Department of Health and Human Services annually publishes in the Federal
Register the annual income figures defining poverty based upon income and family size.
100 percent of poverty is the threshold. The MCH program uses a higher standard or
threshold, such as 200 percent of poverty.
Sliding Fee Scale
A Sliding Fee Scale is required with a minimum of four increments and implemented for
all MCH services provided http://aspe.hhs.gov/poverty/.
Income and Discount Eligibility Guidelines
There is a color-coded example available by request. This is a tool to help ask the hard
question about personal finances. This information is a requirement of the MCH Block
Grant. The local agency must ask about family size and income, but need not require
physical documentation of income. This should be defined in the agency’s fiscal policy
and procedures.
311 Data Collection
To meet federal reporting requirements, minimum data elements must be collected and
reported by each local agency. Kansas has an integrated data system.
Data requirements run on a calendar year from January 1 to December 31 each year.
January 15 is the deadline to submit December’s data to KDHE.
Agencies are to submit client encounter data as part of the MCH grant requirements.
This is done with the paper Client Visit Record (CVR), KIPHS using PH Clinic or by
using WebMCH at least monthly. When submitting large amounts of data (> 50), submit
data at least twice a month. Timeliness is important. Remember, CVRs that are not
keyed are NOT counted. Refer to the Client Visit Record Instruction Manual for more
information. The CVR form may be downloaded from our website at:
www.kdheks.gov/c-f/downloads/CVR2005.pdf.
The WebMCH System Development Project began on January 26, 2006. There are
currently more than 30 counties using WebMCH. The User Security and Confidentiality
Agreement for WebMCH is required for each user. A token is required and used to login
for security purposes. The password changes every 60 seconds on the token.
General Enrollment Process for WebMCH
1. Must currently be using WebIZ
2. Must have a security token (devices that ensure extremely secure sign-on to the
system)
3. KanPhix - Personal Health Information Exchange – new users must register at
this website: https://kanphix.kdhe.state.ks.us/newuser/
54
4. Confidentiality agreements are completed and on file at KDHE, Bureau of Family
Health, Children & Families Section
5. Attend training and practice on the training site
6. Permission has been granted prior to using the production site
KIPHS, Inc. www.kiphs.com
Public Health Software Developers can be reached toll free at 877-905-4747. KIPHS
using PH Clinic is another option of data collecting.
312
•
Schedule
July 1 - beginning of the State fiscal year.
•
July 15 – Fourth quarter affidavits and end-of-year narrative/progress reports are
due.
•
August 1 – Reporting requirements are reviewed and revised by program staff to
assure accurate program objectives and funding criteria for current year.
•
August 25 – Changes of Reporting Guidelines are due.
•
October 15 – First quarter grantee affidavits and reports are due.
•
December 15 - The Grant Applications are reviewed and revised by program
staff to assure accurate program criteria for next fiscal year. This includes
personnel allocation by program and budget forms required for submission.
•
January 10 – Changes of Grant Applications are due.
•
January 15 – Second quarter affidavits and mid-year narrative/progress reports
are due.
•
January 15 - Grant applications are available on KDHE website.
•
March 15 - Grant applications are due.
•
April 15 - KDHE staff completes the review of all grant applications, budgets and
program attachments.
•
April 15 – ATL Worksheets sent to programs by coordinator.
•
April 15 – Third quarter affidavits and reports are due.
•
May 15 – ATL Worksheets are due to coordinator.
•
May 20 – 31 – Review meeting with KDHE Secretary.
•
June 15 – Award Letters for next fiscal year are sent to grantees from KDHE
Division of Management and Budget.
Note: References to local health departments are intended to include all
agencies applying for grant funding assistance. If specified dates fall on a
weekend or holiday, then the first following workday is applicable.
55
Quarterly affidavits of expenditures and required progress reports may be
submitted together to KDHE Division of Management and Budget.
•
June 20 - deadline to request a budget adjustment for current fiscal year.
•
June 30 - end of the State fiscal year.
313 Monitoring
Audit or Examination of Records
1. Sub-recipients of Federal funds are required to have an audit made in
accordance with the provisions of OMB Circular A-133, Audits of States, Local
Governments and Non-Profit Organizations. The Department may require, at any
time and at its sole discretion, that recipients of state funds have an audit
performed. A copy of audit reports acquired and (subject to OMB Circular A-133,
State regulations or otherwise required) shall be forwarded to the Department
upon receipt and at no charge. The MCH grantee may be required to comply with
other prescribed compliance and review procedures. The MCH grantee shall be
solely responsible for the cost of any required audit unless otherwise agreed in
writing by the Department. When the Department has agreed in writing to pay for
the required audit services, the Department reserves the right to refuse payment
for audit services which do not meet Federal or State requirements. Audits are
due within nine (9) months following the end of the period covered.
2. The audit report shall contain supplementary schedules identifying by program
the revenue, expenditures and balances of each contract.
3. Upon completion of the audit, one (1) copy of the audit report shall be submitted
to the Department within thirty (30) working days of its issuance, unless specific
exemption is granted in writing by the Department. To be submitted with the audit
is a copy of the separate letter to management addressing non-material findings,
if provided by the auditor.
Site Visits
Site visits are conducted to evaluate the performance of local agencies. Site visits are
also a mechanism for State staff to receive feedback from local agency staff as well as
to provide technical assistance and training. Unless otherwise notified, all aspects
(clinical, community outreach and information, fiscal and administrative) of the MCH
program will be reviewed. The Site Visit Tool will be sent to the local agency in advance
and should be completed to the extent possible. On the day of the visit this tool will be
reviewed and discussed. In addition, the following items should be available for review:
1. Local protocols, policies and procedures appropriate for the program
2. Fiscal policies, including chart of accounts
3. Schedule of fees
4. Schedule of discounts
5. Personnel policies and job descriptions
6. Referral forms
7. Examples of local brochures or promotional materials which demonstrate
outreach efforts
8. Client receipts and charts
A report will be sent to the local agency upon completion of the review. If deficiencies
are noted, the local agency must submit a corrective plan of action.
56
Withholding of Support
Temporary withholding of funds does not constitute just cause for the MCH grantee to
interrupt services to clients.
Suspension
1. When determined by KDHE that a MCH grantee has materially failed to comply
with the terms and conditions of the contract, KDHE may suspend the contract, in
whole or in part, upon written notice. The notice of suspension shall state the
reason(s) for the suspension, any corrective action required and the effective
date.
2. A suspension shall be in effect until the MCH grantee has provided satisfactory
evidence to KDHE that corrective action has been or will be taken or until the
contract is terminated.
Contract Termination
Failure to comply with the contract may result in reduction of funds or loss of contract.
Changes of Key Personnel
The MCH grantee’s personnel specified by name and title are considered to be
essential to the work or services being performed. If, for any reason, substitution or
elimination of a specified individual becomes necessary, the MCH grantee shall provide
written notification to KDHE. Such written notification shall include the successor’s
name and title. The MCH grantee shall notify KDHE in writing within ten (10) working
days of any change of key personnel.
Changes in Location
The KDHE shall be notified of any change in office or service location from that shown
in the contract at least ten (10) working days prior to such change.
Changes in Service
Changes in the services to be provided by the MCH grantee as outlined in the contract
require prior written approval by KDHE. Discontinuation of any service may result in a
decrease in the contract amount or termination of the contract.
314 Evaluation
MCH SURVEY CARDS
Grantees are to distribute a MCH client satisfaction survey card to every 5th
client or at least 20 percent of the families. The MCH survey card will be
summarized and a report will be sent electronically to the local health agency for
program self-evaluation on a quarterly basis.
Be sure to print, write or stamp your agency’s name on each survey card. Please
do not use county abbreviations.
The MCH client satisfaction survey cards are used by KDHE’s MCH Program to
provide an evaluation of the local program. Each quarter, a summary report will
be e-mailed to the local health agency. This summary includes a list of topics
discussed, a list of “Need more information” and a list of comments.
57
350 - Guidelines for Records Management
Table of Contents
351 - Scope of Records Management
352 - Statutes and Laws for Records Management
353 - Resources
58
351 Scope of Records Management
Records management is crucial in provision of health services to families. Practitioners
must be knowledgeable of the standard of practice for documentation of services and
maintenance of records in health care delivery settings, including protection of patient
information/confidentiality.
The scope of records management is too broad for the purposes of this manual. There
are basic resources that can be used by administrators, clinicians and other
professionals to serve as resources to creating policy and guidelines for documentation
of services and retention of records. Examples of possible records kept by MCH
providers include laboratory test results, health screening results, health supervision
visits, home visiting, telephone consultation with providers/clients and reports of
suspected child abuse.
352 Statutes and Laws for Records Management
Practitioners are directed to the Kansas Legislature website when seeking statutes
related to records management. This website accesses bills and statutes by searching
with specific bill or statute numbers or using key words. The link provided is for the Site
Index that can access particular resource links www.kslegislature.org/legsrvlegisportal/siteMap.do.
353 Resources
Confidentiality and Protection of Health Information
Health Insurance Portability and Accountability Act (HIPAA) -United States Department
of Health and Human Services: Office for Civil Rights
This site provides information for consumers and providers on the national
standard to protect the privacy of health information of clients. Each local agency
is required to notify clients of their right to confidentiality under HIPAA. Agencies
are required to be knowledgeable on current state statutes and regulations that
address confidentiality, protection of health information and when sharing of
health information occurs in the event of a threat to public health.
Information on the HIPAA Privacy Rule is available at:
www.hhs.gov/ocr/hipaa/.
Information on the other HIPAA Administrative Simplification Rules is available at
www.cms.hhs.gov/HIPAAGenInfo/.
Family Education Rights and Privacy Act (FERPA)
The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34
CFR Part 99) is a Federal law that protects the privacy of student education
records. The law applies to all schools that receive funds under an applicable
program of the U.S. Department of Education. FERPA gives parents certain
rights with respect to their children's education records. These rights transfer to
the student when he or she reaches the age of 18 or attends a school beyond the
high school level. Students to whom the rights have transferred are "eligible
students." The FERPA regulations and other helpful information can be found at:
www.ed.gov/policy/gen/guid/fpco/index.html.
59
Joint Guidance on the Application of the Family Educational Rights and Privacy Act
(FERPA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
To Student Health Records
This document was created in 2008 jointly by the U.S. Department of Health and
Human Services and U.S. Department of Education in an effort to address the
issues of sharing of health information between educational and health entities.
This is an important resource that will assist practitioners working with
educational settings. www.hhs.gov/ocr/hipaa/HIPAAFERPAjointguide.pdf
Kansas Public Health Statutes and Regulations
Kansas Public Health Statutes and Regulations Book
The Kansas Public Health Association has available the Kansas Public Health
Statutes and Regulations Book to assist those who work in public health with
compilation of statutes and regulations that pertain to public health practice. For
more information, go to www.kpha.us/documents/documents.html.
Medical Records Management for Public Health
Public Health Resource Manual
This document is from the Bureau of Community Health Systems and contains
important information for nurses and other professionals working in public health.
There are sections pertinent to a comprehensive public health program, including
Medical Records Management.
www.kdheks.gov/olrh/download/PHNResourceGuidebook.pdf.
Records Retention
Records Retention in Government
Locate policies, programs and information for records retention and historic
preservation at the Kansas Historical Society. Records management for State,
local and municipal government agencies can be found at
www.kshs.org/government/index.htm.
SERIES ID
TITLE
0001-111
Client Records
Medical records, including laboratory reports, of persons treated
DESCRIPTION in local health care facilities. Includes adult and child health,
family planning, maternal health, mental health and primary care.
RETENTION
See Comments
Retain 10 years after last contact, then destroy. (For juvenile
COMMENTS
records, retain 10 years after last contact or until 21st birthday,
whichever is later, then destroy.)
DISPOSITION Destroy
RESTRICTIONS K.S.A. 45-221(a)(3)
APPROVED
2008-07-17
K.A.R.
53-2-156
NUMBER
__________________________________________________________________
60
SERIES ID
TITLE
0003-111
Communicable Disease Records
Records and supporting documentation relating to communicable
DESCRIPTION diseases in individual clients. May include name, address,
disease type, when and how contracted and treatment measures.
RETENTION
See Comments
If not treated, retain two calendar years, then destroy. If treated,
COMMENTS
retain 10 calendar years. (For juveniles, retain 10 years or until
21st birthday, whichever is later.)
DISPOSITION Destroy
RESTRICTIONS K.S.A. 45-221(a)(3)
APPROVED
2008-07-17
K.A.R.
53-2-156
NUMBER
61
400 - Maternal and Infant Health
Table of Contents
401 - Program Description
402 - Multidisciplinary Health Professional Team
403 - Program Purpose
410 - Guidelines for Outreach and Family Support: Home Visiting and the Kansas
Healthy Start Home Visitor (HSHV) Services
411 - Description of Services
412 - Eligibility for Services
413 - Program Philosophy, Goals and Objectives
414 - Supervision Standards and Provision of Services
415 - Qualifications of Supervisors
416 - Responsibilities of Supervisors
417 - Qualifications of Home Visitors
418 - Responsibilities of Home Visitors
419 - Community Collaboration and Local Coordination
420 - Healthy Start Home Visitor Services Pamphlets
421 - Orientation and Training Standards
422 - Initial Training for Healthy Start Home Visitors
423 - Continuing Education
424 - Provision of Services
425 - Provision of HSHV Services Algorithm
426 - Confidentiality
427 - Administrative Information and Documenting Services
428 - Documentation of Visits for the Client’s Permanent Health Record
429 - Client Encounter Data
430 - Evaluating Outreach and Family Support Services
431 - MCH Client Satisfaction Survey Card
432 - Do’s and Don’ts of Successful Home Visitation
433 - Federal Healthy Start Programs Serving Kansas
434 - References
440 - Preconception Health
441 - Access to Health Care
442 - Sexually Transmitted Diseases
443 - Intimate Partner Violence
444 - Alcohol, Tobacco and Other Substances
445 - Nutrition
446 - Physical Health and Oral Health Status
447 - Physical Activity
448 - Cultural Competence
449 - Emergency Planning
450 - General Preconception Health Resources
62
460 - Prenatal Health
461 - Access to Health Care
462 - Prenatal Screening Tests
463 - Genetic Screening
464 - Risks, Warning Signs and Hazards
465 - Sexually Transmitted Diseases
466 - Intimate Partner Violence
467 - Alcohol, Tobacco and Other Substances
468 - Nutrition
469 - Physical Health and Oral Health Status
470 - Physical Activity
471 - Cultural Competence
472 - Emergency Planning
473 - Immunizations
474 - Labor and Delivery
475 - General Prenatal Health Resources
480 - Postpartum Health
481 - Access to Health Care
482 - Common Considerations
483 - Sexually Transmitted Diseases
484 - Intimate Partner Violence
485 - Nutrition
486 - Physical Activity
487 - Cultural Competence
488 - Emergency Planning
489 - Immunizations
490 - Mental Health Considerations
491 - General Postpartum Health Resources
500 - Infant Health
501 - Access to Health Care
502 - Parent-Infant Bonding
503 - Infant Mental Health
504 - Newborn Screening
505 - General Infant Health
506 - Growth and Development
507 - Nutrition
508 - Oral Health
509 - Safety and Security
510 - Emergency Planning
511 - Immunizations
512 - General Infant Health Resources
63
401 Program Description
Maternal and infant health services, in MCH Program terms, encompass the work it
takes to promote the health of pregnant women, infants (age birth-12 months, 0 days)
and their families. In order to promote the health of pregnant women, it is important to
consider what happens before an initial pregnancy (preconception health); during
pregnancy (prenatal health); in the postpartum period (up to about one year after
delivery); and between subsequent pregnancies (interconception health). The healthier
a woman is coming into a given pregnancy, the greater are her odds of having an
optimal birth outcome. Further, it is prudent to note the importance of living in a
supportive home environment where few stressors exist and that of living in a healthy
and supportive community in the promotion of optimal pregnancy and birth outcomes for
women of childbearing age.
The portion of the MCH Program that is concerned with maternal and infant services
promotes the provision and/or facilitation of access to comprehensive preconception,
prenatal and postpartum health care and related services for the mother and her infant
up to one year postpartum in local communities. This goal is accomplished by the
promotion of service coordination that provides health, psychosocial and nutrition
assessments and interventions through a collaborative effort between public and private
providers skilled in the various disciplines.
402 Multidisciplinary Health Professional Team
The services of a multidisciplinary health professional team are to include, at a
minimum, a registered nurse (including nurse practitioners, nurse midwives, etc.), a
registered dietician (can be shared with other programs/organizations) and a
professional to address psychosocial issues (includes those with professional
designations regulated by the Kansas Behavioral Sciences Regulatory Board listed at:
www.ksbsrb.org/) and to provide on-site and/or facilitate off-site access to physician or
certified nurse mid-wife providers for prenatal and postpartum medical services. In
addition, clients should have access to multi-lingual translator services and culturally
appropriate care as needed. Finally, ready access must be provided to each discipline
on the health professional team as defined by on-site services and/or through an
established referral process (that should include a written formal plan) to an appropriate
professional with the needed discipline(s) within the community or service area.
Interventions should emphasize risk reduction associated with poor pregnancy
outcomes as well as quality of life for mothers, infants and families. Services should
include, but not be limited to: outreach to identify high-risk pregnant women; pregnancy
testing and case management for pregnant clients. Further, follow-up for the mother,
infant and family that is based on identified risks should be available for one year
postpartum. The overarching goal of the MCH Program’s women and infant services
can be summed up as: healthy mothers giving birth to healthy infants. This goal is
accomplished by promoting public/private partnerships to facilitate ready access to
affordable and risk appropriate care leading to a reduction in the negative
consequences associated with preterm birth, low birth weight and infant mortality.
64
403 Program Purpose
The purpose of the MCH Program’s maternal and infant services is to improve
pregnancy outcomes for mothers and infants by decreasing the incidence of low birth
weight and infant death, maternal complications, infants born to adolescents and infants
born less than 18 months apart. This is accomplished by promoting early entry into
prenatal care and compliance with preconception, prenatal, postpartum and infant care.
In addition, the top three priorities for pregnant women and infants identified during the
Maternal and Child Health (MCH) 2015 Statewide Needs Assessment (MCH 2015)
were:
1. All women receive early and comprehensive health care before, during and after
pregnancy
2. Improve mental health and behavioral health of pregnant women and new
mothers
3. Reduce preterm births (including low birth weight and infant mortality)
4. Increase initiation, duration and exclusivity of breastfeeding
www.datacounts.net/mch2015/mothers_and_infants.asp
410 - Guidelines for Outreach and Family Support: Home
Visiting and the Kansas Healthy Start Home Visitor
(HSHV) Services
411 Description of Services
The Kansas Title V MCH program is an integrated delivery of services to the MCH
population, providing services to families and children in a variety of settings. Part of this
integrated delivery of health services occurs through outreach and family support in the
home setting. Counties receiving MCH grant funding must provide outreach and family
support services.
Kansas HSHVs work in tandem with a registered nurse supervisor in the public health
setting. HSHVs provide outreach and family support to pregnant women and mothers
with newborns.
Home visitation services, by the HSHV, are provided to pregnant women and mothers
up to one year postpartum and beyond if necessary. This outreach service supports
families and complements services to pregnant women and mothers. The HSHV
services are not independent of other MCH services, but rather a component woven
through MCH services.
A HSHV provides education on health and safety promotion and preventive programs.
An important role of the HSHV is to have a broad knowledge of available community
resources. They provide assistance to families in linking them to resources and in
navigating access to systems of care.
HSHV interventions increase knowledge, change beliefs and alter behaviors by
increasing the number of women accessing early and comprehensive health care
before, during and after pregnancy.
65
These interventions impact:
1. Reduction of preterm births and decrease low birth weight
2. Increases breastfeeding initiation and duration of six months and beyond
3. Decreases the number of women that smoke during pregnancy and remain
tobacco free following delivery
4. Decreases the number of women that drink alcohol or take drugs while pregnant
5. Decreases the incidence of family violence, child abuse and neglect
6. Increase the number of women that complete their education and acquire
sustainable employment
412 Eligibility for Services
There is no eligibility requirement. Services are available to ALL pregnant women and
families, including those with adoptive and foster children.
413 Program Philosophy, Goals and Objectives
Interventions through support and education for pregnant women and families with
newborns can increase the use of preventive health services and reduce the incidence
of child abuse and neglect. HSHV provide family support emphasizing early health
promotion, prevention and intervention services provided to the pregnant woman. Basic
assumptions underlying family-centered home visiting efforts include the following:
1. Preservation of the family as the foundation of our social structure is essential.
2. The rights and integrity of the family must be recognized and respected.
3. The family will make important decisions about its interactions with community
resources.
Program goals and objectives are developed within each grantee agency based on the
priority national performance measures (NPM) and state performance measures (SPM)
identified in the MCH 2015 based on the Healthy People 2020 objectives for the nation
found at www.healthypeople.gov/2020/default.aspx.
Outcome objectives to be met by agencies providing outreach and family support
(HSHV) services include short-term and intermediate outcomes identified in the Theory
of Change Logic Model (O’Brien, R., 2004). Outcomes for home visiting include:
•
Short-term Outcomes
o Families identify and use community resources
o Pregnant women demonstrate improved health behaviors such as
decreasing substance abuse (e.g. cigarette smoking and alcohol use)
o Pregnant women will access early prenatal care to reduce the incidence of
premature and low birth weight babies
o Parents will demonstrate nurturing parenting skills
•
Intermediate Outcomes
o Mothers and their families will utilize cost-effective preventive health care
services such as prenatal care, family planning, immunizations, nutrition
and well child services
o Mothers and their families will demonstrate enhanced parenting and
problem solving skills
MCH grantees send in quarterly and annual reports of services provided to families in
their communities and provide data/narrative information addressing the outcomes.
66
A summary of outcome measures for the Kansas MCH program are available through
the Kansas Maternal and Child Health Biennial Summary 2010.
www.kdheks.gov/bfh/download/MCH_2010_Summary.pdf
414 Supervision Standards and Provision of Services
Standards for supervision of the HSHV by the professional registered nurse/social
worker include:
• Meeting individually with the supervisor on a regularly scheduled basis to review
client records and to discuss services needed for the family
• Assisting the home visitor in prioritizing the workload
• Determining which families require a nurse visit after consultation with the home
visitor
• Review/signing documentation of the home visitor
415 Qualifications of Supervisors
The HSHV is supervised by professional staff that includes registered nurses or other
professional staff, such as a social worker. The nurse or social work supervisor will be
responsible for recruitment, screening, interviewing, selection, orientation and
supervision of home visitors. If the Home visitor is not supervised by a professional
registered nurse or social worker, the visitor needs to have access to one of these
health professionals. The supervisor will:
1. Be a graduate of an approved school of professional nursing or social work
2. Be licensed as a registered nurse or social worker in Kansas
3. Ideally, supervisors should have a minimum of one (1) year of experience as a
public health professional
416 Responsibilities of Supervisors
1. Supervise the activities of the visitor
2. Include home visitors in appropriate local staff meetings
3. Consult with the home visitor on a regular and as needed basis
4. Have a thorough understanding of the role of the HSHV and the requirements
to be met for the MCH grant
5. Assist the HSHV in identifying learning needs
6. Complete an annual written personnel evaluation
7. Ensure that the registered nurse/social worker will make follow-up visits to
families when the home visitor observes current or potential problems
8. Periodically accompany home visitors on home visits to evaluate content of visit
and effectiveness of the visitor
9. Promote effective interagency cooperation with other community resources and
programs
10. Consult with other professionals who have provided referrals to HSHV services
11. Promote outreach activities in the local community to promote HSHV services
12. Ensure that all reports are completed and forwarded in a timely and accurate
manner
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417 Qualifications of Home Visitors
The HSHV will:
1. Have a minimum of a high school diploma or GED
2. Be able to differentiate between home visitor and nursing supervisor
responsibilities
3. Demonstrate the ability to respect the confidentiality of a client relationship
4. Demonstrate effective communication skills
5. Present a warm, concerned attitude toward families
6. Be knowledgeable of available community resources and how to utilize them
7. Take direction and carry out decisions made by supervisor
8. Complete reports in a timely and accurate manner
9. Work independently in a dependable manner
10. Be free from all communicable diseases
11. Model a healthy lifestyle while interacting with clients
12. Meet additional requirements of agency
418 Making a Home Visit
An important aspect of promoting the health of population has been the tradition of
providing services to individual families in their homes. Home visits give a more
accurate assessment of the family structure and behavior in the natural environment.
These visits provide opportunities to observe the home environment and to identify
barriers and supports for reaching family health promotion goals. Also, a nurse is able to
work with the client first hand to adapt interventions to meet realistic resources. Meeting
the family on its home ground also may contribute to the family’s sense of control and
active participation meeting its health needs.
Every agency providing home visits should have a well understood and practiced safety
policy. Additionally, if the visit is to be valuable and effective, careful and systematic
planning must occur.
Phases and Activities of a Home Visit
Phase
Activity
1. Initiation phase
Clarify source of referral for visit
Clarify purpose for home visit
Share information on reason and purpose of home visit with
family
Initiate contact with family
Establish shared perception of purpose with family
Determine family’s willingness for home visit
Schedule home visit
Review referral and/or family record
Introduction of self and identity
Social interaction to establish rapport
Establish nurse or visitor-client relationship
Implement educational materials and/or make referrals
Review visit with family
Plan for future visits
Record visit
Plan for next visit
2. Pre-visit phase
3. In-home phase
4. Termination phase
5. Post-visit phase
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419 Responsibilities of Home Visitors
The role of the HSHV is to provide support and information to each family visited,
serving as a screener in identifying potential problems to be referred to the professional
supervisor. Services are ideally provided in the client’s home; however, services can be
provided in a variety of settings including the hospital, clinic, group settings, community
and any other setting a mother may choose. It is recommended that no transportation or
child care be provided by the home visitor. The home visitor will:
1. Visit families to provide nonthreatening, friendly support
2. Visit each family currently expecting a baby or with an infant < 12 months of age
within seven (7) days of referral
3. Observe families for any current or potential problems
4. Provide a resource list to families for local service options such as transportation,
child care, babysitting, SRS, etc.
5. Make referrals to local resources as indicated and follow up on referrals
6. Alert supervisors of existing or potential problems
7. Make return visits to give continued support to families as determined with
supervisor
8. Serve as facilitator for crisis intervention
9. Seek client referrals from local health department programs, hospitals,
physicians, SRS and all available local resources to initiate visits to a client prior
to and during the hospitalization period
10. Complete reports in a correct and timely manner
11. Distribute a client feedback postcard to every fifth family visited
12. Participate in outreach activities in the local community to promote HSHV
services
13. Participate in required training provided by KDHE
420 Community Collaboration and Local Coordination
Every community has different kinds of organizations. These groups may cooperate
regularly, compete with one another, or operate in isolation. However, in every locality
opportunity exists for building cooperative relationships that will benefit families served.
The agencies and organizations listed below have an interest or a mandate in helping
families. Contacting one or more organizations can help HSHV to locate resources and
information to assist families. These may be partners in local projects or initiatives to
address health and safety needs of families. The list is not comprehensive and may not
fully apply to each locality; however these organizations are included to provide a
starting point in which to explore community and regional resources.
Local referral sources include:
• Local health department and public health services
o Maternal and Infant services
o Women, Infants and Children (WIC) Nutrition Services
o Family Planning
o Immunizations
o Well child screening and health assessment
o Developmental screening
• Office of Social and Rehabilitation Services
• Hospital(s) that serve the community and/or county
• Physicians that serve pregnant women and families with newborns
• Regional medical and dental safety net clinics
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•
•
•
•
•
•
•
•
•
Professional associations for physicians and nurses
Mental health services
School nurses and administrators
Licensed and registered child care facilities
Information and referral services
Ministerial alliances
Early childhood educators
Business and health coalitions
County extension offices
421 Healthy Start Home Visitor Services Pamphlets
In addition to locating resources, it is imperative that the HSHV provide education and
outreach to other organizations to strengthen their understanding of the role of the
HSHV in addressing the health and safety of the mother both prenatally and after
delivery. English and Spanish pamphlets titled, “Healthy Start Home Visitor Services”
are found at www.kdheks.gov/c-f/healthy.html. These pamphlets have space on the
back of the pamphlet to insert local agency information and can be used in outreach
efforts.
422 Orientation and Training Standards
Orientation of new home visitors consists of six components:
1. Training and review of relevant agency/local policies and procedures
• Child Abuse and Neglect Reporting. See A Guide for Reporting Child
Abuse and Neglect in Kansas available at
www.srskansas.org/CFS/Child%20Abuse%20Reprting%20Guide.pdf
• Confidentiality related to the Health Insurance Portability and
Accountability Act (HIPAA) www.hhs.gov/ocr/hipaa/
2. Consultation with the registered nurse supervisor or other designated
professional staff regarding public health services in Kansas
3. Completed self study of the Maternal and Child Health Manual
4. Review of the Aid to Local Grant/Contract Application and Reporting Guidelines
for the state fiscal year with supervisor
5. Orientation to all programs and staff in the local health department
6. Orientation to referral resources in the local community and county
423 Initial Training for Healthy Start Home Visitors
Newly hired HSHV will attend the Kansas Basic Home Visitation Training within the first
six months of employment, pending availability of training. This is a requirement of the
MCH grant.
In Kansas, the Nebraska Network for Home Visitation Training Curriculum was instituted
in 2003 in an effort to standardize the core knowledge base needed by any person
providing outreach and family support services, as well as other services in families’
homes. The current curriculum is an adaptation of the Nebraska curriculum and is called
Kansas Home Visitation Training. Participants that have received this training are local
health department Healthy Start Home Visitors, Parents as Teachers, educational
program home visitors and social workers. The extensive curriculum provides
participants with knowledge of family systems, community resources, home visitation
models, family empowerment and collaboration with community agencies/resources to
enhance services for families.
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To learn more about the Kansas Basic Home Visitation Training, go to
www.ksheadstart.org/node/102. The training is provided twice a year by the Kansas
Head Start Association.
424 Continuing Education
As a requirement of the state’s MCH Grant, all HSHV will attend the fall regional HSHV
training and one statewide conference of the local agency’s choice (MCH, 2007).
Training records are maintained through KS-Train (http://ks.train.org), an Individual
Professional Development Plan (IPDP) or other system of documenting educational
training on all MCH personnel and available for review. These need to be updated
annually. The IPDP is a valuable record that documents and demonstrates educational
objectives met by staff and can assist in determining other learning needs of staff.
A variety of learning opportunities are often available locally, regionally and statewide in
various formats. Kansas offers a website linked nationally to a database which lists
learning opportunities for all public health staff. This is a free service of the Public
Health Foundation www.phf.org/. The Training Finder Real-time Affiliate Integrated
Network (TRAIN) provides a portal to learning and maintains staff’s continuing
education records.
HSHV and other MCH staff will be directed to KS-TRAIN as continuing education is
made available. All staff should register on KS-TRAIN to receive notification of courses.
To learn more about educational opportunities available in Kansas, including on-line
training, visit KS-TRAIN at https://ks.train.org/DesktopShell.aspx.
425 Provision of Services
Funding for HSHV services is a decision made locally. MCH funds are to be spent on
outreach and family support services which include the use of HSHV. Most agencies
provide family support services to pregnant women including 1-4 visits prenatally and
postnatally. Generally 1-2 visits are done with the mother; however the number of visits
to be made is a decision of the supervising professional staff and the home visitor
based on needs identified in the family.
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426
Provision of HSHV Services Algorithm
Referral Sources
Maternal and
Infant Program
Nutrition and WIC
Services
Family Planning
Social and
Rehabilitation
Services
Physician
Hospital
Self Referral
Other
Request for home visit
received by supervisor
and / or HSHV
Initial home visit by
HSHV within 7 days of
receiving referral
Supervisor & HSHV
conference to determine
needs of family
Needs identified
Schedule a revisit to the
family & referrals to
resources
No needs indentified
Revisit not necessary,
but may be done.
Referrals to resources
427 Confidentiality
Home visitors typically have a unique relationship with the families they serve. Often,
parents confide in the home visitor about private matters. A family has the right to
expect that what is seen and heard in the home will be kept in the strictest confidence.
Written material, including the HSHV’s working file and central file in the office must be
kept confidential. In addition, confidentiality involves information that is shared verbally
with others. Remember: anytime the HSHV discuss a family with other home visitors,
program staff or agencies, it should be for the purpose of assisting the family or child.
All sharing of health information must conform to the Health Insurance Portability and
Accountability Act (HIPAA) and agency policy. For information regarding HIPAA visit
www.hhs.gov/ocr/hipaa/.
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Basic guidelines for maintaining confidentiality:
• Do not leave confidential records out in the open.
• Write only what is necessary, be objective and factual.
• Subjective information, assumptions and opinions should not be included in
documentation. Consult with the supervisor for documentation standards.
• Parents have the right to read any and all portions of their files so be thoughtful
about what you write.
428 Administrative Information and Documenting Services
It is essential that services being provided to families are documented by the HSHV.
This documentation is part of the permanent client medical record. Documentation is to
be done in a timely, objective and accurate manner. Each agency should have policies
and procedures in writing that address documentation and maintenance of the client
records. For information on information management and patient-integrated records,
consult the Kansas Public Health Nursing and Administrative Resources Guidebook
(2003) available at www.kdheks.gov/olrh/download/PHNResourceGuidebook.pdf.
429 Documentation of Visits for the Client’s Permanent Health Record
HSHV services are reported as services provided by a trained home visitor under the
supervision of a professional registered nurse or other professional staff member (e.g.,
Social Worker). Outreach services by registered nurses are reported as visits under
Maternal and Infant or Child Health. HSHV assist professional nursing staff in providing
outreach and family support to pregnant women and mothers with newborns by
assisting in health and safety promotion and preventive programs, as well as referring to
resources (e.g. medical home, dental home, social/emotional services). The most
essential role of the HSHV is to assist the family in identifying needs and providing
families with resources and linkages to services.
Each agency is to have policies and procedures for documentation of services to clients
including home visitation services. The documentation forms: Prenatal Visit Report and
Postnatal Visit Report can be used by the HSHV and supervisor for documenting
prenatal and postnatal services.
430 Client Encounter Data
The HSHV collects and reports information from each visit. Visits are made with the
mother prenatally and after delivery. The mother’s client number is the identifier for the
visit. The home visitor does not document services to the infant or child. If the infant or
child requires services, these services should be provided by the professional staff that
documents their assessment and intervention. Visits can be completed by a HSHV and
professional staff on the same day and at the same visit as these services are not
duplicated and are not provided by the same level of practitioner.
The HSHV services are documented according to the agency’s documentation and data
collection practices. At this time, there are four data collection formats being utilized,
including three electronic and one downloadable paper version. The paper Client Visit
Record (CVR) is available at www.kdheks.gov/c-f/downloads/CVR2005.pdf. The HSHV
documents outreach and family support services under #14 “Program Services”, noting
where services were provided to the mother. In addition to completing and reporting
forms submitted to the State, it is essential that the HSHV document all referrals or
resources offered to the mother on the date of the visit. Follow-up with the mother at a
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later date will assure that the mother and/or her child received the needed services
identified at the home visit.
431 Evaluating Outreach and Family Support Services
Data obtained from home visitors assists MCH grantees in demonstrating progress
being made toward meeting the National Performance Measures (NPM) and State
Performance Measures (SPM) for the MCH program. To view the NPM and SPM for
Kansas go to https://mchdata.hrsa.gov/TVISReports/.
Timely and accurate documentation of services in the client’s permanent health record
at the agency, as well as completion of required reports for the agency/state database,
assure continuity in services through record keeping/follow-up. In addition, the data
collected on the CVR for the HSHV outreach and family support services to the mother
shows the following:
• Where the service was provided
• What referrals were made with the mother
• Number of mothers served prenatal and postnatal (Users)
• Number of visits made overall (Encounters)
Data from the CVR is collected and reported to the State monthly. Evaluation data
collected through the required reports includes inputs (resources expended); activities
(implementation data on what activities/services the program offers); participation
(characteristics of program participants, numbers participating, nature of involvement
and background); and reactions (what participants say about the program).
These monthly reports, as well as the quarterly/annual reports made by each grantee
agency, provide data and narratives regarding the number of prenatal and postpartum
visits made, the number of preterm newborns, pregnancy outcomes, breastfeeding
initiation/duration data, smoking cessation, injury prevention and progress made toward
meeting goals and outcomes.
432 MCH Client Satisfaction Survey Card
The Maternal and Child Health (MCH) Client Satisfaction Survey card is used to
ascertain the client’s satisfaction with services received through each agency MCH
program. One of the services evaluated by the client is the Healthy Start visit. Survey
cards are to be provided to at least 20 percent of the clients receiving any MCH service.
The use of the survey card assists the MCH program in evaluating services to pregnant
women, their infants and children through both quantitative and qualitative data.
Survey cards are provided by KDHE to each local agency, given to clients at visits and
are sent to the state by each client. Data obtained from the MCH Client Survey cards
are summarized by a MCH administrative consultant and provided to the program
director. The MCH Client Survey cards are then returned to their respective agencies so
that each grantee may use the cards to identify areas of strengths/challenges to be
addressed.
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433 Do’s and Don’ts of Successful Home Visitation
The following “dos and don’ts” will assist home visitors in providing a valuable service to
the families served:
Some “do’s” to consider:
• Do be culturally sensitive, respecting cultural and ethnic values
• Do be a good listener
• Do have specific goals or objectives for each visit
• Do be flexible
• Do arrive promptly to your home visits
• Do realize the limitations of your role
• Do enable parents to become more independent
• Do keep language appropriate
• Do dress appropriately and comfortably
• Do be confident
• Do remember that small successes lead to big successes
• Do be yourself
• Do monitor your own behavior - you represent your agency and serve as a role
model for the parent who is watching you
• Do remember at all times to respect the confidentiality of the families you work
with
• Do remember that each family is trying to do their best with the resources they
have
Some “don’ts” to avoid:
• Don’t impose values
• Don’t bring other visitors without the parent’s permission
• Don’t socialize excessively during the visit
• Don’t exclude other members of the family from the visit
• Don’t talk about families in public
• Don’t be the center of attention
• Don’t expect perfection from the parent
434 Federal Healthy Start Programs Serving Kansas
The Health Resources and Services Administration (HRSA), a division of the U.S.
Department of Health and Human Services, funds a federal Healthy Start program that
is utilized in disparate population/communities demonstrating high infant morality rates
across the U.S. In Kansas, there are two federally funded Healthy Start programs
located in Sedgwick and Wyandotte counties. These programs are funded
independently of the HSHV services, although visitors with either of the programs may
also work with the other program.
In Wichita/Sedgwick County, the federally funded program is called Healthy Babies.
Information can be found at
www.sedgwickcounty.org/healthdept/healthybabies.asp
The Greater Kansas City Maternal Child Health Coalition’s Federal Healthy Start
Program is listed under Missouri as a Kansas City location. Information can be found at
www.mchc.net/programs/healthy_start.aspx
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435
•
•
•
•
•
•
•
References
Kansas Department of Social and Rehabilitation Services (SRS). (2006). A Guide
to Reporting Child Abuse and Neglect in Kansas. State of Kansas, Division of
Printing: Topeka.
www.srskansas.org/CFS/Child%20Abuse%20Reprting%20Guide.pdf.
Kansas Maternal and Child Health Measures. (2008). State 2007 results.
https://mchdata.hrsa.gov/TVISReports/
Kotch, J.B. (1997). Maternal and child health: Programs, problems and policy in
public health. Aspen Publishers, Inc., Maryland. 1997.
Loveland-Cherry, C.J. (1996). “Issues in Family Health Promotion” In M.
Stanhipe and J. Lancaster (Eds.). Community Health Nursing. (4th Edition) St.
Louis: C.V. Mosby Co.
Maternal and Child Health (MCH) Services Title V Block Grant: State Narrative
for Kansas. (2007). Application for 2008 / Annual Report for 2006. Bureau of
Family Health: Topeka. https://mchdata.hrsa.gov/TVISReports/
Shepherd, M. & Starrett, B. (2002). Kansas Department of Health and
Environment Healthy Start Home Visitor Program Evaluation, Kansas Health
Institute, 2002. www.khi.org/resources/Other/59-0202HealthyStart.pdf.
U.S. Department of Health and Human Services. Office for Civil Rights – HIPAA.
Medical Privacy - National Standards to Protect the Privacy of Personal Health
Information. www.hhs.gov/ocr/hipaa/
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440 Preconception Health
Preconception health refers to a woman’s health before she becomes pregnant. If the
woman is between pregnancies, her health may more accurately be referred to as
interconception health. In either case, care focuses on the conditions and risk factors
that could affect a woman should she become pregnant. Often, the concept of
preconception health applies to women who have never been pregnant and also to
women who could become pregnant again. Preconception health looks at factors that
can affect the unborn child as well as future health outcomes for a given child. A couple
of factors to consider are women who consume prescription drugs or alcohol during
pregnancy. The key to promoting preconception health is to combine the best medical
care, with healthy behaviors, strong support and safe environments at home and at
work for the women, infants and families we serve in maternal and child health.
441 Access to Health Care
Improving access to timely and appropriate health care for women of reproductive age
generally leads to an improvement in reproductive health outcomes. Preconception care
accomplishes this by aiming to promote the health of women of reproductive age before
conception and thereby improving pregnancy-related outcomes. For example, pelvic
exams can detect problems before they become severe. PAP tests are particularly
important for early detection of cervical cancer, which when found early can be treated
sooner and generally have a better prognosis. A woman should speak to her health
care provider about any concerns she may have with sexually transmitted infections
(STI’s), including the Human Immunodeficiency Virus (HIV), as well as any other health
concerns. It is of great concern for a woman to have access to readily available and
affordable health care in order to optimize future reproductive outcomes. It is here the
axiom applies, “the healthier the woman, the healthier her pregnancy.”
Resources
This website contains links to pages of information on preconception health for both the
public and health care professionals. The information discusses a wide variety of health
care topics pertinent to women of childbearing age to help educate health care
providers, women and men of the importance of preconception health. Health care
professionals website: www.marchofdimes.com/professionals/preconception.asp Public
website: http://marchofdimes.com/173.asp
The top three priorities for pregnant women and infants are located within the Kansas
2015 Statewide MCH Needs Assessment document. The first priority addresses the
need for women to have access to early and comprehensive health care before, during
and after pregnancy. www.datacounts.net/mch2015/
442 Sexually Transmitted Infections (STI)
Sexually transmitted infections (STI’s) can be spread through sexual intercourse
(vaginal, oral, or anal) with an infected person. They can also be spread by sharing
needles with an infected person. In addition, mothers can pass along STI’s to their
infants during pregnancy, birth and through breast milk, including HIV. The only certain
way to know the status of a given woman is through STI testing.
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Resources
The home page of the Bureau of Disease Control and Prevention on the KDHE website
contains links to information related to HIV/AIDS, STI’s, immunizations and tuberculosis.
This website also contains links to national resources available on the web.
www.kdheks.gov/bdcp/index.html
The CDC’s STD Prevention website contains comprehensive information on STI’s and
the associated methods of prevention. www.cdc.gov/std/
This website contains comprehensive information on HIV/AIDS prevention, statistics
and is stratified across various races and ethnicities. www.cdc.gov/hiv/
443 Intimate Partner Violence
Intimate partner violence (IPV) is abuse that occurs between two people involved in a
close personal relationship. This may involve current and/or former spouses or
significant others. The abuse occurs along a continuum of episodic to ongoing abusive
behavior in the following general categories: physical abuse, sexual abuse, the threat of
physical or sexual abuse, or emotional abuse. Most often, emotional abuse is a
precursor of physical and/or sexual abuse.
Resources
National Domestic Violence Hotline
1-800-799-SAFE (7233), 1-800-787-3224 TTY, or
www.ndvh.org
National Coalition Against Domestic Violence
www.ncadv.org
National Sexual Violence Resource Center
www.nsvrc.org
Family Violence Prevention Fund
www.endabuse.org
This CDC website includes links to a full spectrum of information concerning intimate
partner violence and initiatives to help prevent it.
www.cdc.gov/ncipc/dvp/IPV/default.htm
This is a comprehensive website that addresses the many issues surrounding intimate
partner violence in Kansas. www.kcsdv.org/
444 Alcohol, Tobacco and Other Drugs
Substance use by pregnant women is a leading preventable cause of mental, physical
and psychological problems in infants and children according to reports from the March
of Dimes. Several studies have indicated that the use of alcohol, tobacco and illicit
substances are lower among pregnant women than among non-pregnant women
whether or not they had become mothers recently. Therefore, educating women before,
during and after pregnancy on the adverse effects of the use of alcohol and other
substances on their health and on the health of their infant and family as well as
providing them avenues to counseling and treatment resources will go a long way
toward improving women’s health and in promoting optimal birth outcomes.
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Resources
This website contains information on the regional drug and alcohol assessment centers
in Kansas. A tool is available to locate a drug and alcohol assessment center near
persons in need of these services. www.srskansas.org/services/alc-drug_assess.htm
This national website is a place where resources are available for persons in need of
alcohol and drug prevention information. This site is designed both for the public and
health care professionals. Also, appearing on this site is a national hotline for the public
to use to find treatment services nearest them. www.samhsa.gov/
The Fetal Alcohol Spectrum Disorders (FASD) Center for Excellence website that is
maintained by SAMHSA in HHS at the Federal level contains a wide range of
information discussing FASD and how to prevent it. Their overall motto is: “Stop and
think. If you’re pregnant, don’t drink.” In addition, they have downloadable materials that
are free of charge to individuals and organizations interested in preventing FASD.
www.fascenter.samhsa.gov/
445 Nutrition
The appropriate intake of vitamins and minerals that a well-balanced diet provides to the
health of women in the preconception period helps set the stage for optimal pregnancy
outcomes. With this in mind, it is essential to educate women on the importance of
maintaining an intake of 400 micrograms of folic acid as a means of reducing the risk of
neural tube defects in infants. If a woman cannot maintain an adequate intake of folic
acid from her diet, then she should take it in the form of a nutritional supplement as
directed by her health care provider. Adequate intake of calcium and iron are important
to women’s health as well.
Resources
The March of Dimes provides an educational section on their website devoted solely to
the proper intake of folic acid as part of an ongoing effort to help reduce the occurrence
of neural tube birth defects. www.marchofdimes.com/pnhec/173_769.asp
This website on the National Birth Defects Prevention Network’s (NBDPN) website
provides a list of links to resources from state and national programs developed to
address the education of health care professionals in regard to folic acid and neural
tube defects with tools to help narrow the gap that exists between knowledge and
practice. www.nbdpn.org/current/resources/ntd_resources.html
The website for the Kansas Nutrition and WIC Services Program contains links to
comprehensive information on nutritional topics as well as in-depth program information
for local providers. www.kdheks.gov/nws-wic/index.html
446 Physical Health and Oral Health Status
Two of the more important areas that should be evaluated prior to and after a woman
becomes pregnant are a woman’s physical health and oral health status. Ideally, her
general physical status should be assessed by either the primary care physician or the
physician who will monitor her health during her pregnancy. Also, she should have
routine dental examinations to rule out oral disease and to provide treatment when
necessary, since infections from oral disease can affect the health of the mother and
infant.
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Resources
Bright Futures in Practice: Oral Health – Pocket Guide is designed to help health
professionals implement specific oral health guidelines during pregnancy and
postpartum, infancy, early childhood, middle childhood and adolescence. In addition, it
addresses risk assessment for dental caries, periodontal disease, malocclusion and
injury. www.mchoralhealth.org/pocket.html
This website provides a comprehensive view of oral health for Kansas containing links
to many useful resources. www.kdheks.gov/ohi/index.html
A comprehensive list of health topics and medical conditions for women is presented on
this website. Each topic area provides an in-depth discussion in the area of interest and
provides links to additional resources. www.womenshealth.gov/topics.cfm
447 Physical Activity
It is important to educate women on maintaining a regimen of routine physical activity
that has been shown to have numerous health benefits including: lowering stress and
blood pressure levels, increasing energy, toning of various muscle groups, increasing
flexibility and improving one’s ability to lead a longer and healthier life. Women should
be educated on the balance needed between exercise, rest and nutritional intake.
Resources
The Kansas Physical Activity and Nutrition Program website at KDHE contains a variety
of statewide initiatives in the areas of physical activity and nutrition. A list of upcoming
events in this area is provided. www.kdheks.gov/bhp/pan/index.htm
This CDC website provides comprehensive information on physical activity for
individuals of all ages, health care professionals and links to other healthy lifestyle
topics (e.g., nutrition and healthy weight). www.cdc.gov/physicalactivity/
448 Cultural Competence
Disease-specific health disparities disproportionately impact African-American,
Hispanic, Asian and Native American populations in Kansas and nationally. The health
issues that need to be addressed for these populations include cancer, diabetes,
HIV/AIDS, immunizations, cardiovascular disease, maternal and child health and mental
health. Therefore, a primary goal in Kansas is that of eliminating disparities where they
exist. The KDHE Center for Health Equity has created a strategic plan to develop,
improve and implement effective methods to increase access to culturally and
linguistically competent health care for all racial/ethnic populations statewide.
Resources
The KDHE Center for Health Equity website provides information about the social
determinants of health, equity health disparities and cultural competency. In addition,
information on current activities, links to national resources and upcoming events is
provided. www.healthequityks.org/
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449 Emergency Planning
The possibility of public health emergencies arising in the United States concerns many
people in the wake of recent hurricanes, tsunamis, acts of terrorism and the threat of
pandemic influenza. Though some people feel it is impossible to be prepared for
unexpected events, the truth is that taking preparedness actions helps people deal with
disasters of all sorts much more effectively when they do occur. For families, it is
important to know what to do in the case of such emergencies and to be ready to take
action as these emergencies arise. Much work on emergency planning activities for
women, infants and families remains to be accomplished.
Resources
This website is devoted to information for women and families interested in making
emergency disaster plans to use before, during and after a disaster.
www.marchofdimes.com/pnhec/159_21889.asp
This link is to a document that provides a fairly comprehensive checklist of items for
families to maintain in case of a disaster.
www.getreadyforflu.org/clocksstocks/stockpilingchecklist.pdf
This is an interactive website designed by the Florida Department of Emergency
Management that contains tools and information for the general public, businesses,
emergency management partners, children and the news media in preparation for
disasters. www.floridadisaster.org/family/
This is an interactive website designed by the Kansas Department of Health and
Environment regarding emergency management. It contains tools and information for
the general public, businesses, emergency management partners, children and the
news media in preparation for disasters. www.kdheks.gov/cphp/index.htm
450 General Preconception Health Resources
The ten recommendations to improve preconception care as provided by the
Preconception Care Work Group and the Select Panel on Preconception Care
convened by the Centers for Disease Control and Prevention (CDC) and the Agency for
Toxic Substances and Disease Registry (ATSDR) are presented in this document.
www.cdc.gov/mmwr/PDF/rr/rr5506.pdf
This website contains a wide variety of information dedicated to women’s health topics,
including reproductive health issues. Informational resources can be found here in both
Spanish and in English. www.womenshealth.gov/
One can access links to information on a variety of topics related to HIV/AIDS, STI’s,
immunizations and tuberculosis on this website. It also contains links to national
resources available on the web. www.kdheks.gov/bdcp/index.html
A comprehensive coverage of topics that deal with preconception health from a variety
of viewpoints can be accessed on the March of Dimes website.
www.marchofdimes.com/pnhec/173.asp
To reflect the ever-changing, increasingly diverse population and its characteristics,
Women’s Health USA Data Books selectively highlight emerging issues and trends in
women’s health. Data and information on occupational injury, maternal mortality,
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digestive disorders, oral health, eye health and urologic disorders are only a few of the
new topics included in the data books. www.hrsa.gov/womenshealth/ The data books
appear as web links in the "Women's Health Data Books" section on this web page.
The Prevention Works website at KDHE provides a set of resources to help Kansans
improve their health. Links are included to cancer, tobacco, cardiovascular health,
obesity, diabetes and many other health-related topics and prevention tools.
www.preventionworkskansas.org/
This website at the CDC provides comprehensive coverage of emergency
preparedness issues for the U.S. with links to related resources.
http://emergency.cdc.gov/
460 Prenatal Health
461 Access to Health Care
Prenatal care is care that is provided to women while they are pregnant. The primary
goal of prenatal care is to monitor the progress of the pregnancy and to identify any
concerns as early as possible. Pregnant women are assessed for any individual
characteristics affecting pregnancy, such as genetic, psychosocial, nutritional and
historical and emerging obstetrical/fetal and medical-surgical risk factors. For any
identified risk factors, women are given referrals to appropriate and readily available
services to meet their needs. Research indicates that women who are seen regularly
during their pregnancy generally have healthier infants, are less likely to deliver
prematurely and develop serious pregnancy complications. Women are seen an
average of between 12 and 15 visits per uncomplicated pregnancy.
It is essential that women are able to access appropriate and affordable prenatal care
services in order to achieve optimal birth outcomes.
462 Prenatal Screening Tests
As part of routine prenatal care, health care providers screen for conditions that are
associated with pregnancy by performing a series of tests. For example, this may
include drawing blood to check the Rh factor, iron levels, infections such as hepatitis B
and other STI’s and for immunity to rubella (German measles). Another test that is
usually performed is a Papanicolaou (Pap) smear to check to for cervical cancer. Also,
various tests are performed to check on the health of both the mother and her infant
involving the use of ultrasound, blood sugar screening, assessing for alpha-fetoprotein
(AFP), performing amniocentesis as well as chorionic villus sampling (CVS).
Resources
An in-depth discussion of the many procedures performed in the prenatal (antepartum)
period for both mother and infant are provided in this section of the text, Guidelines for
Perinatal Care, Sixth Edition, American Academy of Pediatrics, The American College
of Obstetricians and Gynecologists, October, 2007, pp. 99-118.
Under the heading of “Prenatal Tests” on this website, a list of links to information on an
assortment of prenatal tests is provided.
www.marchofdimes.com/pregnancy/prenatalcare_routinetests.html
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463 Genetic Screening
Genetic screening and diagnosis should be offered on a voluntary basis for those
individuals with a definable increased risk for a fetal genetic disorder. Genetic
consultation may prove beneficial for women during the preconception and prenatal
periods according to a set of guidelines developed by the American College of Medical
Genetics (ACMG), listed under resources in this section. Prenatal genetic counseling
addresses the prevalence of a genetic disorder in a family. It provides families with
more options when developing a reproductive plan.
Resources
This document, developed by the American College of Medical Genetics provides
guidelines for medical geneticists and other health care providers to provide quality
medical genetics services.
www.acmg.net/AM/Template.cfm?Section=Practice_Guidelines&Template=/CM/Conten
tDisplay.cfm&ContentID=2748
464 Risks, Warning Signs and Hazards
One of the common risks during pregnancy is miscarriage or pregnancy loss. Most
miscarriages occur during the first 12 weeks of pregnancy. The warning signs of
miscarriage may include: abdominal cramps or pain, vaginal bleeding, passing blood
clots or whitish or grayish material or a noticeable decrease in fetal movement. Women
should be instructed to notify their health care provider if any of these signs are noted
during pregnancy.
Another common adverse condition of pregnancy is preterm labor. Preterm labor is
evidenced by a pregnant woman going into labor three weeks or more before she is due
to deliver. This is a dangerous condition for both mother and infant. The hallmark
warning signs of preterm labor are: contractions occurring 4-6 times or more in an hour;
menstrual-like cramps; low, dull back ache; an increase in vaginal discharge or any
other unusual discharge; or the bag of waters breaking. Other warning signs may occur
as well. If a woman has diabetes, high blood pressure or any other health condition, she
should be instructed to ask her health care provider about taking special precautions.
Some hazards to avoid during pregnancy are: x-rays, household or workplace
chemicals, lead, soiled cat litter and hot tubs or saunas. Women should be instructed on
the dangers of physical abuse and that the occurrence of abuse often increases during
pregnancy. Pregnant women should be instructed to talk to their health care provider
about resources to help them immediately.
Resources
The Healthy Pregnancy Home page on The National Women’s Health Information
Center’s website contains a comprehensive set of links to women and health care
professionals regarding pregnancy, complications, readying oneself for a baby,
childbirth, adoption and much more. Resources also are provided in Spanish.
www.womenshealth.gov/pregnancy/
The March of Dimes Pregnancy page provides a comprehensive set of resources for
women and health care professionals on the topic of pregnancy and newborn care
including miscarriage and preterm labor. www.marchofdimes.com/pnhec/pnhec.asp
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The CDC provides comprehensive information related to pregnancy issues that occur
before, during and after women become pregnant. There are also links to information
covering topics related to those women who have difficulty becoming pregnant and for
those who want to avoid pregnancy. There is a link to an area for health care
professionals. www.cdc.gov/ncbddd/pregnancy_gateway/default.htm
465 Sexually Transmitted Infections (STI)
Refer to this topic under the Preconception Health section for resources and
information.
466 Intimate Partner Violence
Refer to this topic under the Preconception Health section for resources and
information.
467 Alcohol, Tobacco and Other Drugs
No safe levels have been established for the use of any of these substances during
pregnancy and much research has been devoted to providing evidence of actual harm
that is caused to pregnant women and infants. A pregnant woman presenting with a
positive screen for the use of alcohol or other substances should automatically trigger
an intervention indicating the clinician’s concern to the pregnant woman for her health
and that of her infant. A referral for intervention and treatment, if indicated, should be
provided. This may be as simple as providing the pregnant woman with a toll-free
hotline or by making a referral to a local mental health center or substance abuse
counseling service.
Resources
The Substance Abuse & Mental Health Services Administration (SAMHSA) provides
comprehensive information on mental health and substance use issues and links to
programs and initiatives designed for individuals, agencies and organizations to use to
implement evidence-based programs and practices in their communities.
www.samhsa.gov/
The Screening, Brief Intervention and Referral to Treatment (SBIRT) booklet provides
information on the effectiveness of this evidence-based practice for the screening, brief
intervention and referral to treatment of individuals assessed for the use of alcohol,
tobacco and other substances. To order a free booklet about SBIRT from the SAMHSA
website visit http://store.samhsa.gov/facet/Issues-Conditions-Disorders
The Kansas Tobacco Use Prevention Program has a website hosted at KDHE that
provides evidence-based information on prevention and intervention techniques for
tobacco cessation. A toll-free quit line number is provided. www.kdheks.gov/tobacco/
The Fetal Alcohol Spectrum Disorders (FASD) Center for Excellence website that is
maintained by SAMHSA in HHS contains a wide range of information about FASD and
how to prevent it. Their motto is: “Stop and think. If you’re pregnant, don’t drink.” They
have downloadable materials that are free of charge to individuals and organizations
interested in preventing FASD. www.fascenter.samhsa.gov/
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This website has information helpful in prevention of the use of alcohol and other
substances within a statewide program to promote positive youth behaviors. It supports
diverse families and communities in Kansas through education, networking and
advocacy. www.kansasfamily.com/index.cfm
468 Nutrition
Pregnant women need to eat a balanced diet that includes a variety of healthy foods in
order to get the nutrients necessary for the healthy development of their infants.
Pregnant women should consume at least six to eight glasses of fluids including water,
milk or juice every day. Drinks containing caffeine (teas, colas, coffee, energy drinks
and others) as well as any drink that contains any amount of alcohol should be avoided
due to safety concerns for the developing infant. A woman of average weight and size
should gain approximately 25 – 35 pounds during pregnancy. Pregnant women should
be cautioned about trying to lose weight during pregnancy as this has the potential to
harm the developing infant. Pregnant women should be instructed to consume an
adequate amount of folic acid to prevent birth defects to the neural tube; additional
calcium to strengthen bones and teeth and a sufficient amount of iron to help her body
maintain an adequate supply of blood.
Resources
The “What to Eat While Pregnant” webpage of The National Women’s Health
Information Center website contains a compendium of links to information concerning
nutrition, exercise and things to avoid during pregnancy.
www.womenshealth.gov/pregnancy/you-are-pregnant/staying-healthy-safe.cfm#a
The website for the Kansas Nutrition and WIC Services contains links to comprehensive
information on nutritional topics as well as in-depth program information for local
providers. www.kdheks.gov/nws-wic/index.html
The March of Dimes Pregnancy website contains topics specific to nutrition during
pregnancy as well as many other pregnancy-related topics.
www.marchofdimes.com/pnhec/159.asp
469 Physical Health and Oral Health Status
Refer to this topic under the Preconception Health section for information and
resources.
470 Physical Activity
Pregnant women should continue to exercise according to a regimen that meets with
the approval of their health care provider to help maintain increased strength and
energy levels, to develop toned muscles needed for delivery, as well as a means of
reducing stress. It is important for pregnant women to get an adequate amount of rest.
Resources
This website provides comprehensive information covering the topic of physical activity,
nutrition and obesity with links to resources, tools and information for the general public
and health care practitioners. www.cdc.gov/nccdphp/dnpa/index.htm
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The website of the Kansas Physical Activity and Nutrition Program at KDHE provides
information that promotes healthy eating and increased physical activity to communities
in Kansas. Links are provided to the Capital City Wellness Project, Kansas Lean, Kids
Kansas Fitness Day, the Healthy Kansas Communities Toolkit, Capitol Midweek
Farmer’s Market and to upcoming events as well as other Kansas and national
resources. www.kdheks.gov/bhp/pan/index.htm .
471 Cultural Competence
Refer to this topic under the Preconception Health section for resources and
information.
472 Emergency Planning
Refer to this topic under the Preconception Health section for resources and
information.
473 Immunizations
Pregnant women, as a group, tend to have higher rates of illness and death from
influenza than other groups. According to some surveys of pregnant women, getting a
shot to prevent influenza is not of primary concern to them when discussing prenatal
care issues.
It is safe for a woman to receive flu vaccine during pregnancy, soon after giving birth
and while breastfeeding. The best protection against flu that a new mother can provide
is for her and all those around her new baby to be vaccinated against the flu virus.
Babies cannot be vaccinated against the flu until they are six months of age.
A woman who has not received the new vaccine for the prevention of tetanus,
diphtheria and pertussis (Tdap) as well as any potential caregivers for her baby should
be vaccinated right after delivery. Vaccinating a new mother and potential caregivers of
her baby against pertussis (whooping cough) reduces the risk of a disease that can
have severe consequences for infants.
Resources
The CDC’s Advisory Committee on Immunization Practices (ACIP) website concerning
the immunization of special populations includes sections on the vaccination of
pregnant and breastfeeding women for influenza utilizing the inactivated version of the
influenza vaccine. www.cdc.gov/flu/professionals/acip/specificpopulations.htm#pregnant
Downloadable influenza materials are provided on this website maintained by the
Kansas Immunization Program at KDHE. www.kdheks.gov/flu/download.html
This March of Dimes website provides in-depth information on vaccinations during
pregnancy. www.marchofdimes.com/pnhec/159_16189.asp
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474 Labor and Delivery
Labor feels different for every woman that experiences it. The only true sign that labor
has begun is when contractions come frequently and regularly. Labor may vary
considerably between women as well. Labor during first deliveries lasts from 12 to 14
hours. During subsequent deliveries labor may occur much faster. The best way to learn
about labor and delivery is for women to take childbirth classes with their spouses or
significant others. Some other signs of labor may include a bloody “show,” which is
evidenced by a thick plug of mucus or discharge and often involves a gush or slow leak
of amniotic fluid as a result of the placental sac that surrounds the infant in the womb
breaking.
Childbirth is complete when the delivery of an infant followed by the delivery of the
placenta occurs. Infants are primarily delivered by two methods: vaginally and by
Cesarean Section (a surgical procedure). Cesarean Sections are usually conducted
when the health of either the mother and/or infant is endangered. Other procedures that
sometimes surround the birth of an infant include: labor induction (causes the uterus to
contract), electronic fetal monitoring, episiotomy and the use of intravenous lines.
Resources
Comprehensive information to consumers and health care professionals alike on the
topic of labor and delivery is presented in this web section.
www.marchofdimes.com/labor.html
A section of text in this resource book discusses the medical procedures and care of
pregnant women and infants during labor and delivery. Guidelines for Perinatal Care,
Sixth Edition, American Academy of Pediatrics, The American College of Obstetricians
and Gynecologists, October, 2007, pp.144-162.
475 General Prenatal Health Resources
This website is a good source of information for answers to frequently asked questions
about prenatal care. www.womenshealth.gov/faq/prenatal-care.cfm
This website provides ordering information for Bright Futures materials for a wide variety
of populations with additional information provided for health care practitioners including
a link for anyone wishing to sign-up for Bright Futures newsletter updates:
http://brightfutures.org/
This website contains a compendium of information on the topic of preterm birth in a
continuing education format. This information is presented as part of a larger initiative
aimed at helping to decrease the increasing trend of preterm births across the nation.
www.marchofdimes.com/prematurity/21329_20738.asp
On this website, one can learn about prematurity issues and join in the campaign to
help prevent premature births if desired.
www.marchofdimes.com/prematurity/prematurity.asp
The March of Dimes Pregnancy page provides a comprehensive set of resources for
women and health care professionals on the topic of pregnancy.
www.marchofdimes.com/pnhec/pnhec.asp
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This is a great resource for mothers written as a survival guide that answers questions
related to sex, pregnancy and children’s care with a focus on African American women.
http://mochamanual.com/mochamanual/
The Healthy Pregnancy Home page on this website contains a comprehensive set of
links for women of reproductive age and health care professionals regarding pregnancy,
complications, readying oneself for a baby, childbirth, adoption and much more.
Resources also are provided in Spanish. www.womenshealth.gov/pregnancy/
Information for the current season including vaccine composition, dosage &
administration, recommendations for specific populations and more topics are provided
by ACIP. www.cdc.gov/flu/professionals/acip/index.htm
This website provides comprehensive coverage of exposures in pregnant women to
medications, drugs, chemicals and other items thought to be harmful to a developing
fetus. http://otispregnancy.org/otis_about_us.asp
480 Postpartum Health
481 Access to Health Care
The adjustments in the postpartum period pertain predominantly to the recovery from
the labor and delivery process and related adaptations to life with a new child.
Adaptations to the role of being a parent become very real and it is necessary for the
woman and her family to make adjustments to previous habits as well as to obtain
mastery of the tasks and responsibilities inherent in the parent role. The mother is
adapting to the many physiological changes taking place in her body after delivery.
Some of these changes may last up to one year or more postpartum and can be
influenced by physical, nutritional and psychosocial needs. An on-going assessment of
her needs during the one year postpartum time period is essential to her health and
well-being and that of her family. Care coordination and discharge planning services as
well as communication among service providers are essential components in a system
of care whose aim is to ensure an orderly transition from pregnancy to parenthood for
women and their families.
482 Common Considerations
Before discharge, recently delivered women should be instructed on the following:
• Signs of complications
• A range of activities that she will safely be able to perform
• Changes in menstruation
• Care of her breasts perineum and bladder
• Dietary needs
• Recommended exercise
• Expected/unexpected emotional responses
Additional care information based on the type of delivery and precautions should be
given as well, especially concerning wound care and the avoidance of lifting heavy
objects and driving vehicles. Sexual difficulties may be seen in the first few months
postpartum related to the healing process and the demands of caring for a young infant.
A discussion of a family’s reproductive health plan is either revisited or developed at this
time.
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Resources
This resource provides information on considerations for recently delivered women and
their infants. Guidelines for Perinatal Care, Sixth Edition, American Academy of
Pediatrics, The American College of Obstetricians and Gynecologists, October, 2007,
pp. 162-172.
This website provides links to information regarding how women can keep themselves
and their infants safe and healthy. In addition, information is provided on immunizations,
birth defects and medical conditions.
www.cdc.gov/ncbddd/pregnancy_gateway/after.htm
This website provides links to a wide variety of information that is useful for women
interested in topics related to feelings after delivery and the care of newborns.
www.marchofdimes.com/pregnancy/postpartum.html
483 Sexually Transmitted Infections (STI)
Refer to this topic under the Preconception Health section for resources and
information.
484 Intimate Partner Violence
Refer to this topic under the Preconception Health section for resources and
information.
485 Nutrition
Dietary needs for postpartum women are similar to their nutritional needs during
pregnancy. If breastfeeding is occurring, then new mothers will need to take in extra
calories, vitamins, minerals and other nutrients in their diets in order to be able to
sustain an adequate milk supply for their nursing infants.
Resources
This website contains links to multiple nutrition resources.
www.kansaswic.org/nutrition_education/nutrition_edu_resources.html
This resource provides a discussion of postpartum nutritional guidelines including
nutritional needs for breastfeeding women, maternal postpartum weight loss and
residual postpartum weight gain.
Guidelines for Perinatal Care, Sixth Edition, American Academy of Pediatrics, The
American College of Obstetricians and Gynecologists, October, 2007, p.168.
486 Physical Activity
Unless there is a medical condition that prevents women from becoming physically
active after childbirth, they can begin a program of moderate activity. Some activities
are: brisk walking, push-mowing a lawn, participation in a dancing class or playing
doubles tennis.
Resources
This website provides information for healthy pregnant and postpartum women in regard
to questions concerning appropriate physical activity.
www.cdc.gov/physicalactivity/everyone/guidelines/pregnancy.html
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487 Cultural Competence
Refer to this topic under the Preconception Health section for resources and
information.
488 Emergency Planning
Refer to this topic under the Preconception Health section for resources and
information.
489 Immunizations
The postpartum period is an excellent time to immunize women against rubella and
varicella infections. The rubella vaccination is given to women who were noted as not
having immunity to rubella during routine prenatal testing. The varicella vaccine is given
to women four to eight weeks apart conferring immunity to about 94 % of those
immunized. The postpartum period is a good time to catch up on other immunizations
such as: tetanus-diphtheria-polio (Td or Tdap), hepatitis B and mumps.
Resources
The website of the Kansas Immunization Program contains in-depth program
information for local health care providers as well as links to comprehensive information
on immunization topics. www.kdheks.gov/immunize/index.html
This section of the text describes the immunizations that can be administered to women
after childbirth and precautions that should be noted.
Wheeler, Linda. Nurse-midwifery Handbook: A Practical Guide to Prenatal and
Postpartum Care, Lippincott, Wilkins & Williams, 2002, p. 355.
This portion of the text provides a discussion of immunizations for women after delivery.
Guidelines for Perinatal Care, Sixth Edition, American Academy of Pediatrics, The
American College of Obstetricians and Gynecologists, October, 2007, p. 166.
490 Mental Health Considerations
Many hormonal changes occurring during the postpartum period can lead to expected
and sometimes unexpected emotional responses. Special consideration needs to be
given to women in regard to situations involving pregnancy loss, infant death, any
previous existing mental health condition and to perinatal mood disorders. Postpartum
depression is the most commonly identified disorder. Women, when given proper
support and resources, can overcome or reduce the symptoms associated with these
disorders.
Perinatal Mood Disorders
Perinatal Mood Disorders is an umbrella term that refers to a range of mental disorders
that occur in some women during pregnancy including: depression, anxiety disorder,
obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder and
bipolar spectrum disorders. Mental health professionals trained in the diagnosis and
treatment of these disorders can best identify and design treatment programs to quickly
help women to recover from and/or control any symptoms.
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Resources
This website contains a comprehensive set of links to information on pregnancy and
newborn loss. Many of the links are to information on grief-related resources and tools
that help in dealing with pregnancy loss and newborn death.
www.marchofdimes.com/pnhec/572.asp
This is a website designed to give parents, child care providers, relatives and health
care professionals information on how to deal with the loss of an infant as well as
current information on infant health and safety. http://firstcandle.org/
This website provides information to those who are or may be touched by the tragedy of
SIDS by providing supportive services for all those affected, community awareness,
professional development and support for medical research efforts. www.sidsks.org/
This website has a comprehensive set of resources for women who are experiencing
the effects of symptoms caused by perinatal mood disorders and for health care
professionals that care for them. Of special note is a national map locator tool that
serves as a link to information on where women can find resources to address their
disorders. http://postpartum.net/
This is a resource for Kansas women, families and health care professionals concerning
postpartum depression. The primary goal of this website is to provide information,
support and resources to assist women and their families in recovering from the effects
of postpartum depression. www.kansasppd.org/
491 General Postpartum Health Resources
A comprehensive discussion of how to provide medical follow-up for mothers in the
postpartum period including topics ranging from immediate hospital-based care to the
care that takes place after going home as well as infant care.
Guidelines for Perinatal Care, Sixth Edition, American Academy of Pediatrics, The
American College of Obstetricians and Gynecologists, October, 2007, pp. 162-172.
This website is a knowledge path that provides comprehensive coverage of depression
during and after pregnancy. www.mchlibrary.info/knowledgepaths/kp_postpartum.html
This website provides information and resources covering exposures to medicines,
drugs, chemicals and other items thought to be harmful to infants who are being
breastfed. http://otispregnancy.org/otis_fact_sheets.asp
This website is a compendium of data compiled on the various aspects that impact
women’s overall health. This annual report of women’s health selectively highlights
emerging issues and trends in women’s health. http://mchb.hrsa.gov/mchirc/whusa/
492 Breastfeeding
Many people agree that breastfeeding is best for infants, families and the world. While
the goal is to help every mom who wants to breastfeed have a successful breastfeeding
experience, barriers to breastfeeding success crop up every day. Preventing barriers
and teaching moms and families how to manage situations is good for everyone.
www.ksbreastfeeding.org/
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493 Sudden Infant Death Syndrome (SIDS)
SIDS is the sudden and unexplained death of an infant who is younger than one year
old. Most SIDS deaths are associated with sleep and infants who die of SIDS show no
signs of suffering. Most SIDS diagnoses come only after all other possible causes of
death have been ruled out through a review of the infant's medical history and a
thorough death scene investigation. This process helps distinguish true SIDS deaths
from those resulting from accidents, abuse and previously undiagnosed conditions,
such as cardiac or metabolic disorders. Other potential risk factors include: smoking,
drinking or drug use during pregnancy, poor prenatal care, prematurity, low birth-weight,
mothers younger than 20, tobacco smoke exposure following birth, stomach sleeping,
overheating from excessive sleepwear and bedding. http://sidsks.org/
494 Safe Haven: Newborn Infant Protection Act
The birth of a child is a life changing event for families. The stresses related to parenting
become overwhelming for some. As a result, baby abandonment is a tragedy that is
happening in the United States. Kansas has the Newborn Infant Protection Act in place
called “A Safe Haven for Newborns” to help prevent baby abandonment.
A Safe Haven for Newborns began in response to the tragedy of infant
abandonment in Florida. We see and read about abandoned babies all too often
– it is heart breaking. The Safe haven law is a safety net for both the mother and
the newborn infant. Instead of abandoning a newborn to an almost sure death, it
allows mothers, fathers or whoever is in possession of an unharmed newborn,
approximately seven days old or less, to leave them at a Safe Haven facility: Any
Hospital, Staffed 24/7 Fire Rescue Station, or Staffed 24/7 Emergency Medical
Service Station, with no questions asked, totally anonymous, free from fear of
prosecution...... A compassionate approach which is saving lives.
www.asafehavenfornewborns.com/
2009 Kansas Statutes Annotated (K.S.A.)
Chapter 38: Minors
Article 22: Revised Kansas Code for Care of Children
Statute 38-2282: Newborn infant protection act.
a) This section shall be known and may be cited as the newborn infant
protection act.
b) A parent or other person having lawful custody of an infant which is 45
days old or younger and which has not suffered bodily harm may
surrender physical custody of the infant to any employee who is on
duty at a fire station, city or county health department or medical care
facility as defined by K.S.A. 65-425 and amendments thereto. Such
employee shall take physical custody of an infant surrendered
pursuant to this section.
c) Continued, see
http://kansasstatutes.lesterama.org/Chapter_38/Article_22/382282.html
Policies, procedures and protocol must be in place.
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The United Way of the Great Plains in Wichita as well as the United Way of Greater
Kansas City both support this project with their 2-1-1 Call Centers.
For more information, visit the following websites:
www.mchc.net/programs/safe_havens.aspx
www.asafehavenfornewborns.com/
For more information about the “Safe Haven for Newborns” signs, contact the Bureau of
Family Health at 785-296-1300.
500 Infant Health
501 Access to Health Care
A unique opportunity exists at birth for the parent and infant to become established in a
medical home through referral to a pediatrician for follow-up care after going home from
the hospital or birthing center. It is during these follow-up care visits that the parent(s)
are in direct contact with practitioners in the health care system. Visits for the newborn
as well as the mother (see Postpartum Health section) may vary according to number of
visits based on health status. The more maternal or neonatal complications, the greater
the number of visits. The earlier any developmental conditions or complications related
to delivery are identified and given appropriate treatment the better the long-term
outcomes will be for a given child. Better long-term outcomes are more likely for a given
child when psychosocial, nutrition and other health-related needs are identified early
and appropriate treatment and referral to resources designed to meet those needs are
provided.
502 Parent-Infant Bonding
Parent-infant bonding is a term that refers to the formation of the natural strong bond
between parent and infant. Parent-infant bonding generally results from interactions
involving the parental responsibility in caring for an infant and the infant’s total
dependence on the care that its parent provides. In this process, very strong emotional
ties are established that affect an individual for a lifetime. Theorists from the field of
psychoanalysis state that the first loving relationship an infant forms with its parent(s)
forms the basis for all future interpersonal relationships.
Resources
This journal reference provides an overview of several books that discuss the topic of
parent-infant bonding from varying viewpoints.
Archives of Disease in Childhood, 1982, 57, pp. 891-2.
A classic text on the subject of parent-infant bonding that has since spurred much
research arguing both for and against the concept.
Klaus, M. H. and Kennell, J. H. Parent/Infant Bonding, Second Edition, St. Louis: Mosby
Co., 1982.
This website has interactive videos for parents and others concerning pregnancy and
newborn care. In addition, there is information about the postpartum period. Many tips
and pointers for parents to put into use are also included.
www.marchofdimes.com/pnhec/pnhec.asp
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503 Infant Mental Health
The field of infant mental health stresses that infancy is a critical period in the
psychosocial and emotional development of individuals. It is a critical period of time
where children and families can receive early intervention services for any identified
psychosocial, emotional, medical or nutritional needs. All of those circumstances which
occur before, during and after pregnancy have an impact on an infant’s mental health as
well. Some of the conditions that can impact infant mental health are: maternal stress
levels during pregnancy, maternal nutrition status before, during and after pregnancy,
living conditions and any chronic or current medical and mental health conditions.
Resources
This is a Kansas resource for parents, health care providers, infant mental health
providers and others interested in learning more about infant mental health. It is both an
information resource and a source of support. www.kaimh.org/
This is a national resource for health care providers and those working in the field of
infant mental health to obtain evidence-based information on promoting first
relationships between mothers and infants.
www.ncast.org/index.cfm?fuseaction=category.display&category_id=23
This website provides the history and results from training efforts instituted in various
early childhood settings using the Promoting First Relationships program.
www.ncast.org/PFR_Research.html
504 Newborn Screening
Two of the more prominent types of screenings for newborns are metabolic and
hearing.
Newborn metabolic screening
Newborn metabolic screening involves screening for chemical changes within the cells
of newborns that can result in physical problems, developmental disorders and death.
Sometimes these conditions are referred to as birth defects. Currently, the American
College of Medical Genetics (ACMG) recommends screening for 29 metabolic
disorders.
Newborn hearing screening
Newborn hearing screening is a screening that the CDC recommends to be performed
within the first month of life to rule out hearing impairment, one of the most commonly
occurring birth defects. Children are not usually identified with hearing impairments until
age two or three. Early screening helps to avoid delays in the development of language
and communication skills for those infants identified with hearing impairment by
assuring follow-up care. As with other areas of development, the goal of early
screening, diagnosis and treatment is to assure that children can develop in a manner
similar to their peers.
Resources
This website provides information on the Kansas Newborn Hearing Screening Program
also known as, “Sound Beginnings.” www.soundbeginnings.org/
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This website provides information for parents and health care providers. In addition, a
short video is available called, “Sound Beginnings” for parents.
www.infanthearing.org/index.html
This website provides information on the Kansas Newborn Screening Program with
links to many different resources including links to related legislation and regulations.
www.kdheks.gov/newborn_screening/index.html
505 General Infant Care
Volumes have been written on the topic of caring for newborns from perspectives
including medical, legal, social services, parent and child advocacy, maternal and child
health among others. Infant care involves taking care of an infant’s needs for
nurturance, safety, avoidance of illness and disease, nutrition, clothing, rest,
cleanliness, development and attention to their attempts made at communicating any of
these needs. As mentioned previously, the establishment of a medical home for the
infant and family will go a long way toward assuring that the needs of infants are being
met.
Resources
This website provides information on recalls for children’s toys, furniture, clothing and
equipment. www.cpsc.gov/
This website links to an interactive program for new parents to learn all about how to
interact with and take care of their new infants.
www.marchofdimes.com/pnhec/28699_19650.asp
This website provides links to a variety of resources for parents to investigate
concerning health and safety topics related to caring for their children.
http://www.healthychildren.org/English/Pages/default.aspx
506 Growth and Development
The normal development of infants includes learning to roll over, sit, crawl and walk.
This developmental process occurs in stages of about three months duration beginning
with their ability to roll over in the first three months to walking by about their first year.
Infants are developing mentally, socially and emotionally as indicated in the sections on
infant mental health and parent-infant bonding in a process that involves the use of all of
their senses. As infants develop, parents grow in their ability to care for and nurture
them as well.
Resources
This website offers information about implementing medical homes.
www.medicalhomeinfo.org/
This link is to a resource on visits during infancy covering a wide variety of topics related
to growth and development as one part of the Bright Futures materials.
http://brightfutures.aap.org/pdfs/Guidelines_PDF/15-Infancy.pdf
This resource is a chart that details the AAP’s recommendations for preventative
pediatric health care. http://brightfutures.aap.org/pdfs/Guidelines_PDF/20Appendices_PeriodicitySchedule.pdf
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This website provides detailed information on the clinical growth charts as well as a set
of links to the clinical growth charts that have been divided into two general sets.
www.cdc.gov/nchs/about/major/nhanes/growthcharts/clinical_charts.htm
507 Infant Nutrition
The decision of how and what to feed an infant should ideally begin in a discussion
between women and their health care provider either before becoming pregnant or
during the first prenatal visit. In this way, women can learn all about making this most
important choice and how to prepare themselves nutritionally, physically, mentally and
emotionally. This involves making a decision on whether to provide breast milk for their
infant or infant formula. The American Academy of Pediatrics (AAP) and the Special
Supplemental Nutrition Program for Women, Infants and Children (WIC) have made
statements strongly in support of breastfeeding infants during the first six months of life
if both mother and infant are capable of providing/receiving this type of nutrition.
Resources
This website provides information to parents on breastfeeding, formula feeding and
when infants should start solid foods. In addition, links to other resources on
breastfeeding, breastfeeding support groups, breastfeeding tools and a guide to feeding
and food safety for infants are available.
www.marchofdimes.com/pnhec/298_26823.asp
This fact sheet provides helpful tips on proper nutrition and physical activity to provide to
breastfeeding mothers.
www.nal.usda.gov/wicworks/Topics/BreastfeedingFactSheet.pdf
An initiative designed to involve African American fathers in supporting their children’s
mothers’ efforts to breastfeed is presented on this website.
www.fns.usda.gov/wic/Fathers/SupportingBreastfeeding.HTM
This is a link to the American Academy of Pediatrics 2005 policy statement on
breastfeeding.
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;115/2/496
508 Oral Health
During infancy much of the focus is on ensuring that infants get sufficient amounts of
nutrition in order to support the rapid growth and development that is occurring. Equally
important is maintaining an infant’s oral health status. Instructions to parents should
cover the effects of baby bottle tooth decay, methods of cleaning teeth and gums as
well as the possible need for fluoride supplementation for infants that breastfeed or
those whose formula is prepared with water containing an insufficient amount of
fluoride. This information will help parents provide care to their infants to help avoid
cavities and promote better overall health.
Resources
This website provides information on oral health topics with some that specifically focus
on infant oral health care. www.kdheks.gov/ohi/index.html
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This website provides access to the Bright Futures Oral Health Pocket Guide. This
guide provides information for health care professionals to implement specific oral
health guidelines for pregnant women, infants, children and adolescents.
www.brightfutures.org/oralhealth/about.html
509 Safety and Security
One of the very basic needs of infants is to have a safe and secure environment in
which to grow and develop. Unfortunately, in our modern society not all children are
provided this basic necessity and situations of child abuse and neglect may occur. The
societal costs that result from lack of a safe and secure environment are beginning to be
understood through research focusing on social/environment factors and the long-term
impact these factors seem to have on a person’s health.
Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected Infant
Death (SUID) are conditions where otherwise healthy infants die for unexplained
reasons or unexpectedly before one year of age. These conditions are the
leading cause of death of infants between one month and one year of age with
most deaths occurring in infants between two and four months of age.
Shaken Baby Syndrome (SBS) is another important syndrome to consider in
the care of infants. This is a syndrome where infants and small children can
present with a wide variety of signs and symptoms resulting from violent shaking
or impacting of their heads. Strongly associated with this syndrome is the inability
of an infant or small child’s caregiver to successfully console crying episodes.
Resources
This website provides comprehensive information on Shaken Baby Syndrome, its
effects on infants and small children and costs to society. www.dontshake.org/index.php
This website provides many resources related to Sudden Infant Death Syndrome and
Sudden Unexpected Infant Death available to Kansans. www.sidsks.org/
This website provides information on child abuse and neglect resources available in
Kansas.
www.srskansas.org/CFS/programservices.htm#Child%20Protective%20Services
This website provides comprehensive information on the child death review process in
Kansas. http://ag.ks.gov/about-the-office/affiliated-orgs/scdrb
510 Emergency Planning
Refer to this topic under the Preconception Health section for resources and
information.
511 Immunizations
As a society, we have witnessed the eradication of many diseases in our nation that
historically produced devastating health effects to millions of children. Routine and
timely vaccination provided to children for these diseases is largely responsible for their
disappearance. However, these diseases could become widespread again if routine and
timely vaccination were discontinued.
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Resources
This website provides a wide array of links to information for health care providers,
parents and other interested in preventing communicable diseases.
www.kdheks.gov/immunize/
This website provides a comprehensive set of information, tools and guidance for health
care providers, policy makers and the general public on the topic of immunization.
www.cdc.gov/vaccines/
This website provides a comprehensive view of infectious disease and immunization
with links to immunization schedules and other helpful tools.
http://aapredbook.aappublications.org/
512 General Infant Health Resources
This portion of the text provides in-depth coverage of health visits for infants from birth
through 12 months of age. Each visit is broken down into categories targeted at history,
observations of the parent-child interaction, developmental issues, physical
examination, screening and immunizations. An anticipatory guidance section of sample
questions follows the discussion of what occurs during each visit that invites discussion,
helps gather information and addresses the needs and concerns of the family.
Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents,
Third Edition. American Academy of Pediatrics, 2008, pp. 271-394.
Chapter seven of this text discusses the care of neonates (infants up to 28 days of age)
and chapter eight discusses neonatal complications up to and including infant death.
Guidelines for Perinatal Care, Sixth Edition, American Academy of Pediatrics, The
American College of Obstetricians and Gynecologists, October, 2007, pp. 205-301.
This website provides information on the comprehensive set of services provided
through Kansas Infant-Toddler Services at KDHE with links provided to other state and
national resources. www.kdheks.gov/its/index.html#Purpose
This website contains a compendium of fact sheets that answer frequently asked
questions concerning exposure to drugs, medicines, chemicals and other items during
pregnancy and lactation that can affect the health of women and infants.
http://otispregnancy.org/otis_fact_sheets.asp
The March of Dimes Pregnancy page provides a comprehensive set of resources for
women and health care professionals on the topic of pregnancy and newborn care.
www.marchofdimes.com/pnhec/pnhec.asp
This is a link to a variety of Bright Futures guides and other resources that cover several
child health priorities in some depth.
http://brightfutures.aap.org/practice_guides_and_other_resources.html
This website provides a chart that compares various child abuse screening instruments
commonly used in clinical practice.
www.ahrq.gov/clinic/3rduspstf/famviolence/cvrevtab1.htm
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This website provides a comprehensive set of resources for parents and health care
professionals on the topic of newborn screening and genetics.
http://genes-r-us.uthscsa.edu/
This website provides comprehensive information on the Early Hearing Detection and
Intervention program (EHDI) through the National Center on Birth Defects and
Developmental Disabilities (NCBDD) at the CDC. www.cdc.gov/ncbddd/ehdi/
The Kansas Services Directory was created to provide Kansas Citizens with easy
access to information about services and programs. The directory is made possible
because of a partnership of state agencies. http://services.ks.gov/
This website provides information to a wide variety of oral health resources in Kansas
and nationally. www.kdheks.gov/ohi/links.html
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550 - Guidelines for Child and Adolescent Health
Table of Contents
551 - Purpose for Child and Adolescent Health Programs
552 - Leading Health Indicators for Children and Adolescents
553 - Settings for Service Provision
554 - Medical Home Program Goal and Outcome Objective
555 - Standards of Practice for Health Supervision of Infants, Children and Adolescents
556 - Components of Health Assessments
557 - Resources
558 - References
100
551 Purpose for Child and Adolescent Health Services
The purpose of child and adolescent health services is to promote the health of children
from birth to age 21 through the development of local systems. Services to this
population in communities are needed in a variety of settings, including childcare and
preschools, public and private schools, residential facilities and local health providers.
Health supervision visits for children begin at birth and should be provided on a regular
basis through a Medical Home. Bright Futures® guidelines encourages diversity of
practice for caring for children, considering a community of care that includes a clinical
practice that is central to providing health supervision (Hagen et al., 2008, p. 4).
http://brightfutures.aap.org/
552 Leading Health Indicators for Children and Adolescents
Priorities for addressing children’s health in Kansas are based on the leading National
Health Indicators addressed in the Healthy People 2020
www.healthypeople.gov/2020/default.aspx .
553 Settings for Service Provision
Children in out of home settings, including childcare, preschools and schools, need
services designed to ensure access or referral to primary health care services, foster
appropriate use of primary health care services, prevent and control communicable
disease and receive age appropriate on-going anticipatory guidance. In addition,
community services must be in place to provide support and education to those
agencies providing services to children, including children and youth with special health
needs. Triads of systems that provide services to children or serve as an avenue to
services often exist within communities: the local public health department, private
providers and childcare/schools. To provide a more comprehensive and holistic delivery
of services to children, there needs to be targeted and integrated access to all services
within the community and a consistent message of health promotion and disease
prevention.
As the role of public health evolves, it becomes imperative that public health staff is
knowledgeable of their community health needs, assets and resources, the diverse
needs of their region and the issues impacting the overall health of their community
members. It is important that public health staff assume a leadership role in developing
health systems within those communities. To that end, gaining knowledge of processes
and resources for conducting assessment, assuring services provision to meet the
needs identified and understanding the critical component of policy development is
essential in working towards integrated child health programs within local health
systems.
554 Medical Home Program Goal and Outcome Objective
Families need to have a regular source of healthcare in a medical home to receive
services that are family-centered, community-based, collaborative, comprehensive,
flexible, coordinated, culturally competent and developmentally appropriate. With a
medical home, early identification and intervention for children may improve health
outcomes. The goal for child health is for children and their families to have an identified
medical home that consists of a provider as a regular source of care and an identified
payer source. Healthcare in a medical home can assist families and their partners in
healthcare to address the health priorities found in the MCH2015 Kansas Maternal and
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Child Health 5-Year Needs Assessment document that can be viewed at
www.datacounts.net/mch2015/
For more information on Medical Home, visit the American Academy of Pediatrics
Kansas Medical Home website at
www.aafp.org/online/en/home/membership/initiatives/pcmh.html
The Medical Home is an essential means to assure access to quality health services for
all children. For children and youth with special health care needs, provision of highquality, developmentally appropriate health care services that continue uninterrupted
from adolescence to adulthood are essential. The National Center of Medical Home
Initiatives for CYSHCN provides a comprehensive website to explore Medical Home
concept for CYSHCN. www.medicalhomeinfo.org/
More information and Medical Home resources are available from the following medical
professional organizations:
• American Academy of Family Physicians www.futurefamilymed.org
• American Academy of Pediatrics
http://aappolicy.aappublications.org/policy_statement/index.dtl#M
• American College of Physicians www.acponline.org/advocacy/?hp
• American Osteopathic Association www.osteopathic.org
555
Standard of Practice for Health Supervision of Infants, Children and
Adolescents
Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents,
http://brightfutures.aap.org/faqs.html, is a guide for provision of health services. “Bright
Futures® is a set of principles, strategies and tools that are theory based, evidence
driven and systems oriented that can be used to improve the health and well-being of all
children through culturally appropriate interventions that address their current and
emerging health promotion needs at the family, clinical practice, community, health
system and policy levels” (Hagan J.F., Shaw J.S., & Duncan P.M., 2008, p. ix).
There should be no discernible difference in the services provided to children who are
uninsured, covered by HealthWave 19 (Medicaid) or HealthWave 21 (State Children’s
Health Insurance) or children that are covered by private insurance. In Kansas, the
health assessment component of the Medicaid/HealthWave Programs is referred to as
Kan Be Healthy (KBH). The standard of practice for health supervision and provision of
services to infants, children and adolescents is the same regardless if a child is on
HealthWave 19, HealthWave 21 and private insurance or has no coverage.
In addition to the Bright Futures® guidelines, the MCH program encourages providers to
utilize the following standards of practice for infants, children and adolescents:
The Early Periodic Screening, Diagnosis and Treatment (EPSDT) Program is the
child health component of Medicaid. It is required in every state and is designed
to improve the health of low-income children by financing appropriate and
necessary pediatric services. This website provides information about how
EPSDT works with public health, families, managed care organizations,
pediatricians and other health providers. www.hrsa.gov/epsdt/
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In Kansas, KMAP www.kmap-state-ks.us/ provides information on the EPSDT
programs offered through Title XIX (Medicaid) or Title XXI (the State Children’s
Health Insurance Program, or SCHIP) of the Social Security Act.
556 Components of Health Assessments
KBH is the Kansas name for the federally mandated EPSDT program. KBH promotes
regular health screening with the goal of prevention, early detection of or correcting
medical conditions before further advancement. The KBH screening program provides
services to children, teenagers and young adults. Beneficiaries who are under the age
of 21 are eligible participants of the Kansas EPSDT program, KBH.
Comprehensive child health supervision includes not only periodic physical and
developmental assessments of a child for the purpose of identifying potential problems
early, but also anticipatory guidance and health education directed towards parents for
the purpose of enhancing parenting skills.
557 Resources
Physical assessment
• American Academy of Pediatrics: Recommendations for Preventive Pediatric
Health Care
Provision of health supervision is based on Recommendations for
Preventive Pediatric Health Care periodicity schedule. The schedule may
be downloaded as a reference tool.
http://brightfutures.aap.org/pdfs/AAP%20Bright%20Futures%20Periodicity
%20Sched%20101107.pdf
• Kan Be Healthy (EPSDT) Screening Form
This form is to be used for KBH screenings. This form may also be used
for any other health screening/assessment. www.kmap-stateks.us/Public/Forms.asp
• Kansas State High School Activities Association
Pre-teens and adolescents participating in middle school and high school
activities may request a Pre-Participation Physical Evaluation form be
completed. This form must be signed by a physician, osteopathic doctor,
chiropractor or physician assistant. The form is available at
www.kshsaa.org/
Height / Weight / BMI screening
• Centers for Disease Control and Prevention
Body Mass Index (BMI)
BMI-for-age charts are recommended to assess weight in relation to
stature for children ages two to 20 years. The weight-for-stature charts are
available as an alternative to accommodate children ages 2-5 years who
are not evaluated beyond the preschool years. However, all health care
providers should consider using the BMI-for-age charts to be consistent
with current recommendations. BMI is a number calculated from a
person's weight and height. BMI provides a reliable indicator of body
fatness for most people and is used to screen for weight categories that
may lead to health problems. This website provides a calculator for adults
and children, as well as links to resources to address weight
www.cdc.gov/nccdphp/dnpa/healthyweight/assessing/bmi/index.htm.
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•
Clinical Growth Charts
The National Center for Health Statistics at the CDC provides clinical
growth charts, including head circumference charts for boys and girls.
Clinical charts with 5th and 95th percentiles and clinical charts with 3rd to
97th percentiles are found at
www.cdc.gov/nchs/about/major/nhanes/growthcharts/clinical_charts.htm.
Head circumference screening (age appropriate)
• See the CDC web site:
www.cdc.gov/nchs/video/nhanes3_anthropometry/breadth/breadth.pdf . For
growth charts refer to CDC web site:
www.cdc.gov/growthcharts/clinical_charts.htm
Vision screening
• See to Learn®
The Kansas Eye Care Council and the SEE TO LEARN® Program,
provides free, no-cost vision screenings for children three years of age
across the state, regardless of whether a family has health insurance. The
program encourages parents and anyone working with any child to be
alert for signs that may indicate vision performance problems. To learn
more about this program, to locate optometrists in your community and
other SEE TO LEARN® initiatives for the workplace and families, visit the
Eye Council’s See-to-Learn website at www.seetolearn.com.
•
•
•
Vision Screening and Assessment Training: Area Health Education Centers
(AHEC)
All vision screeners in child health programs should have the same
qualifications. Vision screening workshops will focus on skills required for
all vision screeners who screen children and youth, birth through age 21.
Training is offered throughout the year with training schedules accessed at
http://kuahec.kumc.edu/vision.html.
Vision Screening Guidelines (2004): For Infants, Toddlers, Children and Youth
Where eye health is concerned, each child should have a complete vision
screening prior to age three in order to detect potential acuity or
oculomotor problems and facilitate effective early intervention and
treatment through referral and follow-up. This manual provides information
on screening guidelines for Kansas and is used in the vision training
workshops. www.kdheks.gov/c-f/school_resources_docs.html
KBH Hearing Screening Tools
o General Hearing Health History
Children who have had many ear infections and periods of hearing loss
are more likely to have language, vocabulary and listening difficulties.
History of development and health is beneficial for a more complete
evaluation. www.kdheks.gov/c-f/school_resources_docs.html
o Risk Indicators For Hearing Loss Checklist (infants and toddlers up to age
four only) www.kmap-stateks.us/Documents/content/KBH/Risk%20Indicators%20for%20Hearing%20
Loss%20Checklist_Oct.pdf
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•
Hearing Screening and Assessment Training: Area Health Education Centers
(AHEC)
All hearing screeners in child health programs should meet the same
standard. The hearing screening workshops will focus on skills required
for all hearing screeners who screen children and youth, birth through age
21. Training is offered throughout the year with training schedules
accessed at http://kuahec.kumc.edu/hearing.html.
•
Hearing Screening Guidelines (2003)
The purpose of this manual is to provide standardized hearing screening
procedures for all Kansas children. The target population for screening is
all children from birth to 21 years in Kansas. Hearing may be screened at
various screening sites, such as:
• Schools
• Local health departments
• Community sites
• Physician or audiologist offices
In 1999, a Kansas law was passed that requires hearing screening of all
babies born in Kansas hospitals. The Hearing Screening Guidelines and
Resource Manual do not address newborn hearing screening prior to
hospital discharge, nor follow-up screening or assessment. The
procedures in this document were written to be used as a training manual
and a resource for people who screen hearing in children. After being
trained, Hearing Screening Technicians are able to conduct screenings to
identify children to refer for further testing.
www.ksde.org/LinkClick.aspx?fileticket=BU9hNBDF2N0%3d&tabid=3155
&mid=7113
•
Kansas Newborn Screening Program
While most newborns look perfectly healthy, there are some diseases that
are not obvious. Unless these diseases are identified and treated early,
they can cause severe illness, mental retardation or in some cases death.
To test for these diseases, about 24 hours after birth, a baby's heel is
pricked and a small sample of blood is collected by the hospital staff. This
sample is then sent to the State public health laboratory where it is tested.
If the test is abnormal, re-testing must be done to confirm a diagnosis.
This site explains the program and what steps are taken when a disorder
is found with screening. www.kdheks.gov/newborn_screening/index.html
Oral health screening
• Office of Oral Health (OOH), Kansas Department of Health and Environment
Links to other dental health resources, including downloadable fact sheets
for families, can be accessed from this site. In addition, the OOH assists in
oral screening for the school-age population is Kansas.
www.kdheks.gov/ohi/index.html
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Nutritional screening
• See the Kansas Kids Educational Booklet at www.kmap-stateks.us/Documents/content/KBH/kansas%20kids%2009_2006.pdf
• Kansas Nutrition and WIC Services www.kdheks.gov/nws-wic/index.html
Social-emotional / developmental screening
• See the Kansas Kids Educational Booklet at www.kmap-stateks.us/Documents/content/KBH/kansas%20kids%2009_2006.pdf.
• Pediatric Symptom Checklist
The KBH program provides the Pediatric Symptom Checklist with
instructions for its use www.kmap-stateks.us/Documents/content/KBH/Pediatric%20Checklist.pdf.
Immunization status screening
• Advisory Committee on Immunization Practices, Centers for Disease Control and
Prevention
Current immunization schedules for all age groups can be found at this
site www.cdc.gov/vaccines/recs/schedules/child-schedule.htm
Additional information and resources for providers and parents pertaining
to immunizations can be accessed through the CDC’s website.
www.cdc.gov/vaccines/default.htm
• Immunization Program, Kansas Department of Health and Environment
This website links providers to immunization resources, including the
Vaccines for Children (VFC) program, school resources, the Kansas
Immunization Registry (WebIZ) and vaccine information.
www.kdheks.gov/immunize/index.html
Laboratory screening tests appropriate to age and risk category
• See the Kansas Kids Educational Booklet at www.kmap-stateks.us/Documents/content/KBH/kansas%20kids%2009_2006.pdf
• KBH Mandatory Blood Lead Questionnaire
This questionnaire is required for each visit for children ages six – 72
months. www.kmap-stateks.us/Documents/content/KBH/KBH%20Mandatory%20Blood%20Lead%2
0Screening%20Questionnaire.pdf
558
•
•
•
References
Hagan J.F., Shaw J.S., & Duncan P.M. (2008). Bright Futures: Guidelines for
Health Supervision of Infants, Children and Adolescents, Third Edition. Elk Grove
Village, IL: American Academy of Pediatrics.
Kansas Department of Health & Environment. (2008). Kansas Maternal and Child
Health 2008 Biennial Summary. Bureau of Family Health: Topeka.
www.kdheks.gov/bcyf/download/MCH_2008_Summary.pdf.
US Census Bureau. (2008). Income, Poverty and Health Insurance Coverage in
the United States: 2007. www.census.gov/prod/2008pubs/p60-235.pdf.
106
600 - Adolescent Health and Development
Table of Contents
601 - Adolescent Health
602 - Adolescent Brain Development
603 - Adolescent Development and Health
604 - Alcohol, Tobacco and Other Drugs (ATOD)
605 - Dental Care
606 - Injury
607 - Mental Health
608 - Nutrition and Physical Activity
609 - Sexual Health
610 - Teen Pregnancy
611 - Violence
612 - Youth Development
613 - Youth Engagement
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601 Adolescent Health
Adolescent health is a complex issue that focuses away from the process issues and
toward the outcome of a healthy teen. This is accomplished by providing leadership
through partnerships with families and communities.
To make an impact in Kansas adolescent health, focus must be on eliminating
disparities and providing access to quality health care, including comprehensive general
health, oral health, mental health and substance abuse prevention and treatment
services. Another area for adolescent health focus is health and safety outcomes for
adolescents in such areas as unintentional injury, violence, mental health, substance
use, reproductive health, nutrition and physical activity.
The advances of science, education, advocacy and health policy allow each of us to
promote optimum health and wellness, eliminating health disparities and helping each
teen to attain their highest capability.
602 Adolescent Brain Development
The idea that the teenage years are full of change and growth is not new to public
health professionals, teachers, parents or teens themselves. Adolescence is often a
time of encountering new freedoms and new situations. Many professionals in the
political and health care fields still debate just how much responsibility teens should be
given and at what age. Over the past few years, strong research has emerged that
documents the enormous changes to the brain in the developing years between
childhood and adulthood. The more difficult issue is how to apply this research when
creating and implementing sound public health policy that affects adolescents. The
degree to which adolescents may be limited by normal brain development processes
may be a factor in weighing appropriate policy decisions. Understanding adolescent
brain development is crucial to building better programs for teens that allow them to
have new experiences and make mistakes in low-risk environments.
http://nwpublichealth.org/archives/s2007/adolescent-brain/?searchterm=sarah
Resources
ACT For Youth Upstate Center of Excellence
This website discusses adolescent brain development and the effects of alcohol
on the brain. www.actforyouth.net/documents/may02factsheetadolbraindev.pdf
Center for Substance Abuse Research
This website looks at the implications for drug use prevention during the
adolescent phase of brain development.
www.mentorfoundation.org/pdfs/prevention_perspectives/19.pdf
Coalition for Juvenile Justice Applying Research to Practice
This website looks at the implications of adolescent brain development for
juvenile justice. http://juvjustice.org/media/resources/resource_138.pdf
Juvenile Justice and Delinquency Prevention Act (JJDPA) A Fact Book
This website contains facts on the capacity of the brain to problem solve and
make decisions related to responsibility and accountability.
www.act4jj.org/media/factsheets/factsheet_12.pdf
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Minnesota Commission on Out-of-School Time
This website looks at how Minnesota teens have engaging opportunities when
they are out-of-school. www.mncost.org/Brain.pdf%20
The National Campaign to Prevent Teen Pregnancy
This website looks at the adolescent brain as a work in progress and how we can
use that knowledge to understand teen sexual behavior and pregnancy and craft
effective interventions. www.teenpregnancy.org/resources/reading/pdf/brain.pdf
The Secret Life of the Brain
This website discusses the history of the brain, shows 3D brain anatomy and
brain scanning technology (MRI, EEG, CAT, PET and MEG).
www.pbs.org/wnet/brain/history/index.html
TI Science Addiction
This website looks at how the immature brain structure may put teens at elevated
risk of substance abuse and arrested brain development.
www.tresearch.org/resources/specials/2004Nov_AdolescentBrain.pdf
University of Pittsburg
This PowerPoint addresses the pragmatic problems in youth linked to emotional
and behavioral development. It also highlights research and brings up interesting
points about risk taking and morbidity and mortality. www.wccf.org/pdf/dahl.pdf
603 Adolescent Development and Health
During adolescence, children develop the ability to:
Comprehend abstract content, such as higher mathematic concepts and develop moral
philosophies, including rights and privileges
Question old values without a sense of dread or loss of identity
Move gradually toward a more mature sense of identity and purpose
Establish and maintain satisfying personal relationships by learning to share intimacy
without inhibition or dread
Resources
Advocates for Youth
This website provides information on adolescent access to confidential health
services. www.advocatesforyouth.org/PUBLICATIONS/iag/confhlth.htm
American Academy of Pediatrics/Bright Futures®
Bright Futures is a national health promotion and disease prevention initiative
that addresses children and adolescent’s health needs in the context of family
and community. In addition to use in pediatric practice, many states implement
Bright Futures principles, guidelines and tools to strengthen the connections
between state and local programs, pediatric primary care, families and local
communities. http://brightfutures.aap.org/
American College of Preventive Medicine (ACPM)
ACPM’s Initiative is focused on preventing the following adolescent health
issues: (1) adverse outcomes resulting from sexual activity; (2) overweight and
obesity; (3) substance abuse; and (4) violence. For more information, go to this
website: www.acpm.org/ah/index.htm
109
American Psychological Association
This website offers Developing Adolescents as an information resource for
professionals as they deal with adolescents in varied roles - as health
professionals, school teachers and administrators, social service staff, juvenile
justice officials and more. www.apa.org/pi/cyf/develop.pdf
Child Development Institute
This website discusses in great detail the adolescent stages of development from
middle school through transition to adulthood.
www.childdevelopmentinfo.com/development/teens_stages.shtml
604
•
Alcohol, Tobacco and Other Drugs (ATOD)
Alcohol
The prevalence and toll of underage drinking in America is widely
underestimated: It costs the nation a conservatively estimated $53 billion
annually. More young people drink alcohol than smoke tobacco or use marijuana.
www.bocyf.org/underage_drinking_brief.pdf
The Kansas Youth Risk Behavior Survey (YRBS) data, including high school
student usage of alcohol, tobacco and other drugs, are available for 2005 and
2007. www.kshealthykids.org/CSHP/KSCH_Docs/YRBS/2007%20kansas.pdf
Resources
College Drinking: Changing the Culture
This website was created by the National Institute on Alcohol Abuse and
Alcoholism (NIAAA) and it has resources for comprehensive researchbased information on issues related to alcohol abuse and binge drinking
among college students. www.collegedrinkingprevention.gov/
Join Together
Research shows that a brief, non-judgmental intervention by a health care
professional can have a positive, long term impact on risky alcohol use. To
find screening and interventions (SBI) that address risky alcohol use long
before it leads to health, financial, social, employment or family problems
go to this website: www.jointogether.org/keyissues/sbi/screening-andbrief-readmore.html.
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
This website offers the latest information on alcohol data and information
on the most effective treatment programs and intervention strategies. It
also has free downloads and pamphlets. It offers links to websites for
adolescents and college age students to get the facts and intervention
services. www.niaaa.nih.gov/
Project Cork
There are ten different screening tests on this website. A chart is provided
showing characteristics of each for easy comparison. Some tests are
alcohol-specific; others cover alcohol and other drugs and; one has been
validated in diverse populations. Each test is accompanied by instructions
for scoring, references and a link to a current bibliography.
www.projectcork.org/clinical_tools/
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Recovery Connection
Recovery Connection® offers live help 24/7. Find a Kansas alcoholism and
drug addiction treatment clinic at:
www.recoveryconnection.org/find_drug_rehab/Kansas.php
The Cool Spot
This website was developed by NIAAA for middle school (ages 11 to 13)
children to provide resources, information and support on alcohol use and
abuse among teenagers. www.thecoolspot.gov/
Youth Risk Behavior Surveillance Survey (YRBSS)
The YRBSS was developed in 1990 to monitor priority health risk
behaviors that contribute markedly to the leading causes of death,
disability and social problems among youth and adults in the U.S. These
six behaviors are often established during childhood and consist of
tobacco use, alcohol and drug use, sexual behaviors, physical activity,
nutrition and unintentional and intentional injuries.
www.kshealthykids.org/CSHP/KCSH_Menus/KCSH_YRBSS.htm
•
Tobacco
Tobacco use is the leading preventable cause of disease, disability and death in
the U.S. www.nida.nih.gov/tib/tobnico.html. Nicotine, the main drug in tobacco, is
one of the most heavily used addictive drugs in the U.S. Nicotine is highly
addictive and acts as both a stimulant and a sedative to the central nervous
system. The ingestion of nicotine results in an almost immediate “kick” because it
causes a discharge of epinephrine from the adrenal cortex. This stimulates the
central nervous system and other endocrine glands, which causes a sudden
release of glucose. Stimulation is then followed by depression and fatigue,
leading the abuser to seek more nicotine. In addition to nicotine, cigarette smoke
is primarily composed of a dozen gases (mainly carbon monoxide) and tar. The
tar in a cigarette, which varies from about 15 mg for a regular cigarette to seven
mg in a low-tar cigarette, exposes the user to a high expectancy rate of lung
cancer, emphysema and bronchial disorders. The carbon monoxide in the smoke
increases the chance of cardiovascular diseases.
www.theantidrug.com/drug_info/drug_info_tobacco.asp
Resources
Kansas Tobacco Use Prevention Program
This website lists Kansas statistics related to tobacco use, best practices,
youth programs and grant resources. They also offer a free 24 hour
(several languages) cessation hot line with experienced cessation
counselors to provide callers one-on-one support. For a unique plan for
quitting tobacco call toll-free 1-866-KAN-STOP (1-866-526-7867).
www.kdheks.gov/tobacco/
Parents - The Antidrug
What teens do versus what parents know are often two different things.
The same is true for drugs and alcohol. This website is for parents to get
up-to-speed on what they need to know. www.theantidrug.com/advice/
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TASK
TASK is a youth-led movement that promotes tobacco free teens and
unites communities to create one strong voice speaking against the
tobacco industry. This website focuses on reducing tobacco use by
Kansas teens and establishing teen regional boards in Eastern, Western
and Central regions of Kansas. www.kstask.org/
Tobacco Free Kansas
This website contains information on strategies to reduce the prevalence
of tobacco use and addiction and assisting Kansans to avoid negative
health and economic impact of tobacco use.
www.tobaccofreekansas.org/home/
•
Other Drugs
Before teens reach adulthood they will be exposed to many drugs and
opportunities to experiment with legal and illegal drugs. Drugs increase the risk of
being injured, experiencing unwanted sexual activity and having academic, social
and family problems; not to mention the health risk of unwanted diseases.
There are also legal and disciplinary consequences for underage drinking and
illegal drug use.
Resources
Brown University Health Education
This website describes several drugs (cocaine, ketamine, LSD, inhalants,
etc.) and how to keep oneself safe.
www.brown.edu/Student_Services/Health_Services/Health_Education/ato
d/od_geninfo.htm
Centers for the Application of Prevention Technologies (CAPTs)
Southwest CAPTs mission is to bring research into practice by assisting
States, Tribes and Jurisdictions in the application of the latest evidencebased knowledge to their substance abuse prevention programs, practices
and policies. http://captus.samhsa.gov/southwest/southwest.cfm
Drugs around Schools/Laws
On the Kansas Legislature website, www.kslegislature.org/legsrvstatutes/index.do, you can find laws: 65-4159; 65-4161; 65-4163, relating
to drugs, manufacturing, possession or distribution of, within 1,000 feet of
a school.
Drug Enforcement Administration (DEA)
This website offers prevalence information on drugs in Kansas, as well as
prevention, law enforcement and insight as to how drugs are transported,
sold and money is laundered in Kansas.
www.usdoj.gov/dea/pubs/states/kansas.html
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Drug Enforcement Kansas Bureau of Investigation
The KBI has compiled an informational website which has Kansas drug
statistics and the dangers involved with using drugs. This website is
geared toward parents, teachers and kids and has information on
recognizing and reporting illegal drug activity in the community. Call 1800-KS-CRIME, or go to:
www.accesskansas.org/drugenforcement/index.html
National Institute on Drug Abuse (NIDA)
This “In Brief Web edition” provides highlights from the Preventing Drug
Use among Children and Adolescents: A Research-Based Guide for
Parents, Educators and Community Leaders, Second Edition booklet. It
presents the updated prevention principles, an overview of program
planning and critical first steps for those learning about prevention.
www.nida.nih.gov/Prevention/Prevopen.html
Office of National Drug Control Policy
This website has prevention, treatment, policy development, data and
facts on drugs across the US. www.whitehousedrugpolicy.gov/index.html
Office of National Drug Control Policy
This is a research based guide for parents, educators and community
leaders for preventing drug use among children and adolescents.
www.drugabuse.gov/pdf/prevention/RedBook.pdf
The Partnership for a Drug-Free America
This website includes information for parents on keeping your child safe
(including a parent blog), Q & A’s for teens, treatment and intervention
strategies and a site for memorials, as well as a description (including
street names) of 30+ drugs teens may come in contact with.
www.drugfree.org/
605 Dental Care
Few things are more personal than information about our bodies and our health.
Access to dental health care is a key factor in the development and well-being of
children. Numerous studies have emphasized the importance of having health
insurance to ensure that children have access to dental health services. Children with
health care coverage are more likely to have a usual place for dental and medical care
and to consistently obtain routine preventive services and medical advice. The inability
to obtain dental services can have far-reaching, negative consequences for children’s
health, the ability to learn at school or the development of healthy behaviors.
www.cdc.gov/nchs/data/ad/ad355.pdf
Resources
American Academy of Pediatric Dentistry
This website from the American Academy of Pediatric Dentistry discusses a
Dental Home, oral health guidelines and clinical policies.
www.aapd.org/media/policies.asp
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American Medical Association
This website offers: an Adolescents and Health Care Disparities Reading List;
Delivering Culturally Appropriate Health Care to Adolescents; Guidelines for
Adolescent Preventive Services (GAPS) and Parent and Patient Handouts.
www.ama-assn.org/ama/pub/category/1947.html
Kansas Oral Health Initiative
This website is Kansas specific. On this site you will find a definition of oral
health, forms and instructions on oral health screening and fluoride varnish
information. www.kdheks.gov/ohi/
606 Injury
Motor vehicle crashes are the leading cause of unintentional injury and deaths for
Kansas’ adolescents ages 15 to 19. According to Kansas Fatal Accident Reporting
System (FARS) data, from 2002-2006, there is a decreasing trend in deaths due to
motor vehicle crashes where the occupant was not wearing a seat belt.
Resources
CDC - National Center for Injury Prevention and Control
The CDC website offers a Graduated Driver Licensing Tool Kit (PDF for state
leaders and decision makers) toward an effort to reduce MVCs.
www.cdc.gov/ncipc/duip/spotlite/teendrivers.htm
Children’s Safety Network
This site helps address injury and violence-related Title V performance measures
by providing guidance in the design and implementation of effective injury and
violence prevention activities.
www.childrenssafetynetwork.org/publications_resources/default.asp
Division of Unintentional Injury Prevention
The CDC has a Division of Unintentional Injury Prevention that monitors trends in
the U.S., conducts research to better understand risk factors and evaluates
interventions to prevent these injuries. Research and prevention programs focus
on two categories of unintentional injury: motor vehicle-related injuries and home
and recreation related injuries. www.cdc.gov/ncipc/duip/duip.htm
Kansas Family Partners (KFP)
This is the website for information on the Kansas chapters of Students Against
Destructive Decisions (SADD) and Red Ribbon. www.kansasfamily.com/
Kansas Information for Communities
This website offers a query to look at Kansas MVC deaths and separate the table
for specific characteristics (MVC), year of occurrence, age, rate, sex and county.
http://kic.kdhe.state.ks.us/kic/
Mothers against Drunk Drivers (MADD)
This website offers insight and action steps on how to eliminate drunk driving.
www.madd.org/Drunk-Driving.aspx
114
National Highway Traffic Safety Administration
This site provides information for teens and their parents on how to prepare to be
a safe driver and resources on graduated drivers license, alcohol impairment,
aggressive driving and support data.
www.nhtsa.gov/portal/site/nhtsa/menuitem.cd18639c9dadbabbbf30811060008a0
c
Staying Safe
This website offers answers and provides advice defensive driving; bad weather
driving tips and how to avoid texting while driving. Basic safety tips from farm
implements, tanning, self defense and internet safety can be found at:
http://teenshealth.org/teen/safety/.
The Kansas Trauma Program
This website looks at a statewide trauma plan and makes recommendations on
how Kansas can reduce human suffering and costs associated with preventable
morbidity and mortality that result from trauma. www.kstrauma.org/
Youth Risk Behavior Surveillance Survey (YRBSS)
The YRBSS was developed in 1990 to monitor priority health risk behaviors that
contribute markedly to the leading causes of death, disability and social problems
among youth and adults in the U.S. These six behaviors are often established
during childhood and consist of tobacco use, alcohol and drug use, sexual
behaviors, physical activity, nutrition, unintentional and intentional injuries.
www.kshealthykids.org/CSHP/KCSH_Menus/KCSH_YRBSS.htm
607 Mental Health
Substance Abuse and Mental Health Services Administration (SAMHSA),
http://mentalhealth.samhsa.gov/, National Mental Health Information Center states
mental health is how people think, feel and act as they face life's situations. It affects
how people handle stress, relate to one another and make decisions. Mental health
influences the ways individuals look at themselves, their lives and others in their lives.
All aspects of our lives are affected by our mental health.
At some point everyone feels worried, anxious, sad, depressed or stressed. Our mental
health determines how we handle those situations. If adolescents have a mental health
disorder, those feelings do not go away and begin to interfere with the way they think,
feel and act. When untreated, mental health disorders can lead to school failure, family
conflicts, drug abuse, violence and even suicide. Untreated mental health disorders can
be very costly to families, communities and the health care system.
Suicide
Youth suicide is the second cause of death in Kansas 15-24 year olds. For the U.S.
suicide is the third cause of death for this age group. According to the 2009 Kansas
Youth Risk Behavior Survey (YRBS), 6.1 percent of Kansas’ high school students had
attempted suicide during the past 12 months; this is down from 2005 (6.5% attempts.).
Often the youth who attempt suicide have associated mental health or other behavioral
concerns such as depression, substance abuse, a sense of hopelessness, increased
stress and/or a lack of family support.
115
Resources
American Psychological Association
This website offers Developing Adolescents as an information resource for many
professionals, including psychologists, as they deal with adolescents in varied
roles - as health professionals, school teachers and administrators, social service
staff, juvenile justice officials and more. www.apa.org/pi/cyf/develop.pdf
Child Development Institute
Adolescent Stages of Development
www.childdevelopmentinfo.com/development/teens_stages.shtml
Department of Health and Human Services
This website provided publications relating to mental health (including depression
and suicide.) www.mentalhealth.org/suicideprevention/strategy.asp
Jed Foundation
This website includes policy guidance, access to research, tools and training to
help college campus professionals effectively promote mental health and protect
at-risk students. www.jedfoundation.org/framework.php
Headquarters Counseling Center
Headquarters Counseling Center and its trained staff are dedicated to providing "life
support" services in Douglas County and throughout the state of Kansas. HQCC has
local counseling lines for Douglas County and Baldwin City and is the state receiver of
the two national suicide prevention networks. HQCC also runs a Suicide Survivors
Support Group.
http://hqcc.lawrence.ks.us/Services/Suicide_Prevention/resources/kansas.html
Maternal and Child Health Library Emotional, Behavioral and Mental Health Challenges
in Children and Adolescents Knowledge Path
This website lists resources on specific emotional, behavioral and mental health
concerns for families, schools and professionals.
www.mchlibrary.info/KnowledgePaths/kp_Mental_Conditions.html
National Center for Suicide Prevention Training
This site offers on-line trainings on youth suicide prevention: (1) locating,
understanding and presenting youth suicide data; (2) planning and evaluation for
youth suicide prevention; and (3) youth suicide prevention - an introduction to
gate keeping. All workshops are ongoing and completed at your own pace.
CEU’s are available for social workers and health educators.
www.ncspt.org/workshops/default.asp
National Registry of Evidence-Based Programs and Practices (NREPP), a service of the
Substance Abuse and Mental Health Services Administration (SAMHSA)
NREPP is a searchable database of interventions for the prevention and
treatment of mental and substance use disorders. SAMHSA has developed this
resource to help people, agencies and organizations implement programs and
practices in their communities. www.nrepp.samhsa.gov/
116
Office of the Surgeon General
This website has the report of the Surgeon General’s conference on children’s
mental health: A National Action Agenda.
www.surgeongeneral.gov/library/mentalhealth/home.html/
One Sky Center
This website is specific for American Indians and Alaska Natives dedicated to
improving prevention and treatment of substance abuse and mental health. This
website includes a variety of resources on adolescent suicide prevention.
www.oneskycenter.org/ and
www.oneskycenter.org/documents/AGuidetoSuicidePreventionDRAFT.pdf
Suicide - Risk and Protective Factors
Risk factors may be thought of as leading to or being associated with suicide;
that is, people “possessing” the risk factor are at greater potential for suicidal
behavior. Protective factors, on the other hand, reduce the likelihood of suicide.
They enhance resilience and may serve to counterbalance risk factors. Risk and
protective factors may be bio-psychosocial, environmental or sociocultural in
nature. www.sprc.org/library/srisk.pdf
Teens Health
This website provides resources for solving problems like anxiety, bi-polar
disorder, stress eating, cutting, divorce, death, grief, depression, post traumatic
stress disorder, anger, self esteem, shyness, etc.
http://teenshealth.org/teen/your_mind/
Youth Risk Behavior Surveillance Survey (YRBSS)
The YRBSS was developed in 1990 to monitor priority health risk behaviors that
contribute markedly to the leading causes of death, disability and social problems
among youth and adults in the U.S. These six behaviors are often established
during childhood and consist of tobacco use, alcohol and drug use, sexual
behaviors, physical activity, nutrition, unintentional and intentional injuries.
www.kshealthykids.org/KCSH_Menus/KCSH_YRBSS.htm
U.S. Department of Health and Human Services (HHS) provides facts and the National
Strategy for Suicide Prevention
http://mentalhealth.samhsa.gov/suicideprevention/default.asp
Yellow Ribbon Program
Yellow Ribbon is a program that works under the premise that “It is ok to ask for
help.” Prevention, intervention and training are offered through the Yellow Ribbon
program. www.yellowribbon.org/
The Kansas contact to develop a Yellow Ribbon Program is Liz McGinness, 201
N. Water, Wichita 67202, [email protected] or call 316-973-4472.
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608 Nutrition and Physical Activity
Nutrition and physical activity are two factors that play into adolescent health. Genetics
plays a role in the physical appearance, but body type is more than biology.
Socioeconomic status is another important factor when it comes to adolescent health;
the more impoverished and undereducated an adolescent is, the more likely they are to
have poor eating habits and activity patterns. An adolescent with poor eating habits and
activity patterns is more likely to become obese.
In today’s society, it is not unusual for a family to eat out, which generally includes fast
foods with high fat and sugar menus. Adding to the poor diet is a more sedentary life
style that includes TV, computer and cell phone texting time that does not burn off the
calories consumed.
CDC and the American Academy of Pediatrics (AAP) recommend the use of Body Mass
Index (BMI) to screen for overweight and obesity in adolescents. Although BMI is used
to screen for overweight and obesity, BMI is not a diagnostic tool and an adolescent
should see a medical professional to diagnose and treat obesity.
Resources
Action for Healthy Kids
This website provides information on how to engage parents and encourage
them to be advocates for healthy living. The website offers ways to involve
students, educators, families and community volunteers in a framework that
supports school-based wellness activities and long term policy change. It has
fun, kid-approved activities for after-school programs, for example; “ReCharge!
Energizing After-School.” http://actionforhealthykids.org
Body Mass Index (BMI)
Body Mass Index (BMI) is a number calculated from a person's weight and height
that indicates the body fatness for most people and is used to screen for weight
categories that may lead to health problems. This site provides information and a
calculator for adolescent BMIs.
www.cdc.gov/nccdphp/dnpa/healthyweight/assessing/bmi/
CDC - Division of Adolescent and School Health This website provides the following:
• Guidelines for School Health Programs to Promote Lifelong Healthy Eating
• Guidelines for School and Community Programs to Promote Lifelong Physical
Activity Among Young People
• Resource Guide for Nutrition and Physical Activity Interventions to Prevent
Obesity and Other Chronic Diseases
• Promoting Physical Activity: A Guide for Community Action
• Promoting better health for young people through physical activity and sports
www.cdc.gov/HealthyYouth/publications/index.htm
Child Trends
This website provides tools for assessing the adolescent diet and managing
weight and nutrition. A Guide for Out of School Time Practitioners
www.childtrends.org/Files//Child_Trends-2007_03_14_RB_TeenDietandOST.pdf
118
Family Guide/Talking to your child about nutrition
This website offers tips for parents on talking with their kids about how food
choices can help their children feel better today and stay healthy for tomorrow.
http://family.samhsa.gov/talk/zucchini.aspx
Institute of Medicine
This website offers a report brief, April 2007, on Nutrition Standards for Foods in
Schools: Leading the Way toward Healthier Youth.
www.iom.edu/Object.File/Master/42/505/Food%20in%20Schools.pdf
609 Sexual Health
The World Health Organization (WHO) states sexual health is a state of physical,
emotional, mental and social well-being in relation to sexuality; it is not merely the
absence of disease, dysfunction or infirmity. Sexual health requires a positive and
respectful approach to sexuality and sexual relationships, as well as the possibility of
having pleasurable and safe sexual experiences, free of coercion, discrimination and
violence. For sexual health to be attained and maintained, the sexual rights of all
persons must be respected, protected and fulfilled.
www.who.int/reproductivehealth/topics/adolescence/en/index.html
Resources
Advocates for Youth
This website offers Sex Education and Other Programs That Work to Prevent
Teen Pregnancy, HIV & Sexually Transmitted Infections.
www.advocatesforyouth.org/publications
Bureau of Disease Control and Prevention. Kansas Department of Health and
Environment: STD Section
This website has Kansas specific information on STD data and services available
in Kansas for prevention and treatment. www.kdheks.gov/std/index.html
Healthy Teen Network
This website offers the Tool to Assess the Characteristics of Effective Sex and
STD/HIV Education Programs and Replicating Success: One Program at a Time.
www.healthyteennetwork.org
National Campaign to Prevent Teen Pregnancy
This website offers several resources for research, data, blogs, grants and
proven programs for teen pregnancy prevention. www.teenpregnancy.org
Youth Risk Behavior Surveillance System (YRBSS)
These websites looks at adolescent trend data. The CDC oversees the YRBSS,
which is conducted every other year during the odd years (e.g. 2007, 2009 and
2011). The CDC selects a random sample of schools from each state to
participate in the survey. In Kansas, the survey is administered by Kansas
Coordinated School Health (KCSH).
For Federal YRBSS data go to: www.cdc.gov/HealthyYouth/yrbs/index.htm
For Kansas data go to:
www.kshealthykids.org/KCSH_Menus/KCSH_YRBSS.htm
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610 Teen Pregnancy
Kansas loves its children, but when children have children, the statistics, data and
consequences are disheartening. Teen pregnancy rates in the U.S. are higher than
most of the industrialized world. In Kansas, 2009, the teen birth rate (ages 15-17) was
20.6 per 1,000 females. This was 6.4% lower than 2008 (22.0). However, no statistically
significant difference was observed. In 2009 (the most recent year preliminary national
data for this age group is available), the birth rate for Kansas young teenagers 15-17
years was slightly higher than the national rate (20.1 per 1,000).
Kansas teenage birth rates for ages 15-17 for all racial and ethnic groups decreased in
2009. The non-Hispanic black teen birth rate in 2009 (26.5) was significantly lower than
the rate in 2008 (37.2). Hispanic teens had the highest rate (60.4) in 2009.
Resources
Healthy Schools/Healthy Youth/CDC
This website offers School Health, Data, Statistics and funding partner’s
information and links to Coordinated School Health, School Health Index and
writing policy on sexuality. www.cdc.gov/HealthyYouth/index.htm
Kansas Department of Health & Environment, Bureau of Family Health, Children &
Family Section
This website provides specific information on grant supported teen pregnancy
prevention programs. www.kdheks.gov/c-f/teen.html
Kansas Department of Health and Environment, Bureau of Family Health
This site provides Kansas specific information and links to:
• 2010 MCH Biennial Summary
• MCH 2015
• The State Systems Development Initiative
www.kdheks.gov/bfh/index.html
National Adolescent Health Information Center (NHIAC)
This website offers guidance and resources for national, state and local
adolescent health leaders to undertake initiatives related to the 21 Critical Health
Objectives, including the guide book: Improving the Health of Adolescents and
Young Adults: A Guide for States and Communities. http://nahic.ucsf.edu/
The National Campaign to Prevent Teen and Unplanned Pregnancy
This website offers national and state data, a calculator to figure the cost of teen
pregnancy. This site addresses responsible policy and writing policy. This site
also has free PowerPoint presentations relating to teen pregnancy and sexuality.
www.thenationalcampaign.org/
Public Health Informatics (KDHE)
This website offers the most recent data on teen pregnancy in Kansas, including
both summary and county level information. www.kdheks.gov/hci/
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611 Violence
Adolescent violence can be found in many forms in today’s societies. Violence can be
physical, verbal, sexual or psychological and inflicted by individuals, groups, institutions
or nations. Violence is described as acts exerted for the purpose of violating, damaging,
or abusing.
To understand why individuals commit violence, criminologists and psychologists often
focus on the individual's personality type, family background, physiological
abnormalities and environment. In 1984, violence was given formal recognition when
Surgeon General C. Everett Koop stated: “Violence is every bit as much a public health
issue for me and my successors in this century as smallpox, tuberculosis and syphilis
were for my predecessors in the last century.”
Since the rampage shooting at Columbine High School in the spring of 1999, much
concern about violence at schools and among teens has been aired and fears that such
events could happen anywhere have emerged. However, with this increased fear came
the identification of risk factors that identify the probability of violent acts.
Resources
CDC -National Center for Injury Prevention and Control
This website looks at data relating to adolescent violence and best practices. It
has resources of podcast, fact sheets, injury response overview, injury
prevention, data and statistics.
www.cdc.gov/violenceprevention/pub/YV_bestpractices.html
Center for the Study and Prevention of Violence
Blueprints model programs
Blueprints promising programs
www.Colorado.edu/cspv/blueprints
Focus Adolescent Services
This website examines potential adolescent violence and looks at reducing risk
factors and warning signs. www.focusas.com/Violence.html
612 Youth Development
Youth development or adolescent development is the process through which
adolescents (alternately called youth or young adults) acquire the cognitive, social and
emotional skills and abilities required to navigate life. The experience of adolescence
varies for every youth: culture, gender and socioeconomic class are important
influences on development. This development occurs throughout a young person's life,
including formal and informal settings such as home, church or school; and similar
relationships, such as peer friendships, work, parenting, teaching or mentoring.
Resources
Assets Coming Together (ACT) for Youth Center of Excellence
This site provides a manual to educate community groups about positive youth
development with the ultimate goal of facilitating organizational and community
change. www.actforyouth.net/
121
Board on Children, Youth and Families – The National Academies
The Board on Children, Youth and Families (BCYF) addresses a variety of
policy-relevant issues related to the health and development of children, youth
and families. It does so by convening experts to weigh in on matters from the
perspective of behavioral, social and health sciences.
www7.nationalacademies.org/bocyf/
Gang Awareness Training Education (GATE)
The mission of GATE is to educate school aged youth about the dangers of gang
involvement and teach youths to say no thank you and walk away. This mission
is accomplished by promoting positive self-image and self-esteem, self-discipline
and demonstrates socially acceptable behavior during later unsupervised
activities. For more information on this program and how to bring this program to
your community go to http:/openthegate.org/middle/risk/.
Find Youth Info
This website provides numerous topics, information, strategies, tools and
resources for youth, families, schools and community organizations related to a
variety of cross-cutting topics that affect youth such as:
• After school programs
• Positive Youth Development
• Service Learning
• Bullying
• Preventing Youth Violence
• Transition Age Youth
www.findyouthinfo.gov/
National Criminal Justice Reference Services
Delinquency prevention and the risk and protective factors associated with it are
highlighted on this website: www.ncjrs.gov/App/Topics/Topic.aspx?topicid=136
National Institute on Drug Abuse (NIDA)
This website looks at the risk and protective factors related to teen drug use.
www.nida.nih.gov/Prevention/risk.html
Search Institute
Search Institute Press provides practical, positive resources to help create a
world in which all young people thrive. The materials focus on the 40
Developmental Assets, which are a framework of qualities, experiences and
relationships youth. www.search-institute.org/.
Social Development Research Center
For research findings on evaluations of positive youth development programs, go
to: http://aspe.hhs.gov/hsp/PositiveYouthDev99.
122
Youth Development
One can define ‘youth development’ as: “...the ongoing growth process in which
all youth are engaged in attempting to (1) meet their basic personal and social
needs to be safe, feel cared for, be valued, be useful and be spiritually grounded
and (2) to build skills and competencies that allow them to function and
contribute in their daily lives.” (Pittman, 1993, p. 8) Center for Youth
Development and Positive Research. http://cyd.aed.org/whatis.html
613 Youth Engagement
“The greatest lessons in life, if we would but stoop and humble ourselves, we would
learn not from grown-up learned men, but from the so-called ignorant children.” Mahatma Gandhi
Over the past two decades, the field of youth development has emphasized youth as
assets, rather than as potential societal problems. As part of this trend, youth are sitting
at tables where programmatic and community governance decisions are being made. It
is increasingly recognized that young people are both products and agents of the
settings in which they engage and that these bidirectional processes provide a basis for
their own development.
The research base for the practice and policy of youth engagement and decisionmaking is rather new, but a consensus has emerged based on several syntheses
(Coalition of Community Foundations for Youth, 2002; Kirshner, O’Donoghue, &
McLaughlin, 2002; Lansdown, 2001; National Research Council & Institute of Medicine,
2002; Zeldin, Camino, & Calvert, 2003). The research indicates that:
1. Young people benefit from having their voices heard and being taken seriously
by adults and peers.
2. Young people learn knowledge, skills and competencies when they are fully
engaged in program decision-making and planning.
3. Program and community governance is a collective, not individual process.
Consequently, governance is best shared between youth and adults.
4. Organizations and community groups need to have the capacity to engage youth
in decision-making.
5. Young people can be stewards of program and community resources and make
sound decisions for programs and communities.
www.actforyouth.net/documents/engagement%20Issue%20Brief.pdf
Resources
ACT (Assets Coming Together) for Youth
This website has demographic resources to support the application of positive
youth development and youth leadership strategies across organizations and
communities.
www.actforyouth.net/documents/engagement%20Issue%20Brief.pdf
Building Partnerships for Youth
This website describes a partnership between the National 4-H Council and the
University of Arizona, designed to build the capacity of societal institutions that
work with young people. The project supports professionals in educational,
health, faith-based and voluntary youth organizations to facilitate the intentional
integration of youth development concepts and approaches into policies and
programs. http://ag.arizona.edu/fcs/bpy/
123
Innovation Center
This a resource that offers tools, resources, strategies and lessons from the field
on promoting youth-adult partnerships as a way to strengthen individuals,
organizations and communities engaged in social change, as well as the practice
of youth development. www.theinnovationcenter.org/what-we-do/youth-adultpartnership
Youth Engagement Strategies (YES)
This site features a resource packet that includes how to:
1. assess the readiness to involve young people
2. select young people
3. support and maintain youth engagement
4. evaluation of youth engagement efforts
http://downloads.cas.psu.edu/4h/yesbookweb.pdf
Youth Infusion
This website on “Youth Infusion”` will help your organization figure out how best
to engage youth through policy development and evaluation.
www.youthinfusion.com/
124
650 - Guidelines for Children and Youth with
Special Health Care Needs (CYSHCN)
Table of Contents
651 - Defining Children and Youth with Special Health Care Needs (CSHCN)
652 - Individuals with Disabilities Act (IDEA)
653 - Resources
654 - References
125
651 Defining Children and Youth with Special Health Care Needs (CYSHCN)
Children and youth with special health care needs (CYSHCN) are defined by the
Department of Health and Human Services, Health Resources and Services
Administration (HRSA), Maternal and Child Health Bureau (MCHB) as:
“...those who have or are at increased risk for a chronic physical, developmental,
behavioral, or emotional condition and who also require health and related services of a
type or amount beyond that required by children generally.” 10
Families that have CYSHCN may have a child that has learning disabilities, chronic
health conditions or severe multiple disabilities. Because of the need to visit health care
professionals more often and the need to provide support and community resources for
families, care coordination in a Medical Home model of care is essential in the care of
CYSHCN.
652 Individuals with Disabilities Act (IDEA)
Individuals with Disabilities Act (IDEA) of 1990 (PL 101-476) is a law ensuring services
to children with disabilities throughout the nation. IDEA governs how states and public
agencies provide early intervention, special education and related services to more than
6.5 million eligible infants, toddlers, children and youth with disabilities. Infants and
toddlers with disabilities (birth-2) and their families receive early intervention services
under IDEA Part C. Children and youth (ages 3-21) receive special education and
related services under IDEA Part B. To learn more about the implications of IDEA for
these populations, go to http://idea.ed.gov/.
653 Resources
See section “MCH Resources for Practice” resources
See section “School Health”
Bright Futures® Family Materials Developed by Family Voices
Family Voices is a national grassroots network of families and friends speaking
on behalf of children and youth with special health needs. Family Voices works to
encourage partnerships between families and professionals for children’s good
health. With funding from the Maternal and Child Health Bureau, Health
Resources and Services Administration, Family Voices produces and distributes
a wide range of materials for families including the Bright Futures Pocket Guides
in English and Spanish, newsletters, fact sheets and other materials. These
materials and others can be found at www.brightfuturesforfamilies.org
Children's Developmental Services, Bureau of Family Health, Kansas Department of
Health and Environment
This section of the Bureau of Family Health promotes the provision of early
intervention services for newborns, infants and toddlers with developmental
delays or disorders and for their families through a statewide, family-centered,
community based, comprehensive, coordinated and culturally competent
assessment, early identification and intervention system. This site provides links
10
U.S. Department of Health and Human Services, Health Resources and Services Administration,
Maternal and Child Health Bureau. The National Survey of Children and Youth with Special Health Care
Needs Chartbook. 2005–2006. Rockville, Maryland: U.S. Department of Health and Human Services,
2008.
126
to Newborn Screening, Infant-Toddler Services and the Coordinating Council on
Early Childhood Developmental Services. www.kdheks.gov/cds/index.html
Children and Youth with Special Health Care Needs (CYSHCN), Bureau of Family
Health, Kansas Department of Health and Environment
This program promotes the functional skills of young persons in Kansas who
have or are at risk for a disability or chronic disease by providing or supporting a
system of specialty health care. The program is responsible for the planning,
development and promotion of the parameters and quality of specialty health
care for children and youth with disabilities in Kansas in accordance with state
and federal funding and direction. www.kdheks.gov/cshcn/index.html
Guidelines for Nursing Management of Students with Chronic Disease or Health
Conditions in School Settings
This manual provides guidelines for meeting the health needs of students in the
school setting who have special health care needs. The content of this manual
gives nurses who are providing school health services with an overview of the
more commonly encountered chronic health conditions, illnesses and concerns
that impact children. This includes students through age 21 and young children
attending child care homes, centers and preschools. In addition to a brief
overview of each condition, the practitioner will find links to websites with expert
resources relating to students’ special health needs. www.kdheks.gov/cf/downloads/School_Nurse_Chronic_Disease_Manual.pdf
Guidelines for Serving Children and Youth with Special Health Care Needs, Part I
These guidelines were developed to assist lawful custodians, teachers,
administrators and health care professionals in developing appropriate
Individualized Health Care Plans for students who have specialized health care
needs which must be addressed during the school day. When appropriate,
emergency or anticipated health crisis plans should be included in the
Individualized Health Care Plan. The guidelines address the process for the
development of Individualized Health Care Plans and the training of school
personnel. The guidelines can be adapted for other settings including early
childhood education settings and day care. www.kdheks.gov/cf/guidelines/special_needs.pdf
Guidelines for Serving Children and Youth with Special Health Care Needs, Part II:
Specialized Nursing Procedures
Part II of the manual outlines the specific nursing procedures for maintenance of
the student in the school setting and is written to assist school systems in
establishing a safe environment for students with significant health problems.
www.kansas.gov/uaa/c_f/guidelines/Intro.pdf
654
References
• Hagan J.F., Shaw J.S., & Duncan P.M. (2008). Bright Futures: Guidelines
for Health Supervision of Infants, Children and Adolescents, Third Edition.
Elk Grove Village, IL: American Academy of Pediatrics.
127
700 - Guidelines for School Health Services
Table of Contents
701 - School-Age Populations
702 - Federal Laws to Consider when Providing Health Services in School Settings
703 - Delivery of School Health Services
704 - Definition of School Nursing
705 - Services Provided by School Nurses
706 - Health Care Plans, Accommodations and Special Education
707 - Collaborative Partners
708 - School Health Policies, Statutes and Regulations
709 - Kansas Statutes and Regulations Addressing School Health
710 - School Health Statutes and Regulations in the Kansas Nurse Practice Act
711 - Confidentiality and School Health Records
712 - Resources
128
701 School-Age Populations
The school setting is a venue for the delivery of health services and educational healthpromotion and prevention programs that are population-based. According to the 2007
Kansas Information for Communities (KIC), there are 581,010 children age 5-19 years,
considered “school-age.” This accounts for 21 percent of the total population in Kansas.
If the birth through age four population of 196,138 is considered, the total number of
children 19 years of age and younger account for 28 percent of the total population. 11 In
Kansas, educational services are provided to children in Infant-Toddler Programs, early
childhood programs, at-risk 4-year old programs, Early Head Start and Head Start,
residential schools for the deaf and blind, alternative schools, home schools, private and
parochial schools, as well as the public school system. The potential for provision of
health-related screenings, services and education for this population is notable.
702
Federal Laws to Consider when Providing Health Services in School
Settings
In Kansas, there are no mandates that require a health professional to be on staff in
school districts. However, there are Federal statutes and regulations, as well as State
requirements that require consideration of access to a health professional for the
provision of health services in the school setting.
•
Individuals with Disabilities Act (IDEA) of 1990 (PL 101-476)
The Individuals with Disabilities Education Act (IDEA) is a law ensuring services
to children with disabilities throughout the nation. IDEA governs how states and
public agencies provide early intervention, special education and related services
to more than 6.5 million eligible infants, toddlers, children and youth with
disabilities.
Infants and toddlers with disabilities (birth-2) and their families receive early
intervention services under IDEA Part C. Children and youth (ages 3-21) receive
special education and related services under IDEA Part B. To learn more about
the implications of IDEA for these populations, go to http://idea.ed.gov/.
There are six principles of IDEA that apply to children in the school setting:
1. Free appropriate public education
2. Appropriate evaluation
3. Individualized education program
4. Least restrictive environment
5. Parent and student participation in decision making
6. Procedural due process
703 Delivery of School Health Services
The school district is responsible for providing school health services required under
IDEA. Many school districts have one or more school nurses on staff or contracted to
oversee health services in the school district. Statutes and regulations designed to
assure that students receive minimal health screening are addressed in section “709
Kansas Statutes and Regulations Addressing School Health”.
11
Kansas Information for Communities (KIC). (2007). Population for Kansas: Age Group. Center for
Health and Environmental Statistics, Kansas Department of Health and Environment.
http://kic.kdhe.state.ks.us/kic/Populate.html
129
704 Definition of School Nursing
School nursing is a specialty practice area of public health nursing. School nurses and
public health nurses collaborate to provide community based services to preschool and
school age children and youth. Health care services must focus on disease prevention,
health promotion and health protection. This involves community, school and individual
partnerships. To learn more about the Role of the School Nurse in Providing School
Health Services; see the American Academy of Pediatrics Council on School Health
website: www.aap.org/sections/schoolhealth/.
705 Services Provided by School Nurses
The primary role of the school nurse is to support student learning. The nurse
accomplishes this by implementing strategies that promote student and staff health and
safety. As the school health services expert, the school nurse serves as the health
professional for the school community and provides services to support learning. Health
services provided to the school is dependent on the contract and will vary with each
school district.
For more information specific to school nursing go the KDHE School Health Resources
website: www.kdheks.gov/c-f/school.html
706 Health Care Plans, Accommodations and Special Education
Children who require any services outside of what is provided in the regular education
setting may fall under the Individuals with Disabilities Education Act (IDEA) and require
an Individual Education Plan (IEP), Individual Family Service Plan (IFST) or 504.
Children receiving special education services are evaluated by a school team who
works closely with the parents and student, health providers and/or specialists to
develop an educational plan taking into account accommodations needed to assure
academic success for the student.
To learn more about Special Education, visit the Kansas Department of
Education Special Education Services website at
www.ksde.org/Default.aspx?tabid=3152.
•
Individual Healthcare Plans (IHP) or Standard Nursing Care Plan
Students may require a care plan to meet their health needs while attending
school. In districts that have secured services of a school nurse, a nursing care
plan or IHP will be written to address the health needs and any emergency
situations that may arise while the student is attending school and school-related
activities. The IHP should include the following:
1. Implementation of health plan for continuity of care
2. Be individualized to meet unique needs of each student
3. Annual updates or revision of physician order
4. Parent and/or student approval
5. Provisions for emergencies
130
707 Collaborative Partners
Care coordination for children in the school setting is essential to the child’s academic
success and in supporting families in raising their children. Collaboration with other
health professionals and members of the community can create partnerships and
programs to promote health and safety for children and their families. In addition,
collaboration is central to case management for children with chronic health conditions.
Partners to consider in collaborative efforts include:
• Local health agencies, community health centers or federally qualified health
clinics
• Local hospitals
• Local physicians
• Local dentists
• Local mental health providers
• Philanthropic and faith-based groups with interests in health
• Local businesses
• Local government
• Children’s advocacy groups
708 School Health Policies, Statutes and Regulations
Each school district has written policy to address all aspects of their local educational
system, including health policy. Common policies for addressing health needs of
children in schools include:
• Medication
• School entry examinations
• Immunization
• Communicable diseases
• School screening
• Blood-borne pathogens
• Injury and illness
709 Kansas Statutes and Regulations Addressing School Health
To access the specific information related to the statutes below, go to the Kansas
Legislature’s website at www.kslegislature.org
• Child Health Assessment at School Entry K.S.A.72-5214 definitions and
requirements
• School Personnel Health Assessment K.S.A. 72-5213 requirement for TB testing,
physical examination, certificates
• Dental Screening K.S.A. 72-5201 definitions, K.S.A. 72-5202 inspectors and
regulations, K.S.A. 72-5203 certificates and dental work
• Hearing Screening K.S.A. 72-1204 definitions, K.S.A. 72-1205 free screening
and who performs test, K.S.A. 72-1206 forms and records
• Vision Screening K.S.A. 72-5203 reports, K.S.A. 72-5204 definitions, K.S.A. 725206 inapplicable to certain children
• Communicable Diseases K.S.A.65-118 reporting to local health authority, K.S.A.
65-122 exclusion for contagious diseases
• Communicable Disease Regulations K.A.R. 28-1-5 provision for isolation and
quarantine, K.A.R. 28-1-6 requirements for isolation and quarantine of specific
infectious and contagious diseases
131
•
•
Immunization Statutes K.S.A.72-5208 definitions, K.S.A.72-5209 certificates,
K.S.A.72-5210 public health duties and fees, K.S.A.72-5211A exclusion
Immunization Regulations K.A.R. 28-1-20 state requirements
710 School Health Statutes and Regulations in the Kansas Nurse Practice Act
Kansas Board of Nursing regulates the Nurse Practice Act regardless of the setting.
Delegation - The transfer of responsibility for the performance of an activity from one
individual to another, with the former retaining accountability for the outcome (ANA,
1994).
• K.A.R. 60-15-10 definitions
• K.A.R. 60-15-102 delegation procedures
• K.A.R. 60-15-103 supervision of delegated tasks
• K.A.R. 60-15-104 administration of medications in the school setting
The Kansas Nurse Practice Act is an essential document for public health nurses and
should be consulted with any question related to nursing practice in any setting. The
regulations for school nursing practice, as well as other practice settings and nurse
licensure/certification levels can be accessed at www.ksbn.org.
711 Confidentiality and School Health Records
Confidentiality and protection of health information is critical in any setting and poses
some additional challenges for practitioners serving in educational settings. The
following resources addressing confidentiality:
•
Health Insurance Portability and Accountability Act (HIPAA) -United States
Department of Health and Human Services: Office for Civil Rights
This site provides information for consumers and providers on the national
standard to protect the privacy of health information of clients. Each local
agency is required to notify clients of their right to confidentiality under
HIPAA. Agencies are required to be knowledgeable on current state
statutes and regulations that address confidentiality, protection of health
information and when sharing of health information occurs in the event of
a threat to public health. Information on the HIPAA Privacy Rule is
available at: www.hhs.gov/ocr/hipaa/.
Information on HIPAA Administrative Simplification Rules is available at
www.cms.hhs.gov/HIPAAGenInfo/. Sites accessed November 14, 2008.
•
Family Education Rights and Privacy Act (FERPA)
The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. §
1232g; 34 CFR Part 99) is a Federal law that protects the privacy of
student education records. The law applies to all schools that receive
funds under an applicable program of the U.S. Department of Education.
FERPA gives parents certain rights with respect to their children's
education records. These rights transfer to the student when he or she
reaches the age of 18 or attends a school beyond the high school level.
Students to whom the rights have transferred are “eligible students.” The
FERPA regulations and other helpful information can be found at:
www.ed.gov/policy/gen/guid/fpco/index.html
132
•
Joint Guidance on the Application of the Family Educational Rights and Privacy
Act (FERPA) and the Health Insurance Portability and Accountability Act of 1996
(HIPAA)To Student Health Records
This document was created in 2008 jointly by the U.S. Department of
Health and Human Services and U.S. Department of Education in an effort
to address the issues of sharing health information between educational
and health entities. This important resource will assist practitioners
working with educational settings.
www.hhs.gov/ocr/hipaa/HIPAAFERPAjointguide.pdf
712 Resources
School Health Resources, KDHE
This site has been developed by the Bureau of Family Health to serve as the
portal to documents, forms and other links that pertain to school health/nursing,
as well as public health for the school-age population in Kansas.
www.kdheks.gov/c-f/school.html
133
750 - MCH Resources for Practice
Table of Contents
751 - General State of Kansas Resources
752 - Child Abuse and Neglect
753 - Childhood Diseases, Infections and Immunizations
754 - Children and Youth with Special Health Care Needs
755 - Confidentiality and Protection of Health Information
756 - Dental and Oral Health
757 - Disabilities and the Law
758 - Emergency and All-Hazards Preparedness
759 - Health Literacy
760 - Health Screenings and Assessment
761 - Maternal and Child Health Resources
762 - Mental Health and Behavioral Needs
763 - Nutrition Assistance Programs
764 - Parenting Skills
765 - Public Health Resource Manual
766 - Safety
767 - Sudden Infant Death Syndrome (SIDS)
134
751 General State of Kansas Resources
Kansas Legislature
This website accesses bills and statutes by searching with specific bill or statute
numbers or using key words. The link provided is for the Site Index that can
access particular resource links www.kslegislature.org.
Kansas Department of Health and Environment
This is the homepage for the State health department and will serve as a portal
to State bureaus and programs. In addition, links to Federal resources and
information that addresses health, environment and laboratory can be accessed
here. A topical index is available on the homepage at www.kdheks.gov/.
State and regional directors for programs can be found at
www.kdheks.gov/contact.html.
Kansas.gov
This is the official website to access services and programs available in Kansas.
www.kansas.gov/index.php
Kansas Resource Guide
The Kansas Resource Guide was created to provide easy access to information
about services and programs. www.ksresourceguide.org/index.htm
752 Child Abuse and Neglect
Child Abuse Reporting
• To report call 1-800-922-5330
• Parents can be referred to the Kansas Children’s League Parent Helpline at
1-800-332-6378.
http://www.srs.ks.gov/agency/cfs/pages/abuseneglectregistry.aspx
Child Abuse Reporting Laws
To access the Revised Kansas Code for Children statutes related to child abuse
and reporting visit the Kansas Legislature and enter the statute number:
• K.S.A. 38-2201. Citation; construction of code; policy of State.
• K.S.A. 38-2223. Reporting of certain abuse or neglect of children; persons
reporting; reports, made to whom; penalties; immunity from liability.
• K.S.A. 38-2224. Same; employer prohibited from imposing sanctions on
employee making report or cooperating in investigation; penalty.
• K.S.A. 38-2226. Investigation of reports; coordination between agencies.
• K.S.A. 38-2227. Child advocacy centers.
www.kslegislature.org
Children's Bureau
The Children’s Bureau is part of the Dept. of Health and Human Services
Administration for Children and Families. The Bureau works with state and local
agencies to develop programs to assist children and families. The site provides
information on (1) how to report suspected abuse, with state hotline telephone
numbers; (2) answers to frequently asked questions about child abuse and
neglect; (3) abuse and neglect resources including publications, services, funding
sources, announcements and policies; and (4) related links.
www.acf.hhs.gov/programs/cb/
135
Child Welfare Information Gateway
This site provides access to information and resources to help protect children
and strengthen families. Information includes:
• Resources about child maltreatment, including definitions, signs and
symptoms, statistics and prevalence, types of child abuse and neglect,
risk and protective factors, the impact on individuals and society and child
fatalities.
• Resources on child abuse prevention, protecting children from risk of
abuse and promoting healthy families. Includes information on supporting
families, protective factors, public awareness, community activities,
positive parenting, prevention programs and more.
• All families can benefit from information, guidance and help in connecting
with resources as they meet the challenges of parenthood and family life.
Find resources and information on family support and family preservation
services.
• Resources and information about out-of-home care (also called foster
care), including family foster care, kinship care, treatment foster care and
residential and group care. Includes information on working with children
and youth in out-of-home care; working with birth families; recruiting,
preparing and supporting resource families (e.g., foster, adoptive and
kinship families); independent living services; placement decisions and
stability; and system-wide issues.
http://childwelfare.gov/
Kansas Children’s Service League (KCSL)
Information regarding on-line training and other resources for child abuse
reporting training is available at www.kcsl.org/
Kansas Department of Social and Rehabilitation Services (SRS)
This site provides information on child abuse and neglect, including access to
Guidelines for Reporting Child Abuse and Neglect in Kansas. It suggests
guidelines for:
• When to report child abuse
• What evidence needs to be noted
• The consequences of failure to report child abuse and neglect
The guide may be ordered or downloaded from: www.srs.ks.gov
Prevent Child Abuse America
A National Association with state chapters and community outreach programs
and materials. Site offers:
1. Information and education about child abuse issues (e.g., newsletter, fact
sheets, survey reports, position statements and press releases)
2. Materials (e.g., Child Abuse Prevention Month materials and community
prevention packet)
3. Access and information regarding state chapters
4. Programs (e.g., parent support programs, Healthy Families America
programs)
5. Advocacy opportunities
www.preventchildabuse.org/index.shtml
136
Promoting Healthy Families in Your Community: 2008 Resource Packet Child Welfare
Information Gateway, Children's Bureau, FRIENDS National Resource Center for
Community-Based Child Abuse Prevention.
This information packet was written to support child maltreatment prevention
efforts by describing strategies and activities that promote protective factors. It is
written for service providers to encourage and support them as they engage and
partner with parents to protect, nurture and promote the healthy development of
children. The packet includes suggestions for enhancing each of the five
protective factors in families; tip sheets in English and Spanish for providers to
use when working with parents and caregivers on specific parenting challenges;
strategies for sharing the message about child abuse prevention in communities;
and information about child abuse and neglect.
www.childwelfare.gov/pubs/res_packet_2008/.
753 Childhood Diseases, Infections and Immunizations
Centers for Disease Control and Prevention (CDC)
This site provides an alphabetical listing of disease and health topics with fact
sheets for each topic. Index is updated on an ongoing basis. This website has
materials available in Spanish and other languages. www.cdc.gov
Kansas Immunization Program (KIP)
The KIP has resources for educating families regarding immunizations, including
fact sheets and schedules. In addition, this site links to the CDC and the National
Immunization Program which have resources for providers and parents.
www.kdheks.gov/immunize/index.html
754 Children and Youth with Special Health Care Needs
Americans with Disabilities Act
Site lists general ADA resources and legal information. www.ada.gov/
Family Voices of Kansas
Family Voices is a national coalition of families of CYSHCN and their caregivers,
professionals and friends whose lives have been touched by these children and
their families. Family Voices of Kansas (FV KS) is a project of Families Together,
a statewide non-profit organization assisting Kansas families which include sons
and/or daughters who have any form of disability. FV KS and Families Together
collaborate to help families of CYSHCN and the professionals who serve them by
providing individualized information and support, training, focus and support
groups, parent matching, list-serves, newsletters and conferences. FV KS
participates in a Family Advisory Group to help shape the programs and policies
of Title V - Special Health Services in Kansas. www.familyvoices.org
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Kansas Newborn Screening Program
While most newborns look perfectly healthy, there are some diseases that are
not obviously visible. Unless these diseases are identified and treated early, they
can cause severe illness, mental retardation or in some cases death. To test for
these diseases, about 24 hours after birth, a baby's heel is pricked and a small
sample of blood is collected by the hospital staff. This sample is sent to the State
public health laboratory where it is tested for several different diseases. If the test
is abnormal, re-testing must be done to confirm a diagnosis. This site explains
the program and what steps are taken when a disorder is found with screening.
www.kdheks.gov/newborn_screening
Services for Children and Youth with Special Health Care Needs, Kansas Department
of Health and Environment
This section of the Bureau of Family Health promotes the functional skills of
young persons in Kansas who have or are at risk of having a disability or chronic
disease by providing or supporting a system of specialty health care. The
program is responsible for the planning, development and promotion of the
parameters and quality of specialty health care for children and youth with
disabilities in Kansas in accordance with state and federal funding and direction.
www.kdheks.gov/cyshcn
755 Confidentiality and Protection of Health Information
Health Insurance Portability and Accountability Act (HIPAA) -United States Department
of Health and Human Services: Office for Civil Rights
This site provides information for consumers and providers on the national
standard to protect the privacy of health information of clients. Each local agency
is required to notify clients of their right to confidentiality under HIPAA. Agencies
are required to be knowledgeable on current state statutes and regulations that
address confidentiality, protection of health information and when sharing of
health information may occur in the event of a threat to public health.
Information on the HIPAA Privacy Rule is available at:
www.hhs.gov/ocr/hipaa/.
Family Education Rights and Privacy Act (FERPA)
The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34
CFR Part 99) is a Federal law that protects the privacy of student education
records. The law applies to all schools that receive funds under an applicable
program of the U.S. Department of Education. FERPA gives parents certain
rights with respect to their children's education records. These rights transfer to
the student when he or she reaches the age of 18 or attends a school beyond the
high school level. Students to whom the rights have transferred are “eligible
students.” The FERPA regulations and other helpful information can be found at:
www.ed.gov/policy/gen/guid/fpco/index.html.
756 Dental and Oral Health
Centers for Disease Control: Brush Up on Healthy Teeth
This site lists facts and information about pediatric oral health. Some materials
are available in Spanish.
www.cdc.gov/OralHealth/publications/factsheets/brushup.htm
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Office of Oral Health (OOH), Kansas Department of Health and Environment
The OOH site helps locate resources and information on oral health for families
and providers. Links to other dental health resources, including downloadable
fact sheets for families can be accessed at: www.kdheks.gov/ohi/index.html.
757 Disabilities and the Law
American with Disabilities Act
The ADA prohibits discrimination on the basis of disability in employment, State
and local government, public accommodations, commercial facilities,
transportation and telecommunications. It also applies to the U.S. Congress. To
be protected by the ADA, one must have a disability or have a relationship or
association with an individual with a disability. An individual with a disability is
defined by the ADA as a person who has a physical or mental impairment that
substantially limits one or more major life activities, a person who has a history or
record of such impairment or a person who is perceived by others as having such
impairment. The ADA does not specifically name all of the impairments that are
covered. To learn more, visit www.ada.gov/cguide.htm
Individuals with Disabilities Act (IDEA) of 1990 (PL 101-476)
IDEA is a law ensuring services to children with disabilities throughout the nation.
IDEA governs how states and public agencies provide early intervention, special
education and related services to more than 6.5 million eligible infants, toddlers,
children and youth with disabilities.
Infants and toddlers with disabilities (birth-2) and their families receive early
intervention services under IDEA Part C. Children and youth (ages 3-21) receive
special education and related services under IDEA Part B. To learn more about
the implications of IDEA for these populations, go to http://idea.ed.gov/.
758 Emergency and All-Hazards Preparedness
American Red Cross
This website provides information on disaster services and how to prepare for
disasters click the tab, “Preparing and Getting Trained”. www.redcross.org/
Federal Emergency Management Agency (FEMA): Individuals with Special Needs
This website has resources and information for planning for special needs during
an emergency. Links are provided to other emergency preparedness websites at:
www.fema.gov/plan/prepare/specialplans.shtm.
Preparedness, Kansas Department of Health and Environment, Bureau of Community
Health Systems
This site provides links to resources to assist individuals, families and others in
the event of an emergency, including pandemic flu, severe weather and natural
disasters. www.kdheks.gov/cphp
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759 Health Literacy
Health literacy - the ability to read, understand and act on health information - is one of
the least recognized yet most widespread challenges to achieving better health
outcomes and lowering health care costs in the United States. By some accounts, low
health literacy is estimated to cost the U.S. health care system more than $58 billion
annually. Yet many health care providers, payers and policymakers remain largely
unaware of the extent of the problem.
Health literacy involves more than a measurement of reading skills - it also relates to
listening, speaking and conceptual knowledge. Low health literacy can affect any
population segment, regardless of age, race, education or income and cannot be
detected by physical symptoms or examinations. Because health literacy is a hidden
health care crisis arising from varying educational, social and cultural factors, it requires
that diverse fields work together to fully penetrate and improve upon the issue.
http://nces.ed.gov/naal/
Literacy Levels of Adults in America: Sample of Tasks Typical of Level (NAAL)
Below Basic
• Searching a short, simple text to find out what a patient is allowed to drink
before a medical test
• Signing a form
• Adding amounts on a deposit slip
Basic
• Finding in a pamphlet for prospective jurors an explanation of how people
were selected for the juror process
• Using a television guide to find out what programs are on
• Comparing the ticket prices for two events
Intermediate
• Consulting reference materials to find out which foods contain a certain
vitamin
• Identifying a specific location on a map
• Calculating the total cost of ordering office supplies from a catalog
Proficient
• Comparing viewpoints in two editorials
• Interpreting a table about blood pressure, age and physical activity
• Computing and comparing the cost per ounce of food items
For more information go to: http://nces.ed.gov/naal/
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Definition
In the report Healthy People 2010
(www.healthypeople.gov/Document/pdf/uih/2010uih.pdf), the U.S. Department of
Health and Human Services included improved consumer health literacy as
Objective 11-2 and identified health literacy as an important component of health
communication, medical product safety and oral health. Health literacy is defined
in Healthy People 2010 as: “The degree to which individuals have the capacity to
obtain, process and understand basic health information and services needed to
make appropriate health decisions.”
Skills Needed for Health Literacy
Patients are often faced with complex information and treatment decisions. Some
of the specific tasks patients are required to carry out may include:
• Evaluating information for credibility and quality
• Analyzing relative risks and benefits
• Calculating dosages
• Interpreting test results
• Locating health information
In order to accomplish these tasks, individuals may need to be:
• Visually literate (able to understand graphs or other visual information)
• Computer literate (able to operate a computer)
• Information literate (able to obtain and apply relevant information)
• Numerically or computationally literate (able to calculate or reason
numerically)
Background
According to the American Medical Association, poor health literacy is "a stronger
predictor of a person's health than age, income, employment status, education
level and race" (Report on the Council of Scientific Affairs, Ad Hoc Committee on
Health Literacy for the Council on Scientific Affairs, American Medical
Association, JAMA, Feb 10, 1999). As a result, patients often take medicines on
erratic schedules, miss follow-up appointments and do not understand
instructions like “take on an empty stomach.”
For more information on literacy go to:
www.chcs.org/publications3960/publications_show.htm?doc_id=291711
760 Health Screenings and Assessment
American Academy of Pediatrics
Infants and children should receive periodic health screening that includes
developmental/social-emotional screening as well as physical exams and lab if
indicated. The Recommendations for Preventive Pediatric Health Care document
is a schedule of recommended times that a child should be seen from birth to
age 21 years. For more information go to www.aap.org and search periodic
screening.
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HealthWave 19 (Medicaid)/HealthWave 21(State Children’s Health Insurance Program
(SCHIP)
Medicaid/HealthWave programs are available to provide no-cost/low-cost health
insurance coverage for children and families. Information regarding these
programs can be found on the KDHE Division of Health Care Finance:
www.kdheks.gov/hcf/.
761 Maternal and Child Health Resources
Bright Futures®
This site links to information for women, children and providers, including
downloadable Bright Futures manuals and resources. www.brightfutures.org/
Maternal and Child Health Bureau Home
This site links to information and resources for MCH programs and services,
including history of MCH. http://mchb.hrsa.gov/
National Center for Education in Maternal and Child Health
This site provides practitioners working with families, access to a plethora of
resources, including access to the MCH Alert newsletter, publications and the
MCH library. www.ncemch.org/
762 Mental Health and Behavioral Needs
Association of Community Mental Health Centers of Kansas, Inc.
This site provides a listing of community mental health centers available in
Kansas. www.acmhck.org/BusinessDirectoryII.asp
CDC Emergency Preparedness and Response
Given the uncontrollable nature of disasters, some people question whether they
can take steps to plan for catastrophic events. Actually, we know that the more
people prepare for the unexpected, the better they manage these situations. This
website provides links for the following topical areas related to common reactions
to disasters and how people in different age groups can prepare for, respond to
and recover from their experiences. Categories include:
• Parents and Caregivers
• Middle School Students
• High School Students
• Adults
• Seniors
www.bt.cdc.gov/preparedness/
763 Nutrition Assistance Programs
Family Nutrition Program (FNP), Kansas State University
This program offers nutrition education for Kansans of all ages that receive or are
eligible to receive food assistance. FNP is implemented by Kansas State
Research and Extension with the sponsorship of the Department of Social and
Rehabilitation Services (SRS) and U.S. Department of Agriculture (USDA).
www.humec.ksu.edu/fnp/
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Food Available From Local Organizations throughout Kansas
In addition to state and federal food assistance programs listed, there are many
helping organizations that distribute locally donated food through food banks,
churches or other methods. Access the website and click on your county to view
food distribution sites. Contact the local helping organizations listed for additional
information. www.srs.ks.gov/services/Pages/default.aspx
Food Stamps or Supplemental Nutrition Assistance Program (SNAP), U.S. Department
of Agriculture (USDA)
As of Oct. 1, 2008, Supplemental Nutrition Assistance Program (SNAP) is the
new name for the federal Food Stamp Program. SNAP offers educational
resources for families on obtaining and using food. Food Assistance and Nutrition
Program, provided by the USDA, provides Food Stamp benefits for low-income
households who qualify. It also provides education on food preparation and
nutrition to these families. This program is meant to provide low income
households with access to a healthy, nutritious diet and serves as a first line of
defense against hunger. Contact the SRS hotline at 1-800-922-5330 for
information. www.srs.ks.gov/services/Pages/default.aspx
Kansas Nutrition and WIC Services
This program administers one USDA funded program, the Special Supplemental
Nutrition Program for Women, Infants and Children (WIC). This program provides
nutrition education and supplemental foods to income eligible Kansas women
who are pregnant, postpartum or are breastfeeding. Services are also provided
to infants and children. www.kdheks.gov/nws-wic/index.html
The Emergency Food Assistance Program (TEFAP)
The TEFAP provides free food to low income households throughout Kansas.
Families learn where and when to pick up the food, how to contact the local food
bank, helping agency or the local SRS office. Families wanting information may
call toll free 1-800-922-5330. www.srs.ks.gov/services/Pages/default.aspx
United States Department of Agriculture (USDA)
Food and Nutrition Services, which operates under the Department of
Agriculture, provides children from low-income families access to food, a
healthful diet and nutrition education. FNS has many programs including WIC,
school lunches and food stamps. This site also has information specifically for
children about nutrition. www.fns.usda.gov/fns/
764 Parenting Skills
Kansas Children Service League (KCSL)
For more than 100 years, KCSL has provided a continuum of programs and
services, advocated for children and collaborated with public and private
agencies to impact the lives of more than 40,000 children and families each year.
KCSL is dedicated to providing services and advocacy efforts that focus on
keeping children safe, families strong and communities involved. This site
provides links to Parent Tip Cards, educational opportunities and resources for
those working with families. www.kcsl.org/index.aspx
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Kansas Parent Information Resource Center (KPIRC)
This organization is a federally funded parental information and resource center
that provides training, information and support to parents. www.kpirc.org/.
765 Public Health Resource Manual
Public Health Resource Manual
This document from the Bureau of Community Health Systems contains
important information for nurses and other professionals working in public health.
There are sections pertinent to a comprehensive public health program, including
Medical Records Management.
www.kdheks.gov/olrh/download/PHNResourceGuidebook.pdf.
766 Safety
Fireproof Children, Prevention First
This site is designed to be a resource for fire safety education, juvenile firesetting prevention and intervention and injury prevention. Of interest is
information for parents, early childhood educators and childcare providers. In
addition, there are resources for mental health and social services.
www.fireproofchildren.com/.
Fire Safety for Babies and Toddlers. U.S. Fire Administration, Federal Emergency
Management Agency
Information on fire prevention and resources including a “Parent’s Guide to Fire
Safety,” can be found at www.usfaparents.gov/.
Injury and Disability Prevention Programs
This site has links to programs available that include Emergency Medical
Services for Children, Sexual Violence and Education, Suicide Prevention, as
well as Safe Kids Kansas. www.kdheks.gov/idp/
Safe Kids Kansas
Preventable injury remains the leading killer of Kansas children ages 1-14, taking
more lives than any other cause including diseases, homicide and suicide.
Prevention works to reduce injury and death in children. The unintentional injury
death rate for Kansas children 0-14 in the 10 years following the inception of
Safe Kids Kansas has decreased 24 percent when compared with the previous
10 years. This site links to resources to addressing safety.
www.kdheks.gov/safekids/index.html
767 Sudden Infant Death Syndrome (SIDS)
CJ Foundation for SIDS
This foundation provides publications and resources to local SIDS networks,
including downloadable posters and educational materials. www.cjsids.com/
SIDS Network of Kansas, Inc.
This site provides information of topics including the Back to Sleep campaign,
surviving grief, parent support meetings, understanding grief in children and other
resources. www.sidsks.org/
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800 - Appendix
History of Maternal and Child Health Services in Kansas
MATERNAL AND CHILD HEALTH SERVICES IN KANSAS
By: Patricia T. Schloesser, M.D.
Director, Bureau of Maternal and Child Health
Kansas Department of Health and Environment
The legislative mandate to the newly created Kansas Division of Child Hygiene stated in 1915 “that
the general duties of this Division of the State Board of Health shall include the issuance of
educational literature on the care of the baby and the hygiene of the child, the study of the causes of
infant mortality and the application of preventive measures for the prevention and suppression of the
diseases of infancy an early childhood.” These original charges have served as the framework for the
Kansas Maternal and Child Health programs which have evolved over the last 60 years and are an
integral component of our present services.
The Kansas Maternal and Child Health Service was organized as a bureau in 1974 when legislation
established a Department of Health and Environment with a secretary of cabinet status in the
Governor’s office to replace the original Board of Health. (See attached organizational charts)
The Bureau of Maternal and Child Health is concerned with a multiplicity of preventive and treatment
health services for a designated population group: Persons under 21 and women in child bearing
years, a total of approximately 1,300,000 persons, or 60 percent of the Kansas population. The
funding of the bureau is a fusion of federal and state funds with matching local public funds, which
total an estimated $5,000,000.
The Bureau of Maternal and Child Health has many functions. They involve standard setting,
consultation, administration of certain regulatory programs concerned with the protection of mothers
and children (hospitals, schools, child care away from home) and public and professional educational
activities (pamphlets, guides, films, radio and TV programs, workshops, seminars). The bureau also
conducts health studies and surveys, plans delivery systems of maternal and child health care
(Migrant Health Services, genetic diseases program) and allocates and monitors grants for
specialized medical care projects (family planning clinics, maternal and child health nursing services,
children and youth projects, maternity and infant care projects, perinatal projects, dental projects and
nutrition projects).
The staff of the bureau consists of a multidisciplinary team of two physicians, seven nurses, three
health educators, a nutritionist, two child development specialists, two hearing conservationists, two
social workers, program aides and various volunteer workers from organizations such as VISTA, as
well as a clerical staff. Organizationally, the bureau is divided into five sections: Family Planning,
Child Care, Licensing, Health Conservation Consultation Services and Migrant Health Services.
The small size of the staff obviously limits the amount of direct services which the bureau can
provide. The program orientation, therefore, is directed at the identification of health problems,
demonstration of services when nonexistent and coordination of maternal and child health services
provided within communities by private physicians, hospitals, schools, local health departments and
other agencies.
Our foremost task has remained the study of the causes of infant mortality and the application of
measures to prevent these deaths. Infant mortality rates of then and now may therefore be used as
the index which has influenced selection and application of Maternal and Child Health programs and
which provides the measurement of their effectiveness.
The Tenth Biennial Report of the Kansas Board of Health in 1920 relates that there were 258
maternal deaths for a rate of 63.9 for each 10,000 live births. In 1975 there were six maternal deaths
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and a rate of 1.9. Infant mortality in 1920 was 71.8 for each 1,000 live births with 2,899 infant deaths.
Between 1970 and 1975, a sharp decline in infant mortality rate occurred simultaneously with a
decline in the birth rate. The greatest decline occurred in 1975 when the infant mortality rate dropped
to the all time low of 12.5.
In 1919 the Kansas legislature enacted legislation requiring licensing and supervision of children
receiving out-of-home care. This licensing law was unusually forward-thinking for its day and remains
so even now. It required the Board of Health to license all facilities providing maternity care or care of
one or more infants or children up to 16 years of age who had been separated from their homes or
relatives. This law was another Kansas “first,” with many states modeling their legislation of the
1950s after the Kansas version.
The licensing inspection function has been delegated by the Bureau of Maternal and Child Health to
community county health and social and rehabilitation service units. Currently there are 1,700 foster
homes providing 24-hour care and another 2,800 family day care homes providing family care to
children of working mothers. A total of over 5,000 known residential and day care facilities are under
health and social service supervision and provide “safe” care to over 35,000 Kansas children each
year. These children all have current immunizations and are under medical supervision. Accidental
deaths of children, which occur far too often in the general population from poisoning, fire, and so on,
are also being prevented.
The concept of combining infant deaths and stillbirths (fetal deaths) for analysis finally became the
accepted approach in the 1950’s, with the use of perinatal rates to assess pregnancy outcome.
The Kansas Perinatal Casualty Report of 1964-65, based on a revised comprehensive medical
supplement to the birth certificate adopted in 1959, set the stage for further studies and programs to
decrease the loss of life in the perinatal period. The downward trend of infant mortality from 19151975 slowed its sharp decline in 1950 and even lost momentum from 1960s. The health department’s
perinatal studies of 1960-1969 pointed up a number of possible prevention areas: the need for
pregnancy prevention in persons under 18 and over 40, smaller family size, spacing of births and
efforts to prevent illegitimacy.
Beginning in the early 1960s the Bureau of Maternal and Child Health reviewed Kansas legislation
concerning reproduction, and recommendations were made for changes in Kansas laws which
prohibited abortion, contraception and sterilization. In 1963, the bureau’s efforts were successful in
repealing the original Comstock law passed before the turn of the century which prohibited public
agencies from providing information on prevention of unwanted pregnancy or obtaining an abortion.
In 1963 an abortion modification law was considered, based on the model law of the American Law
Institute, but was defeated. Finally in 1969, the Kansas legislature passed a law which opened the
way to medically indicated and performed abortions. In 1965 Kansas enacted a family planning law
requiring the Department of Health to establish family planning centers throughout the state. Also in
the 1960s the Kansas Sterilization Law, which had served as a barrier to voluntary sterilization, was
repealed. By 1970 women, both rich and poor, had contraceptive, abortion and sterilization
procedures available when they wished to regulate their fertility.
I would like to comment briefly on some of the other programs which have laced Maternal and Child
Health Services over the sixty years. The issuance of educational literature on the care and rearing of
children, one of the original mandates, has played a primary role throughout the decades. This effort
has expanded into the development of a comprehensive film loan library, with films viewed by over a
million persons each year in Kansas, and to a large variety of pamphlets, guides and workshops for
the general public and professionals. Between 1915 and 1930, much of the educational emphasis
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related to proper infant nutrition. Today the nutrition of mothers and infants is a major component in
the Supplemental Feeding programs for pregnant and lactating women and their infants (WIC,
Department of Agriculture) and Maternity and Infant Care projects (Title V, Health, Education and
Welfare).
Another traditional service of the bureau has been the issuance of guides on prenatal, infant and child
health care.
Child abuse and neglect are on the increase in 1976, and the methods of handling cases are
changing from punishment to protection of the child and positive help to the adults involved, with a
strong emphasis upon prevention. The Bureau of Maternal and Child Health describes the laws in
Kansas and encourages reporting by the public and professionals of suspected child abuse and
neglect.
Infant Mortality Rate at Five Year Intervals
Kansas, 1915-1975
90
80
70
Rate*
60
50
40
30
20
10
0
1915
1925
1935
1945
1955
1965
1975
Year
*Rate per 1,000 live
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