National Performance Measure 6: Percent of children, ages 9 through 35months, receiving a developmental screening using a parent-completed screening tool.

 

1. Coordinate and/or provide developmental screening trainings to medical providers, child care providers and community organizations. Twelve local health departments and one tribal health agency selected NPM 6 in 2019. These agencies worked to build and promote early childhood systems that address the Preventive Screening and Follow‐up Priority Need. The Title V Program also supported agencies and community partners throughout the state to promote optimal physical, social‐emotional, and developmental health of children and their families in Wisconsin. Local and tribal health agencies worked with local community coalitions and other partners to coordinate and facilitate developmental screening trainings for medical providers and their teams, childcare providers, and community organizations (Figure 1).

 

The Title V Program worked throughout 2019 to increase the number of healthcare providers and their team members, child care providers, community organization staff, and partners trained to promote and use a valid developmental screening tool such as the Ages and Stages Questionnaire (ASQ) ‐ 3. Additionally, the Title V Program ensured adoption of the AAP and Bright Futures (4th Edition) recommendations within systems of care and community partners, and promoted consistent messages for Wisconsin families and communities to increase awareness and understanding of child development and their roles in developmental monitoring and screening. The Title V Program also partnered with local agencies to improve data collection regarding developmental screening results and referral to early intervention.

 

Agencies implemented systems‐building strategies focusing on developmental screening, and reported information related to the sites they engaged with, what facilitated their work with the sites, and successes and barriers that encountered throughout the year. Of the 78 sites that agreed to participate in the 2019 initiative, 33.3% (21) were childcare groups, 20.6% (13) were community organizations, 46% (29) were clinics, and 19.2% (15) did not report their agency type. These 78 sites reached 16,461 children younger than 6 years old. Educational events conducted with 6 community organizations had 175 total participant attendance. Local and tribal health agencies reached 323 community and health care organizations through this work.

 

Main barriers that agencies identified include, but are not limited to, lack of time or capacity, not knowing who to refer to, failure to follow best practices, and staff turnover. The Title V Program and Wisconsin Medical Home Initiative staff reviewed these barriers and plan to address some of these barriers in 2020.

 

2. Support the Wisconsin Statewide Medical Home Initiative to provide technical assistance to MCH-funded agencies and other partners working on developmental screening. The Wisconsin Medical Home Initiative was established in 2010 by the Wisconsin DHS and has been administered by Children’s Health Alliance of Wisconsin since 2015. The Wisconsin Medical Home Initiative is funded by the Wisconsin DHS’s Title V Children and Youth with Special Health Care Needs Program.

 

Wisconsin Medical Home Initiative staff led developmental screening technical assistance efforts in 2019, and supported local and tribal health agencies in building community systems of care to promote developmental screening and timely referral to appropriate supports using quality improvement methodologies and tools (i.e., driver diagram, Plan-Do-Study-Act cycles, control or run charts). A 2019 driver diagram (Figure 2) was revised to guide, track and show team efforts and improvement. Measures included percent of sites conducting developmental screening; percent of sites that received training; percent of sites that changed their protocols or practices to include developmental screening; percent of local and tribal health agency professionals who disagree/strongly disagree that developmental screening work complements other professional responsibilities.

Figure 2: 2019 Developmental Screening Driver Diagram

 

Title V Program and Wisconsin Medical Home Initiative staff provided in-person mid-year site visits with each of the local and tribal health agencies to share resources, offer technical assistance related to barriers encountered, and acknowledge successes. Discussion during these site visits also included brainstorming with agencies to offer new and other opportunities for advancing developmental screening efforts.

 

In addition to childcare, trainings for medical providers and community organizations implemented by the local and tribal health agencies, Wisconsin Medical Home Initiative conducted targeted outreach to medical clinics throughout Wisconsin (Figure 3). These Developmental & Mental Health Screening Trainings took place from January-December 2019 and were integrated with NPM 11 work. Two training types were offered: Developmental Screening/Surveillance as part of Well‐Child Care, and Pediatric Mental Health Screening Tools. Twenty-six trainings took place in five public health regions (22 for developmental screening and 4 for mental health screening tools). Forty agencies participated in these trainings, including 26 health clinics, four health departments, and other agency types including a school district and a Birth to 3 Program. There were 272 attendees, 82 of whom were clinicians, and 135 attendees claimed Continuing Medical Education credit.

 

Specific to the 22 Developmental Screening Trainings, Wisconsin Medical Home Initiative conducted 182 pre-training assessments, nine post-training assessments, and obtained 243 post-training evaluations from attendees. In a pre-training assessment, 31% of sites reported they do not perform screenings using a standardized, validated tool. Thirty-nine percent (39%) of sites do screen; of those sites screening, 86% are using the ASQ-3. Post-training, 100% of sites reported they intend to perform standard screening. Ninety-nine percent (99%) of those responding to the post-training evaluation indicated their knowledge of developmental screening increased from participating in the training. Ninety-eight percent (98%) indicated their knowledge of recommended referrals and resources for children with concerning screening results increased. Pediatric Mental Health Screening Trainings data can be found under NPM 6, Strategy 7.

 

In 2019, the Title V Program supported an in-person MCH Summit on April 16 – 17 in Eau Claire, Wisconsin titled “Building an Equitable System of Support.” Wisconsin Medical Home Initiative staff delivered a presentation centered on developmental screening and Medical Home in collaboration with other state partners who presented on transitioning from pediatric to adult health care and other CYSHCN Network resources.

 

3. Provide quarterly developmental screening Learning Community for stakeholders, including funded Title V partners. Four Learning Community calls were hosted throughout 2019 on February 20th, June 19th, August 21th and December 4st. Wisconsin Medical Home Initiative staff facilitated each of the four Learning Community calls. Each call agenda hosted four local teams who shared information, including the number of years they have been working on developmental screening, partnerships that have enhanced local strategies, and successes and barriers to implementation strategies. Other Learning Community topics included quality improvement highlights and activities from various teams. New in 2019, teams were introduced to a new quality improvement platform titled, Life QI. Life QI was piloted as a communication tool for agencies to track and share their quality improvement activities. While the teams were testing out the platform with an open mind, they quickly found that it was burdensome and did not meet their needs or enhance their work. Once this feedback was received, changes were made to help facilitate the work in different ways. These strategies included using poll questions during Learning Community Calls to gather data, and the creation of a master contact list for all teams shared with everyone. These steps allowed teams to share feedback with the entire group and connect with individual teams between meetings to advance their efforts. Team call participation ranged from 85% to 92% throughout 2019. Call evaluations were completed following each call. See chart below for data from those who completed the call evaluations. Table 1 displays the percent of those completing the evaluation rating each category as “good” or “excellent.”

 

Throughout the year, Wisconsin Medical Home Initiative staff used internal quality improvement approaches to ensure that team needs were being met. The increased quality of discussion, cohesiveness among the group and productivity of the Learning Community Calls throughout the year indicate that the changes made resulted in positive outcomes.

 

Wisconsin Medical Home Initiative staff developed new web pages specific to developmental screening and mental health screening with information and resources for both professionals and families. The developmental screening web page had 318 views for 2019. This new page included Learning Community Call agendas, presentations, archived/recorded meetings for those not able to attend and additional resources for agencies.

 

4. Collaborate with other statewide agencies/stakeholders to promote awareness and alignment of efforts related to developmental screening in Wisconsin. The Act Early initiative in Wisconsin encompasses the Act Early State Team, the CDC’s Act Early Ambassador to Wisconsin, and Learn the Signs Act Early outreach. The Act Early State team brings the Title V Program and CYSHCN Network together with other key early childhood and disability stakeholders to coordinate efforts related to improving systems of early identification and care for children with autism spectrum disorder and other developmental disabilities. Members of the Act Early State Team represent multiple organizations: the Title V Program; DHS Bureau of Children’s Long Term Support Services; Individuals with Disabilities Education Act Part B & C Programs; the Wisconsin Women’s Health Foundation/WellBadger; Family Voices of Wisconsin; Parent to Parent of Wisconsin; Wisconsin Board for People with Developmental Disabilities; Wisconsin Chapter of the Autism Society; Wisconsin Family Ties; Wisconsin Statewide Parent-Educator Initiative; Children’s Health Alliance of Wisconsin; Cooperative Educational Service Agencies; Wisconsin AAP; Wisconsin Head Start Association; autism spectrum disorder therapy providers; community-based service providers; health care providers; higher education/research agencies; family organizations.

 

The current Wisconsin Act Early State Plan was updated in 2016 to address the service gaps and needs of families and communities in Wisconsin and improve the rates of developmental monitoring, screening, and referral, assessment and diagnosis, and enrollment in appropriate services for children with autism spectrum disorder/developmental disabilities. The plan prioritizes goals and action steps to support family engagement and cross‐agency collaboration to improve statewide outcomes. Over the past two years, the team has focused on quality improvement strategies to improve health equity and access to services among medically underserved families.

 

The CDC’s Act Early Ambassador to Wisconsin leads the Learn the Signs Act Early outreach efforts in the state. The Act Early Wisconsin website supports widespread access to and ordering of Learn the Signs Act Early resources. In 2019, a significant effort was the full integration of developmental monitoring using these materials in MIECHV‐funded Family Foundations home visiting programs, which included a developmental monitoring training module for home visitors. The Title V staff supported Act Early team members in successfully applying for a competitive continuation of the “Innovation in Care Integration for Children and Youth with Autism Spectrum Disorders and other Developmental Disabilities,” referred to as the Wisconsin Care Integration Initiative, a four-year initiative that aims to increase early access to developmental and autism spectrum disorder screening, assessment, and early intervention among medically underserved populations across Wisconsin through three strategies: 1) provider education, 2) family navigation services, and 3) building sustainability and dissemination in partnership with Act Early State Team members. The Wisconsin Care Integration Initiative provided trainings and family navigation to over twelve primary care clinics across the state, which serve large populations of medically underserved children age 0-5 years old. In close collaboration with the Act Early State Team members, the Wisconsin Care Integration Initiative worked to integrate efforts with ongoing Title V activities related to family engagement, early identification, and health equity.

 

In 2019, the Act Early Team explored the Engaged Community Quality Improvement Project Family Navigators' experience in supporting and connecting families in three different counties in Wisconsin, promoting strategies for helping families navigate service systems. The Act Early Team members discussed how these best practices and lessons learned could be shared and applied to other programs. Additionally, the team utilized quality improvement tools to address disparities in access to systems of early identification and care for children with autism spectrum disorder/developmental disabilities within two focus areas: 1) support the build and promotion of the WellBadger Resource Center, and 2) identify strategies for meeting families where they are. Some change ideas comprised co-branding an online survey to determine family experience in accessing autism spectrum disorder identification and services offered in both English and Spanish, engaging team members in the review of autism spectrum disorder-related programs, services and agencies included in the WellBadger Resource Center database, testing the new WellBadger web platform during the soft release and obtaining family feedback regarding effective promotional messages and images.

The team also reviewed the regulatory issues surrounding telehealth in Wisconsin and discussed how telehealth methods could be applied in the state to further the goals of the Act Early State Plan. Finally, the team worked on using quality improvement strategies to improve the accessibility of the shared resource network for culturally and linguistically diverse families. Title V Program staff worked with the Act Early Ambassador and other team members to successfully apply to “States of Solutions,” a program that supports state coalitions addressing health equity that is co‐sponsored by the Robert Wood Johnson Foundation and the Institute for Healthcare Improvement. Through the States of Solutions project, MCH/CYSHCN and Act Early stakeholders were able to support a rural community in launching an “Equity Action Lab,” an 18-month initiative to foster locally-driven change efforts related to early identification of autism spectrum disorder/developmental disabilities.

 

In 2019, the Wisconsin Early Childhood Collaborating Partners transition continued with implementation of the new outreach structure. All of the Regional Collaboration Coaches positions were filled to sustain and support ongoing cross-sector professional development and improvement activities. Title V Program staff promoted collaboration and linkages with local and tribal health agencies, and CYSHCN priorities and delivered orientation for new staff. The Wisconsin Early Childhood Collaborating Partners continued to promote and provide links to state and national resources (Figure 4) for parents and care providers to support common messaging about developmental monitoring and screening, specifically the developmental screening tip sheets. Title V Program staff served on the Healthy Children Committee in 2019, a multidisciplinary workgroup responsible for an organic mix of initiatives advancing supports for early childhood care and education. Partners included the public and private sector encompassing DHS, Department of Children and Families, Department of Public Instruction, the Wisconsin AAP, Prevent Blindness Wisconsin, the UW Waisman Center and the Wisconsin Dental Association. The Wisconsin Blueprint continues to be a resource for guidance on developmental screening in addition to screening for autism spectrum disorder, vision/hearing, oral health, and newborns. The Title V Program provided continued support throughout 2019 for the Wisconsin Early Childhood Collaborating Partners’ Coaches and their regional teams through braided funding efforts with the Department of Public Instruction and Department of Children and Families.

 

5. Promote consistent use of national and state resources and tools for consistent messaging about importance of developmental screening. Local agencies implementing the MCH Objective focusing on developmental screening were connected to professional workforce development opportunities, such as Title V resources and competencies linked to the MCH Navigator.

 

Act Early resources developed by the CDC and Birth to Five Watch Me Thrive created by the US Department of Health and Human Services were promoted, shared and implemented by various teams. All agencies were provided technical support to apply innovative approaches utilizing the Life Course framework to assist in building local capacity within communities for medical providers, childcare agencies, and other professional partners to assure common messaging, appropriate training and use of evidence‐based standardized developmental screening tools/resources.

 

Educational materials, such as Learn the Signs Act Early and the DHS Birth to 3 ‐ Primary Care Provider Health Information Portability and Accountability Act/Family Educational Rights and Privacy Act Joint Release Form, were consistently promoted and distributed during all 2019 trainings. Title V Program staff promoted the DHS Referral and Joint Release of Information between medical homes and early intervention local agencies, along with strategies to strengthen outcomes for following referrals. This work is also connected to the NPM 11.

 

The Wisconsin Medical Home Initiative promoted children’s health and development through its direct targeted outreach and support to primary care clinicians, public health and families through the Wisconsin Medical Home Initiative website, which houses national and state educational resources.

 

In December 2019, a group of statewide partners began discussing the reprinting of the Learn the Signs Act Early resources promoting cost sharing opportunities.

6. Promote resources that provide information and referral services to providers and/or families after a concerning screening result. Developmental screening trainings provided to childcare, medical providers and other community organizations were conducted in collaboration with local community resource professionals serving children with delays and their families, including the Regional Centers for CYSHCN, Birth to 3 Program, and local public health professionals focusing on child development. Working with these partner agencies at the trainings allowed for each site to meet their local representative and learn more about each of the programs and services that can be utilized within their community. Having staff present directly correlated with increasing knowledge of available resources for families, children, public health and clinical providers offered by the Regional Centers for CYSHCN in the five public health regions. Regional Centers assisted families with accessing local and state intervention services. Fifty-six percent (56%) of calls to Regional Centers were related to a child with developmental, emotional, behavioral, or mental health concern.

More information related to the Regional Centers can be found in the NPM 11 narrative.

The Title V Program continued to partner with the Wisconsin Women’s Health Foundation to administer the Wisconsin WellBadger Resource Center. The WellBadger Resource Center made significant progress in establishing and implementing a web-based information and referral service program during 2019 by adding web-technology, text and chat advancements. Monthly WellBadger data reports show statewide utilization by state constituents across multiple disciplines. Data show there were 1,568 information and referral calls made to WellBadger in 2019. Of these calls, 454 were for children and youth with special needs.

 

7. Support social-emotional and behavioral health screening for children. In 2019, Wisconsin Medical Home Initiative conducted four Pediatric Mental Health Screening Trainings and 75% of these trainings were done in collaboration with the Child Psychiatry Consultation Program. Trainings included 17 pre-training assessments, two post-assessments, and 60 training evaluations.

 

During a pre-training assessment, one trainee reported they were using the ASQ: Social-Emotional, Second Edition (ASQ: SE-2). 1 trainee reported using the Vanderbilt Diagnostic Rating Scales. Two trainees indicated they were using Bright Futures recommendations. During the post-training assessment, 100% of respondents indicated that they perform standard screening using the ASQ: SE-2.

 

According to Mental Health Screening Trainings evaluations, 98% of respondents indicated that their knowledge of pediatric mental health screening increased, and 98% of respondents indicated that their knowledge of recommended referrals and resources for children with concerning screening results increased.

 

Resulting from the training, 100% of sites are now using mental health screening tools at AAP-recommended ages. Three clinics (100%) enrolled in the Child Psychiatric Consultation Program as a result of collaborative Mental Health Screening Trainings.

 

The Office of Children’s Mental Health continues to serve as the backbone organization to support collective impact activities through a multidisciplinary stakeholder group known as the Collective Impact Executive Council. The council met six times in 2019. The Title V Program is a council partner and actively participated in the council meetings. There were four collective impact workgroups: access, trauma-informed care, resiliency and Collective Impact Partners and the infant and early childhood mental health consultation. Each workgroup met monthly to work on strategies then presented activities and challenges to the council for large group analysis. Title V partners participated in one or more of the workgroups. Examples of 2019 activities included:

 

• The council approved a definition for lived experience: a person with lived experience has, or is a family caregiver for someone with mental health, substance abuse, trauma, and/or special needs and understands this unique journey. They use their voice and perspective to transform systems to better serve children and families and highlight the services and supports that are most empowering in raising healthy, thriving children.

 

• Lived Experience panels were convened in February, June, August, and October of 2019. Culture change for organizations was incorporated and lived experience was highlighted by Sue McKenzie from Rogers Behavioral Health.

 

• The lived experience engagement survey was completed in 2019 to gauge the level of involvement of individuals with lived experience among the Collective Impact network. Results showed that 43 child and family-serving organizations completed the survey and 68% had been engaging lived experience for 5+ years. Level of implementation: 43% were somewhat developed, 23% were fully developed, 23% were starting to be developed, 53% said lived experience’s voice had a high level of impact and 30% had a moderate level of impact.

 

• Educating others on lived experience remained a top priority for Collective Impact partners in 2019. Lived experience was a topic for presentations for two statewide conferences and one national conference: 2019 Mental Health and Substance Use Recovery Training Conference

(October 29-30), Annual Children Come First Conference (November 11-12) and the Federation of Families for Children's Mental Health Conference (November 14-15).

 

• Trauma-Informed Care workshops were convened in Wisconsin: Enhancing Family Engagement by Understanding Cultural and Historical Trauma was delivered by a live panel broadcast from DHS and hosted by 18 sites across the state; 614 people registered. After this successful workshop on May 6th, the workgroup reviewed workshop survey responses in planning for the November 4th workshop with the addition of a number of cities (Appleton, Eau Claire, La Crosse, Madison, Milwaukee, Rhinelander, Viroqua, Waukesha, and Wausau).

 

• The Model/Workforce Development and Communications/Finance subcommittees met together and reviewed the Connecticut and Illinois models for infant and early childhood mental health consolation. Although there were many similarities between the two models, the Illinois model works across systems allowing for the universal approach the workgroup prefers. The workgroup selected the Illinois model to move forward.

 

• The Resilience workgroup launched a pilot to test the Youth Mental Health Crisis Plan Card on October 25, 2019 at Northland Pines High School, Eagle River.

 

• Title V Program staff ensured connections to council activities such as suicide prevention and the Wisconsin YRBSS while linking to agencies working on the MCH Objective of Adolescent Suicide. An annual report was completed by the Office of Children’s Mental Health in 2019. This report outlines Wisconsin’s 48 Child Well-Being Indicators: Resilience, Risk, and Outcomes: How Wisconsin Stacks Up.

 

• Indicators represent some factors, as well as interventions and potential outcomes. The 2019 Report provides more information, and comparisons over multiple years are provided showing trends over time.

 

• The Office of Children’s Mental Health went through staff changes in 2018-2019. Linda Hall, their Director, was appointed. The Collective Impact partners bring decades of lived experience and leadership to the Children’s Mental Health Collective Impact Executive Council meetings and workgroups. With Linda’s leadership the council convened and introduced plans for increasing the level of engagement using the model below.

 

• The Wisconsin Project Launch Program started the Wisconsin Knows: Children’s Mental Health Matters movement in 2012 and this movement continued in 2019. In May, Wisconsin hosted the annual My Feeling Matters Project activities along with other Children’s Mental Health events.

 

• The Office of Children’s Mental Health worked closely with the Department of Public Instruction to prioritize school mental health and to share work related to the grant funding offered to schools in 2019.

In December 2014, the Wisconsin Child Psychiatric Consultation Program funded with general purpose revenue was launched. The Title V Program continues to support the Medical College of Wisconsin to implement the Child Psychiatric Consultation Program in Wisconsin (Northern, Northeast, Southern, and Southeast regions and Milwaukee County). Title V Program staff directs and manages this program. The Child Psychiatric Consultation Program continued to build primary care provider capacity to support the behavioral health needs of children and families by: 1) providing consultation to primary care providers regarding diagnosis and management options for children and adolescents with mental health problems, 2) providing and ensuring a referral support system for these pediatric patients to other mental health professionals and community resources as identified and needed, and 3) providing education and training in mental health issues for primary care providers. The Child Psychiatric Consultation Program enrolled providers continued to establish an ongoing trusting relationship with a child psychiatrist, received efficient and timely expert consultation, access to ongoing education and support leading to increased confidence and received referral assistance for local mental health resources. The following are additional characteristics pertaining to the Child Psychiatric Consultation Program:

 

• Continued outreach to health systems and pediatric/family practices resulted in a steady increase in enrollment of primary care providers. Since program inception through December 31, 2019, 198 clinics and 950 providers have been enrolled. Furthermore, since program inception through December 31, 2019, there were 3627 Child Psychiatric Consultation Program consults provided to enrolled providers. Active primary care provider enrollment continues in the Northeast and Southern regions of Wisconsin.
• Since receiving a five-year grant titled Pediatric Mental Health Care Access Program from the US Department of Health Resources and Services Administration Maternal Child Health Bureau in October 2018, DHS has expanded Child Psychiatric Consultation Program services to additional primary care providers in southern Wisconsin. A new regional Child Psychiatric Consultation Program hub in this area is in negotiation stages. As of December 31, 2019, 14 providers have been enrolled and seven consults were completed.
• The Child Psychiatric Consultation Program encounter data continued to show that most primary care providers were calling about children ages 6‐10 years old and adolescents ages 11‐20 years old, with an average age of 10.11 years old. The three most common reasons for consultation were general medication questions/education, recommending another provider/resource and medication prescription details.

8. Support an Adolescent and Child Health Quality Collaborative to improve developmental screening rates within health systems, medical groups and clinics across Wisconsin. In 2019, the Title V Program continued collaboration with the Wisconsin Collaborative for Healthcare Quality to track child health and adolescent health ambulatory data related to well care visits. This strategy is part of the broader systems’ improvement work being done to improve adolescent and child health. The goal of this project is to engage Wisconsin health care systems/clinics to improve developmental screening and adolescent well visit rates. This effort is voluntary and provides one way for organizations to address and work to improve health outcomes. Wisconsin has a unique approach that involves multiple organizations collaborating to track and improve child developmental screening and adolescent specific well visit rates over time, and are able to compare data across the state. The goal is that information related to activities and outcomes related to the adolescent and child health performance measures will be shared with statewide partners and the public. The DHS Quality Improvement Director for the Title V Program worked to focus on strategies to advance the Title V performance measures in Wisconsin utilizing quality improvement processes with internal and external partners engaged in this work. In 2019, the Wisconsin Collaborative for Healthcare Quality’s Adolescent and Child Health Steering Team completed project year 5. The 2019 project goals were: 1) continue data collection and measurement, 2) increase adolescent well care visits from 64% to 67% among reporting teams and 3) discuss public reporting of adolescent well care visits. Monthly Adolescent and Child Health Steering Team meetings provided a platform to disseminate quality improvement strategies and practices among healthcare systems. This team guided the development, dissemination, and monitoring of annual goals, strategies, and tools to improve adolescent and child health outcomes across the health systems, medical groups, and clinics in Wisconsin. Four examples of the information gathered and/or disseminated in 2019 included:

 

1. A presentation from Pam Lano, PhD Division of Medicaid Services Bureau of Benefits Management. Dr. Lano provided an introduction to HealthCheck and HealthCheck Other Services, clarified details of the benefit, defined other services, and shared the updated prior authorization process to enhance member access to HealthCheck Other Services.

 

2. Dr. Bob Rohloff from Primary Care Pediatrician Children’s Medical Group shared his work related to ASQ developmental screening, documentation of results and follow up in clinical workflow and the electronic medical record.

 

3. A survey on child health quality improvement opportunities for Wisconsin primary care providers. The survey results informed prioritization of efforts to build a portfolio of quality improvement projects with Maintenance of Certification Part Four credits for pediatric primary care providers. The survey was developed by the Title V Program, in collaboration with the Wisconsin AAP, Wisconsin Association for Perinatal Care, the Wisconsin Collaborative for Healthcare Quality, and the Children’s Health Alliance of Wisconsin. The survey was completed by 98 clinicians. High-ranked topics included nutrition for infants, children and adolescents, developmental screening, safe sleep for infants, and depression screening in adolescents. Results of the survey led to Wisconsin’s involvement in a national quality improvement project for physicians to improve depression screening and follow up in adolescents and young adults.

 

4. A survey was conducted among the Wisconsin Collaborative for Healthcare Quality members to determine elements motivating health systems to participate in a child and adolescent health quality collaborative. Sixteen members completed the survey, and over 67% were not current steering team members. Top-ranked items included movement toward value-based payment, community priority alignment (including health equity), and required reporting alignment. One of the lowest ranked items was state program recognition. Given these results, the planning team proposed having a standing agenda item during 2020 meetings to discuss the Medicaid Child Core Set metrics. The goal will be to support systems in improving their processes in advance of required reporting starting in 2023.

 

Dr. Arianna Keil, the Quality Improvement Director served as the Title V Program’s lead contact with the Wisconsin Collaborative for Healthcare Quality for the MCH Quality Improvement Project. She was also selected to participate in the 2019 cohort of the CDC’s Population Health Training in Place Program. The focus of her project was on strengthening Wisconsin’s adolescent and child health quality collaborative. In 2019, the Wisconsin Collaborative for Healthcare Quality experienced staff turnover resulting in orientation for new staff. Title V Program staff worked closely with the Adolescent and Child Health Steering Planning Team, which includes the Wisconsin Collaborative for Healthcare Quality, to review, plan and create valuable Wisconsin Collaborative for Healthcare Quality Adolescent and Child Health Quality Improvement Steering Team meeting agendas. With Title V Program staff guidance and expertise, measure specifications were refined for developmental screening and adolescent well care visits. The Wisconsin Collaborative for Healthcare Quality’s measures remained aligned and endorsed by national bodies such as the National Quality Forum or National Committee for Quality Assurance HEDIS measures. For example, the NPM 10 age range (12-21 years) matches the HEDIS age range. Members reported measures that were reviewed during the steering team meetings. In 2019, participation in the project included 39 individuals in relation to 14 health systems and 11 other statewide partners. The majority of the 14 participating health systems reported monthly rates of adolescent well care visits to the Wisconsin Collaborative for Healthcare Quality. The Collaborative compiled submitted data on this metric and shared data with the steering team to examine progress over time.Despite ongoing barriers, dedicated Title V Program and Wisconsin Collaborative for Healthcare Quality staff maintained momentum for sustaining and continually shaping the future of this public health and health system partnership initiative. The Wisconsin Collaborative for Healthcare Quality’s Adolescent and Child Health Steering Team maintained a higher interest in the adolescent health focus area due to the health systems’ ability to collect and report this measure to the Wisconsin Collaborative for Healthcare Quality. Developmental screening data is not readily available for most systems participating in the steering team. The proposal of having adolescent well care visits as a publicly reported measure for all Wisconsin Collaborative for Healthcare Quality members was rejected by their Measure Advisory Committee. The committee’s decision was driven by concerns over burdening primary care and limited evidence supporting adolescent well care visits as a comprehensive intervention, as compared with individual components of the well visit, such as depression or Body Mass Index screening. Despite this, in 2019, the Wisconsin Collaborative for Healthcare Quality Board of Directors still recognized child health as a key priority for the future. This project continues to provide ongoing attention to essential adolescent and child health topics, particularly those focusing on disease prevention and wellness promotion.

 

In 2019, the Wisconsin AAP and Title V Program submitted an application and were selected to participate in the Adolescent and Young Adult Behavioral Health CoIIN. This CoIIN is affiliated with the Adolescent and Young Adult Health Resource Center and The National Improvement Partnership Network. The 9-month Adolescent and Young Adult Behavioral Health CoIIN project is for primary care providers interested in focusing on the implementation of a validated depression screening tool and referral system. The Wisconsin AAP recruited medical practices and providers from the AAP and American Academy of Family Physicians chapters, improvement partners, health systems, insurance networks, and community health centers to participate. The selected practices will participate in a virtual learning collaborative and earn Maintenance of Certification credit beginning in 2020.

9. Collaborate with home visiting to promote developmental screening and referral. The Title V Program collaborates and provides support to the Department of Children and Families MIECHV Program known as the Family Foundations Home Visiting Program. This program aims to promote the health of the MCH populations of women, infants, children and families in the identified at‐risk communities, including the reduction of child abuse and neglect. Home Visiting Program leadership staff continued to provide support in planning, implementation, technical assistance and training for evidence‐based home visiting models: Nurse Family Partnership, Parents as Teachers, Early Head Start and Healthy Families America. In January of 2019, the Title V Program hired a full-time Home Visiting Nurse Consultant following a long vacancy for this position. The position is funded in partnership with the MIECHV Program. In 2019, staff connected several Title V programmatic activities to the Home Visiting Program. In January of 2018, the Home Visiting Program continuous quality improvement learning collaborative was initiated for developmental screening. Home Visiting Program leadership facilitated two expert meetings for supporting developmental screening information sessions with the Title V Program contributing to these expert sessions. For the first half of 2019, the implementing agencies submitted regular data for a series of measures and conducted and reported on tests of change. The continuous quality improvement collaborative included 13 Home Visiting Program agencies focused on developmental screening. An expert panel including staff; the UW-Milwaukee Child Welfare Partnership Program along with the Home Visiting Program state team provided technical support to the learning collaborative; this support included ongoing Learning Community calls. The 16-month learning collaborative, which ended in August 2019, provided information related to a change package and tool kits, which will continue to support and expand upon the work accomplished during the collaborative.

 

Data from the Home Visiting Program benchmark indicators related to developmental screening show that for 2019, 77.1% of children had a timely screening for developmental delays using a validated parent-completed tool (ASQ-3) completed on time (at least one by age 6 months, 9 months, 18 months, and 24 months). During home visits, 98.8 % of caregivers were asked if they had any concerns regarding their child’s development, behavior or learning. If there was a concerning screen and/or caregivers had concerns about their child’s development, behavior or learning, a referral from home visitors to early intervention was initiated.