Implementing One Key Question in Kenosha, WI

Power to Decide’s One Key Question^® has an audacious goal: nothing short of transforming women’s health care. One Key Question is a tool for health and social service providers that helps start a conversation about if and when women want to get pregnant and have a child. In Kenosha, Wisconsin the County Department of Human Services has implemented One Key Question. Katie Hanks, MBA, Reimbursement Analyst, Kenosha County Department of Human Services, spoke about the program's growth and success in a recent interview. 

What services do you provide to your clients, generally?

The Comprehensive Community Services (CCS) took on asking One Key Question in coordination with the Public Health Department, who receives referrals from CCS. CCS is a recovery-based mental health program looking to help consumers with severe and persistent mental illness and/or alcohol and other drug abuse (AODA) issues function independently within the community.

Where are you implementing One Key Question? 

Within our CCS program only we have implemented One Key Question at a county-wide level. This includes home visiting, office-based services, and services provided within the community.

Describe the patient/client population you serve with One Key Question.

The CCS program provides services across ages, geographic area, and financial lifespan of county residents. One Key Question is now par for the course of any women 15+ (with parental permission for those age 15-17) who are of childbearing age and capable of getting pregnant.

Describe how you implement One Key Question at your site(s). What does it look like in practice?

We incorporated One Key Question into our initial in-depth assessment, which must be updated every six months. At intake and then every six months afterwards every qualified participant is asked One Key Question.

We even ask the question to those who aren’t qualified under One Key Question! We don’t record it as part of the program, but because we thought it was important to make asking One Key Question a part of the philosophy at CCS, we ask men as well. We have also asked women who couldn’t bear children though we never ask again after we learn about that they cannot have kids.

Does implementation look different than you originally envisioned? How has it changed/evolved in practice since you first started implementing? 

Yes and no. What we didn’t envision in the beginning was asking One Key Question of young people age 15-17. We created a consent form for parents to sign so we could ask minors. That was very important to us because we wanted to include them, but we didn’t want to ruin our relationship with their parents as it’s important for us to keep that relationship strong to provide them other services. Many parents gave permission, which was fantastic. We did have a percentage of parents who refused to give consent so, we then tried to have educational conversations with them before asking again for consent. Sometimes they were more receiving afterwards, but most of the time once it was no it was always no.

What we didn’t expect was that so many people would answer that they were already on a birth control that worked well for them. Many didn’t want to have another One Key Question conversation after we initially asked them because they already felt like they were in a good place.

How are you measuring success?

We measure success in two ways. If consumers tell us they have no knowledge of contraception or preconception care and then they got on a birth control method after being asked One Key Question that’s success. Success is also when clients tell us yes, they do want to get pregnant in the next year and we help them go about that process in the healthiest way.

What has been your biggest success?

Getting people on birth control who didn’t want to have children in the next year.

Describe any specific challenge(s) you had to overcome to implement One Key Question. Were you successful in overcoming these challenges? If so, how did you overcome it? 

The most difficult thing for us was getting results. We anticipated that none of our clients would have a doctor of their own that they see. We assumed that we’d refer everyone to the health department, with whom we have a good relationship. And then we could get results straight from the department.

But most people have a doctor already and so our only way of getting results is through their responses to us. We overcame this problem to the best of our ability by continuously asking consumers if they’d been to the doctor and had the One Key Question conversation and getting us to answer them. We have to trust that the information they give us is truthful.

What advice would you give others who want to implement One Key Question?

Get a great system that allows you to track the data.