National Performance Measure 06: Percent of children, ages 9 through 35 months, receiving a developmental screening using a parent-completed tool
Evidence-based Strategy Measures
|
Measure |
2021 Data |
|
Percent of medical providers trained who report using an evidence-based screening tool |
38% |
|
Percent of medical providers trained who report a change in knowledge related to developmental screening age interval recommendations |
No data to report due to COVID-19. |
|
Percent of community developmental screening training participants who report an increase in knowledge regarding developmental screening |
No data to report due to COVID-19. |
Promote HealthCheck (developmental screening and lead screening) resources to result in greater knowledge and utilization of HealthCheck services within Title V and other programs serving children.
To enhance utilization of HealthCheck services, a work group was convened in January 2021 with representatives from the Title V Program, Children and Youth with Special Health Care Needs Network, and Division of Medicaid Services to promote cross-system collaboration. The workgroup initially met monthly to develop project plans and supports. ABC for Health staff led this group and conducted a preliminary environmental scan of four similar programs in other states providing case and coverage management services through HealthCheck. The environmental scan identified best practices that other states used to support access management and case management with HealthCheck. The findings provided ideas and recommendations to inform Medicaid outreach and education.
The Title V Program continued efforts to promote HealthCheck resources within medical providers and health systems through virtual trainings. Promotional pamphlets were added to medical provider training online resource material.
Collaborate with the Wisconsin Lead Program to align and support activities with medical providers, childcare providers, and others.
The Title V Program convened quarterly meetings with the Wisconsin Lead Program to share, plan, and identify cross-promotion activities. Many local and tribal health agency activities (including WIC projects) regarding lead screening were suspended due to staff capacity and a lack of in-person services being offered directly due to the COVID-19 pandemic.
In partnership with the Title V program, the Wisconsin Lead Prevention Program created and completed an educational video which is currently being used for public health orientation.
Developmental screening as a standard of care in children with lead poisoning was highlighted in 2021. The Lead Program presented at the March 2021 Home Visiting All Grantee meeting, sharing information, strategies, and ideas for promoting lead prevention information with families. The Lead Program was invited to present at the Wisconsin Collaborative for Health Care Quality’s Steering Team Meeting planned for February 2022.
As a result of the pandemic and a recall of point-of-care blood lead tests, Wisconsin has seen a drastic decrease in blood lead testing. To increase the rate of testing, the Wisconsin Childhood Lead Poisoning Prevention Program sent Medicaid reports to providers who saw at least five Medicaid patients in calendar year 2020. The report allowed providers to compare themselves to the best performer in the state and listed clients who were not tested.
The Wisconsin Title V program also funded the Wisconsin Lead program in 2021 to support staff capacity for collecting environmental samples from homes of children who screened positive for lead poisoning. Samples were analyzed to identify whether the isotopic signature of the lead in the samples matches isotopic signatures from the child’s blood, which can help pinpoint the source of poisoning. These programs continue to discuss opportunities and collaborative efforts to share messaging around lead exposure and developmental screening.
Plan and coordinate a small pilot program to implement the Developmental Milestone Project in at least two local public health agencies with the Wisconsin WIC Program.
The “Learn the Signs. Act Early” Program is an evidence-based program developed by CDC, aimed to improve early identification of developmental delays and disabilities, including autism, by promoting developmental monitoring and encouraging screening. The main strategy CDC employs to do this is integrating the use of the "Learn the Signs, Act Early” Program’s developmental monitoring tools and messages into existing programs that serve infants, children, and their families, such as the Supplemental Nutrition Program for Women, Infants, and Children (WIC). Title V staff met with State of Missouri WIC Program leaders to learn about how their WIC Developmental Milestone program was implemented. With COVID-19, the WIC Developmental Milestone Project pilot was unable to be implemented in 2021, though project planning and preparation for integration in 2022 took place.
Although the COVID-19 pandemic continued creating multiple barriers and challenges in 2021, the Wisconsin Title V Program and Wisconsin WIC Program continued to pursue the incorporation of the "Learn the Signs, Act Early” Program materials into Platform One for WIC providers.
The Title V team revised the developmental screening strategy options for local and tribal health agencies in 2021 and added the WIC Developmental Milestone Project as an option in 2022 so that local and tribal health agencies could self-select developmental screening work and elect to be part of the 2022 WIC Developmental Milestone Project Pilot. In the fall of 2021, two local health agencies opted to implement the WIC Developmental Milestone Program for 2022. The Act Early Ambassador (team leader for year 2 of the COVID-19 Response Project) worked collaboratively with the Title V team and WIC to prepare for a 2022 pilot to test the integration of the "Learn the Signs, Act Early” Program materials.
Wisconsin applied to the Association of State and Public Health Nutritionists for technical assistance to gain access and opportunity to learn from other states doing similar work and advance developmental monitoring for young children and their families.
Collaborate with the Wisconsin Department of Public Instruction, Department of Children and Families, and the American Academy of Pediatrics to produce a mini screening guide adopted from Bright Futures for children 0 to 5 years and promote as s a standard of care for Wisconsin.
The Title V Program, the Wisconsin Department of Public Instruction, Department of Children and Families, and the American Academy of Pediatrics met to discuss the pros and cons of producing a mini screening guide for Wisconsin. Due to competing priorities, staff capacity, and ongoing pandemic response efforts, this strategy was not identified as a priority and will not continue at this time.
Coordinate and provide developmental screening trainings to medical providers throughout Wisconsin.
The Wisconsin Medical Home Initiative promoted children’s health and development through direct, targeted outreach and support to primary care clinicians, public health professionals, and families through the Medical Home Initiative’s website, which provides national and state educational resources. The developmental screening web page had 285 views for 2021.
The Title V Program planned to support and collaborate with many agencies and community partners throughout the state to promote optimal physical, social‐emotional, and developmental health of children and their families in Wisconsin in 2021. Just as in 2020, COVID-19 response efforts resulted in reduced time to address activities related to developmental screening. In 2021, only two local health departments and three tribal health agencies elected to address developmental screening with their Title V funds. Nevertheless, these agencies provided developmental screening education to 5 sites (35 individuals) which serve a total of 7,876 children younger than 6 years old (this includes the City of Milwaukee Health Department). Educational events conducted with 7 community organizations had 50 total participants in attendance.
The Wisconsin Medical Home Initiative worked with local community coalitions and other partners to coordinate and facilitate developmental screening trainings for medical providers and their teams, and community organizations from January 1, 2021, to December 2021. In 2021, the Wisconsin Medical Home Initiative provided 7 trainings to 79 attendees (44 of whom were clinicians) on developmental screening within well-childcare, as well as mental health screening tools. The training continued to be offered in a virtual format to allow for greater reach across the state and to limit the spread of COVID-19.
The Wisconsin Medical Home Initiative was asked to provide a virtual developmental screening training to Wisconsin based HMO’s. Four trainings were scheduled for providers. There was low attendance due to the pandemic. Continued collaboration is planned with Wisconsin based HMO’s as they prepare for reporting the CMS Child Health Core Measures beginning in 2024.
Coordinate and provide developmental screening, monitoring, and awareness trainings to childcare providers.
Due to the COVID-19 pandemic, no local public health agencies elected to work with childcare agencies in 2021.
Partner with Supporting Families Together, Child Care Resources & Referral Agencies and Family Resource Centers to increase staff knowledge and awareness of the importance of developmental monitoring.
The Title V program partnered with Supporting Families Together (SFTA), Child Care Resources & Referral Agencies and Family Resource Centers (CCR&R) to increase staff knowledge and awareness of the importance of developmental monitoring. The Title V Program facilitated conversation with SFTA partners and CCR&R directors in Wisconsin to understand their concerns and barriers to developmental screening within childcare agencies. Childcare agencies reported:
- High levels of turnover in 2021. COVID-19 created much anxiety and stress, many centers closed.
- A severe shortage of childcare providers.
- Trusting relationships with childcare providers takes time.
- Challenges balancing competing priorities.
- Negative past experiences where agencies have taken advantage of childcare providers to meet their own needs.
Promote awareness and education on the importance of developmental monitoring and screening among community groups and partners.
Due to the COVID-19 pandemic and public health response there are no activities to report for this strategy.
Promote education and training of the public health workforce to ensure skills and competencies for completing a developmental screening.
Due to the COVID-19 pandemic and public health response there are no activities to report for this strategy.
Coordinate with the Wisconsin Medical Home Initiative to provide technical assistance related to developmental screening to local and tribal health agencies.
Due to the COVID-19 pandemic and public health response there is limited activities to report for this strategy. Title V staff approached technical assistance differently with the pandemic. Staff reached out quarterly to each agency offering space to talk about challenges as the pandemic continued and agencies remained stressed.
Collaborate with the Wisconsin Medical Home Initiative to plan, facilitate, and evaluate quarterly developmental screening learning calls with local and tribal health agencies.
In 2021, there were two learning calls with the 5 local public health departments that selected developmental screening. Learning calls focused on providing a safe environment for teams to share their experiences and self-care as they continue to respond to the COVID-19 Pandemic. Developmental screening, like well child visits, lead screening and immunizations were not completed due to the pandemic. The Medical Home Initiative’s website continued to house national and state educational resources. The web page included learning community call agendas, presentations, archived/recorded meetings for those not able to attend, and additional resources for agencies.
Facilitate and promote social and emotional health and access to mental health services through administration of the Wisconsin Child Psychiatry Consultation Program and HRSA Pediatric Mental Health Access Program, collaboration with the Office of Children’s Mental Health, and partnerships with Well Badger Children’s Mental Health Navigator and the Wisconsin Medical Home Initiative to conduct mental health screening trainings.
The Child Psychiatric Consultation Program began in late 2014, supported by an allocation from the Wisconsin State Legislature. Since 2014, the Wisconsin Department of Health Services has contracted with the Medical College of Wisconsin to implement the Child Psychiatry Consultation Program across Wisconsin. The Title V Program continues to provide in-kind contract administration, project management and support to the Medical College of Wisconsin to implement this program across Wisconsin’s five regions and in Milwaukee County. In addition to the July 2020 funding increase, the Wisconsin State Legislature in 2021 allocated an additional $500,000 to this project beginning in July 2022. The program continued to build primary care provider capacity to support the behavioral health needs of children and families.
The Child Psychiatry Consultation Program enrolled providers shared a trusting relationship with a child psychiatrist, received efficient and timely expert consultation, access to ongoing education and support, all of which led to increased confidence. They also received referral assistance for local mental health resources. Active primary care provider enrollment continued across all regions of Wisconsin with 355 clinics enrolled. Since program inception through December 31, 2021, 1,367 providers were enrolled, and there were 5,893 consultations provided to enrolled providers. The Child Psychiatry Consultation Program encounter data continued to show that most primary care providers were calling about children and adolescents ages 6 to 20 years old, with an average age of 10.11 years old.
The four most common reasons for consultation were general medication questions/education, diagnostic question, resources referral, and parent guidance. Title V staff facilitated quarterly check in calls with Child Psychiatry Consultation Program staff, and discussions resulted in program improvements, marketing opportunities and reporting outcomes through intentional joint branding to include Child Psychiatry Consultation Program logo and the Wisconsin Department of Health Services logo on yearly reports. In 2021, staff collaborated to create a yearly 2020-2021 CPCP Brief Report highlighting cumulative outcome data.
Since receiving a five-year Pediatric Mental Health Care Access Program grant from the US Maternal Child Health Bureau in October 2018, Child Psychiatry Consultation Program services has been able to expand to additional primary care providers in southern rural Wisconsin, which state funding could not support. A fifth regional hub was established with Viroqua Medical Center. This grant supports a part-time child psychiatrist and regional coordinator. As of December 31, 2021, 107 providers have been enrolled and 239 consultations were completed in this region.
The Pediatric Mental Health Care Access Program Grant supported the development of a Children's Mental & Behavioral Health Navigator tool in 2020-2021. The tool was developed by the Title V-funded Well Badger Resource Center with guidance from mental health professionals and families with lived experience. The Well Badger Resource Center is Wisconsin’s Title V-funded health information and referral service, connecting families and professionals to social, health and government programs available in their own community. The Wisconsin Children's Mental & Behavioral Health Navigator is a free, confidential, online tool designed to help parents, caregivers and professionals in Wisconsin navigate (find, access, pay for) mental and behavioral health services and support for children, adolescents, and young adults under the age of 21. The Navigator provides a customized guide to connect kids and families with the resources and support they need and deserve. The official launch of this tool was July 1, 2021. Twenty-seven promotional activities were conducted with in six different strategies (e.g., presentations and demos, paid aids, e newsletters, face book and was part of a two-part segment on NBC 15 New: Families Every Day).
A Medical Home Minute story was created, in partnership with the Wisconsin Women’s Health Foundation to include a featured story on the new Children's Mental & Behavioral Health Navigator in August 2021. This story generated awareness and traffic to Navigator Tool with 199 unique clicks. The Medical Home Minute open rate for the story was 28% which was the highest open rates in 2021.
Title V staff collaborated throughout 2021 with the Wisconsin Office of Children’s Mental Health (OCHM) and their Collective Impact partner teams. Additional details on this strategy can be found in the Adolescent domain report.
In 2021, The Wisconsin Medical Home Initiative conducted only two Pediatric Mental Health Screening Trainings for medical providers in collaboration with the Child Psychiatric Consultation Program due to the COVID-19 pandemic. In 2021, the Wisconsin American Academy of Pediatrics and Title V Program, the Child Psychiatric Consultation Program initiated project planning to produce future behavioral health podcast for primary care providers. This work was stalled due to staff capacity but restarted in January of 2022.
In 2021, First Five Fox Valley launched the first Help Me Grow affiliate in Wisconsin. First Five Fox Valley is funded through multiple funding streams at a community/grassroots level. Utilizing the Help Me Grow system allowed childcare providers to join the developmental screening efforts while having access to free screenings and navigator support. For example, one childcare center in Appleton participated in the work and completed 29 ASQ-3 screens. 20 were reassuring and 9 were in the monitoring or concerning zones. The Help Me Grow navigator (paid position) worked with families to get connected to Birth to 3 and other resources as needed. The navigators are key to supports to childcare providers, taking the burden off them, and ensuring that families can maneuver through the complicated system. Throughout 2021, the Title V staff met regularly with First Five Fox Valley to explore collaboration and partnership opportunities. Meetings led to a better shared understanding of each other’s programs. In partnership with Act Early Ambassador and the Wisconsin Care Integration program, a Provider Education work group formed to identify and address provider educational needs related to developmental screening.
The Act Early initiative in Wisconsin encompasses the Act Early State Team, the Centers for Disease Control and Prevention’s Act Early Ambassador to Wisconsin, and Learn the Signs Act Early outreach. The Act Early State team brings the Title V Program together with multiple other key early childhood and disability stakeholders to coordinate the improvement of early identification systems, and care for children with autism spectrum disorder and other developmental disabilities.
The current Wisconsin Act Early State Plan activities were put on hold due to COVID-19, however, activities that continued in 2021 were very successful. Work groups formed to support targeted efforts related to goals. The Provider Education Workgroup monthly meetings led to opportunities to support and collaborate on provider education across Wisconsin. In 2021, the group provided guidance and training to the HMO Children’s Community Health Plan as the organization prepared for upcoming changes in developmental screening reporting requirements. The group established a relationship with First 5 Fox Valley (F5FV), Wisconsin’s Help Me Grow affiliate. Workgroup members met with the F5FV Director several times in 2021 to identify ways Act Early members could support provider education efforts. The F5FV Director joined the Act Early State Team in 2021 and will join the Provider Education Workgroup in 2022. In addition, the Wisconsin Care Integration Initiative provided an online webinar for primary care providers on supporting optimal child development in their practices in June 2021. Fourteen providers attended.
The Act Early Data & Measurement Workgroup was established in May 2021 to create a shared understanding of how developmental screening, referral and follow-up data are tracked across Wisconsin. This group includes representation from Wisconsin’s Birth to 3, Title V team, Family Foundations Home Visiting, Special Education Programs, F5FV Help Me Grow, Supporting Families Together Association, the Wisconsin Care Integration Initiative, the Wisconsin Chapter of the American Academy of Pediatrics, and the Children’s Health Alliance of Wisconsin. Monthly meetings explored measures that could be used as statewide performance indicators and discussed efforts to track these measures in Wisconsin.
The Act Early family leader group met monthly to outreach and offer support to medically underserved families, including families living in resource-poor rural or urban areas, and Black and Latinx families. This work group is made up seven leaders and includes representation from rural, urban, Black, Latinx, and LGBTQ+, parent and self-advocate lived experience.
Monthly “Bright Spots” interactive webinars were initiated as an opportunity for Act Early members to spotlight innovative work relevant to Act Early State Plan goals. These 20-minute presentations followed by group discussions also provided a way for members to stay connected with one another in between Act Early State Team meetings. Examples of Bright Spot presentation in 2021 included: Family Foundations Home Visiting programs efforts to complete developmental monitoring and screening, public service announcement campaign regarding the State's Birth to 3 Program, and the Wisconsin Early Autism Project discussed the advocacy efforts of the Wisconsin Autism Provider Association.
In August of 2021, the CDC funded Year 2 of the Act Early COVID-19 Recovery and Resilience Initiative. During Year 2, work groups including Title V Program staff continued to identify and respond to current barriers and identify opportunities to improving early identification of developmental delay: developmental and autism monitoring; screening; referral and evaluation; and access to early intervention. Project goals included: maintaining an ambassador-led state/territory team that includes key early childhood program partners, and develop, implement, and evaluate a plan to improve early identification of developmental delay/disability. Five community connectors (family members with lived experience or program staff with knowledge of Birth to 3) were hired to disseminate early identification materials in their respective communities.
The “Innovation in Care Integration for Children and Youth with Autism Spectrum Disorders and other Developmental Disabilities” continued throughout 2021. Referred to as the Wisconsin Care Integration Initiative, this four-year initiative aims to increase early access to developmental and autism spectrum disorder screening, assessment, and early intervention among medically underserved populations across Wisconsin through provider education, family navigation services, and building sustainability and dissemination. The Wisconsin Care Integration Initiative provided trainings and family navigation to over twelve primary care clinics across the state serving large populations of medically underserved children from birth to 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 Program activities related to family engagement, early identification, and health equity. Representation on the team expanded to include additional family leaders working with the Wisconsin Care Integration Initiative. These family leaders bring experiences as parents of children with autism or other developmental disabilities and represent medically underserved populations in Wisconsin. In 2021, two Black family leaders joined the team, joining three family leaders added in 2020 who represent Latinx and rural communities.
Partner with the Wisconsin Collaborative for Healthcare Quality to lead and facilitate the Adolescent and Child Health Collaborative to improve developmental screening and adolescent well visit rates within medical groups and clinics across Wisconsin.
The Wisconsin Department of Health Services, under the Title V Maternal and Child Health partners with Wisconsin Collaborative for Healthcare Quality to facilitate a monthly virtual improvement team to improve the quality of care and health outcomes for adolescent and child health topics in Wisconsin. Additional detail on this strategy can be found in the Adolescent domain report.
Collaborate with the Family Foundations Home Visiting Program to promote developmental screening and referral.
The Title V Program provides support to the Department of Children and Families, Maternal, Infant, and Early Childhood Home Visiting Program known as the Family Foundations Home Visiting Program. The Title V Program continued collaboration with the Home Visiting team to specifically promote development screening and referral. The full-time Home Visiting Nurse Consultant position is funded in partnership with the Maternal, Infant, and Early Childhood Home Visiting Program. The consultant collaborated with the Wisconsin Medical Home Initiative to organize monthly meetings to share and learn more about Title V and Home Visiting-specific activities related to developmental screening and a deeper dive into this data. Meetings also included presentations from Head Start and Early Head Start.
The Wisconsin Maternal, Infant, and Early Childhood Home Visiting Program was awarded funding for the COVID-19 Response Relief Grant from September 2020 to September 2021. The Wisconsin Act Early Ambassador and other project staff promoted "Learn the Signs, Act Early” Program resources. Over 2000 books and resources were distributed to the Wisconsin Family Foundations Home Visiting Program families, and to pediatrician’s offices through the Wisconsin Chapter of the Reach out and Read Program. These books focused on developmental promotion for children ages birth to 3 years old. Reading materials provide an avenue for parents to increase awareness and understanding of developmental milestones. At the All-Grantee Meetings for home visiting programs, the Title V Child Health Consultant presented on the Title V Developmental Screening State Action Plan for 2021, and Wisconsin Childhood Lead Prevention Program staff discussed lead screening initiatives with staff.
The Family Foundations Home Visiting programs track measures that align with Title V goals, including the percent of children with a timely developmental screen, percent of home visits where primary caregivers were asked if they have any concerns regarding their child’s development, behavior, or learning and, percent of children with positive screens for developmental delays (measured using a validated tool) who receive services in a timely manner. Data from October 2020 – September 2021 show that 73% of children enrolled in home visiting were screened for developmental delays using a validated parent-completed tool (a 3% increase from 2020), 99% of primary caregivers enrolled in home visiting programs were asked if they had any concerns regarding their child’s development, behavior, or learning, and 68% of children enrolled in home visiting with positive screens for developmental delays (measured using a validated tool) received services in a timely manner (a 6.6% decrease from 2020). *Note: Birth to 3 enrollments decreased around the state during COVID-19
Family Foundations Home Visiting partnered with the Wisconsin Sound Beginnings Program to promote involvement and use of hearing assessment tools within Family Foundation Home Visiting programs. The Sound Beginnings Program received grant funding to provide hearing equipment and technical training for Home Visiting program staff serving Tribal communities. This project allowed Wisconsin to establish two new tele-audiology centers in rural Wisconsin tribal health agencies through use of audiology equipment. Telemedicine was not being utilized by the Home Visiting programs or the Tribal Health Agencies, especially in the rural north and indigenous communities. In a time of constricted and over-burdened health systems, parental concern about COVID-19 exposure, and diminishing numbers of pediatric audiologists, telemedicine is the most promising approach to increasing access during this pandemic and beyond. Tele-audiology will lay the foundation for accessing additional telemedicine services for rural and Native American residents. No longer will Indigenous families need to travel up to three hours one way to receive audiology and hearing health care. They can now receive care within a culturally responsive clinic from native health care providers. Additionally, non-native families can also access pediatric audiology services after a failed newborn hearing screening closer to home.
National Performance Measure 08.1: Percent of children, ages 6 through 11, who are physically active at least 60 minutes per day
Too many children in Wisconsin are considered overweight or obese by BMI standards (30.5% ages 10-17 as a proxy measure from the National Survey of Children’s Health), which is a strong predictor of poor health outcomes throughout their lives. In choosing to address this national performance measure, Wisconsin has the following goals:
- Decrease the number of children in Wisconsin with an overweight or obese classification by from 30.5% to 28% (-2.5%) by 2025. (As measured in the National Survey of Children’s Health for ages 10-17; Baseline from 2017-2018 National Survey of Children’s Health)
- Increase the percent of children, ages 6 through 11, who are physically active at least 60 minutes per day from 30.8% to 33.9% (+10%) by 2025. (Baseline from 2017-2018 National Survey of Children’s Health)
Evidence-based Strategy Measures
|
Measure |
2021 Data |
|
Percent of partners actively involved with the Wisconsin Title V Program’s physical activity work connected through the physical activity and nutrition StEM (discontinued) |
N/A |
|
Percent of local and tribal health agencies in Wisconsin receiving Title V funds who choose a physical activity and nutrition objective (new) |
New in 2022; no data currently available |
Being physically active and having nutrition security (access to sufficient and nutritious food options) are critical to the health of our communities, especially as many are still experiencing the impacts of the COVID-19 pandemic and struggling to recover from it. The Wisconsin Department of Health Services’ Chronic Disease Prevention Program, Wisconsin Maternal and Child Health Program, and healthTIDE partnered to engage stakeholders around the creation and funding of a statewide Physical Activity and Nutrition Road Map that is community-centered, community-driven, and equity-focused.
Listening sessions held in late 2020 engaged community voices and statewide partners to inform the physical activity and nutrition roadmap. Key themes included the need to address systemic and institutional racism, the need to fund capacity building, and the need to leverage cross-sector partnerships.
A full-scale investment in local communities and tribal nations, with stable and flexible funding for dedicated staff, leadership, and resources is needed to implement sustainable change prevention strategies that go beyond pilot efforts and mini-grants. Creating and sustaining environments that make breastfeeding, healthy eating, and physical activity easier for people of all ages and abilities can have a major impact on the prevention of chronic diseases and can help address the vast health inequities that exist across our communities. This type of investment would represent a substantial and unprecedented public-private partnership in state and community-level health promotion and chronic disease prevention in Wisconsin. These are the ideal components needed to establish a Healthy Communities approach for statewide physical activity and nutrition work:
- Rebuild community and state-level resources to adequately support investment in local communities and tribal nations, with stable and flexible funding for dedicated staff, leadership, and resources
- Engage across sectors and mobilize broad multi-sectoral partnerships to build momentum and investment in prevention including meaningful engagement with under-represented groups within each community and groups most affected by health inequities
- Design for statewide implementation and investment across all 72 counties and 11 tribes for broad-based support from stakeholders
- Provide a “menu” of evidence-based change strategies, with an emphasis on breastfeeding, nutrition, and physical activity in populations most impacted by inequities
- Adapt resources for implementation with tribal communities to ensure culturally responsive technical assistance and evaluation strategies are developed in collaboration with the tribes
- Develop and strengthen partnerships with a variety of different sectors to leverage funding and resources for scale and sustainability
- Build broad support for a sustained investment of this scale requires accountability that the program is making a meaningful impact on the health and well-being of our state. The Road Map includes funding for formal and ongoing evaluation of project processes and outcomes
The intention of this road map is to serve and support Wisconsin communities and their efforts to create healthier places and spaces that support optimal health. For communities to be healthier, significant investments and equitable changes are needed. This Road Map outlines how to build and center these necessary supports that are in alignment with what communities’ needs are. To support communities in these efforts, statewide infrastructure, change, and funding are also needed. Of note, the term ‘local’ is discussed in the Road Map and is synonymous with ‘community’. Road Map Action Areas include:
Local-Level Policy, Systems, and Environmental Change Aim: Collectively advance evidence-based and practice-based, culturally appropriate strategies in various settings, including local policies and systems changes. This action area allows for innovative community strategies.
State-Level Policy, Systems, and Environmental Change Aim: Collectively advance state policies and systems-level change strategies that support healthy eating and active living. This action area will require identifying key state-level strategies and developing a centralized structure for technical assistance and capacity building. This work should align with COVID-19 relief and recovery efforts.
Infrastructure Aim: Establish sustainable funding for investment in local healthy communities and a centralized, statewide infrastructure including dedicated staff and capacity building for physical activity and nutrition work at state and local levels.
Collaborate with community partners to develop strategies for local health and tribal agencies for 2022 which incorporate physical activity and nutrition.
By August 31, 2025, the Title V Program aims to fully integrate public health nutrition into Wisconsin Title V efforts related to NPM 08.1. The first year was focused on the same three main areas as the overall 5-year plan which include partnerships, workforce development, and nutrition-related data. The year one achieved outcomes and process findings lay the groundwork for the beginning phases of partnership collaboration with a large network of initial connections and further collaborations for training opportunities to offer to local agencies.
Acknowledging that physical activity and nutrition were new, unexplored areas within the Wisconsin Title V Program, staff developed an online survey at the start of 2021 that could start to “map” out work that was already occurring throughout the state related to the physical activity and nutrition of school-aged children. Initially, the survey was distributed to existing partners and contacts, with the request that they share it widely within their own networks.
Highly successful, over 300 responses were collected from more than 60 organizations throughout Wisconsin, including local and tribal health agencies, non-profits, and others. The Title V team made it a priority to create a Physical Activity and Healthy Eating one-pager to display key findings from the survey, so respondents could understand how their responses were being used.
Nearly every respondent indicated that they were interested in attending trainings related to both physical activity and nutrition. According to one respondent, “Food and physical activity are medicine. Teaching kids how to create healthy habits at a young age will help them create optimal health for a lifetime.” When asked what type(s) of projects they would be interested in pursuing in this area, top responses included:
- Youth gardening
- Healthy eating education for parents, especially through COVID-19
- Innovative ideas for year-round outdoor activities
- Social and emotional education, including techniques like mindfulness, meditation, or deep breathing
Once the survey results were assessed and published, Title V staff worked with local and tribal health agencies mid-2021 to identify physical activity and nutrition-related strategies they would want to use their Title V funds to implement. The following three strategies were published in 2021 as options for local and tribal agencies to opt to implement in 2022:
- Partner with University of Wisconsin Extension and FoodWise Programs to support health in children ages 6-11 years old
- Partner with K-5 schools and local partner on school wellness requirements
- Partner with local after school/out of school time programs and community organizations to support opportunities for improved physical activity and nutrition in children
Build and establish nutrition capacity in Title V work through the Children's Healthy Weight State Capacity Building Program, led by the Association of State and Public Health Nutritionists.
This strategy aims to build state capacity around maternal and child-focused nutrition by increasing nutrition competency of the state Title V workforce and optimizing maternal and child health nutrition-related data sources to contribute to data-driven programs and activities related to assessment, policy development, and assurance.
Many Wisconsin children are at risk for poor health outcomes throughout their lives because they are overweight or obese. Rural and urban areas in Wisconsin face different challenges in nutrition security, safe neighborhoods, transportation, economic inequity, and accessible spaces which decrease the opportunity for healthy living. The people of Wisconsin chose nutrition as a theme they would like to see addressed by Title V in a recent statewide needs assessment. The Children’s Healthy Weight Collaborative Innovation and Improvement Network helped with building partnerships across statewide organizations and Wisconsin is well-positioned to leverage these existing partnerships for improving nutrition in maternal and child populations with the Children’s Healthy Weight Capacity Building Program. Furthermore, the Wisconsin Title V Program does not currently have a nutrition-focused staff member. Wisconsin is proposing a multi-disciplinary team that includes staff with skills related to: maternal and child health Nurse Consultants, Children and Youth with Special Health Care Needs, Public Health Nutrition, Grants Coordination, Epidemiology, Evaluation, Quality Improvement, YoungStar regulations (Wisconsin’s childcare quality rating and improvement system), and networks.
In the first year of this work, over 60 organizations and community champions were identified who are involved in implementing public health nutrition efforts and strategies. The Title V Program worked with these groups to develop a ‘stakeholder list’ of key partnerships as a means for keeping new and existing partnerships organized.
Wisconsin’s Title V team also developed a health equity model of continuous feedback and worked to assess the public health workforce’s baseline public health nutrition knowledge, skills and experience through a statewide survey. Results were shared with all partners that completed the survey to ‘give data back’ and inform their efforts, and the team then identified existing data sources while determining data gaps to inform local and statewide public health nutrition efforts. Existing data sources were also evaluated for nutrition-specific items.
The team also identified valuable collaborations to inform this work. They connected with the University of Minnesota-School of Public Health’s Maternal and Child Health Trainee Program regarding potential partnering on maternal and child health workforce training, especially around policy, systems and environmental change strategies. They connected with the University of Wisconsin, Division of Extension, Health and Wellness Institute regarding collaborating on support for school wellness-related strategies connected with tribal and local health department GAC Objectives. They also connected with the Wisconsin Academy of Nutrition and Dietetics to discuss improving and increasing connections between them and the Wisconsin Public Health Association. Finally, the Title V team met with National Survey of Child Health staff and discussed adding questions nutrition questions to the national survey that informs Title V across the U.S., including items to capture the type of foods available, such as healthy, local foods, and fields focused on the availability of healthy spaces such as safe and accessible walk/bike paths, parks or playgrounds.
Additionally, discussions were started regarding the automation of an out-of-school time environmental assessment tool with the Wisconsin Department of Children and Families and Harvard School of Public Health.
A learning collaborative model was built through connections with FoodWise, University of Wisconsin’s Division of Extension, and Dr. Jamie Stang at University of Minnesota’s School of Public Health to offer opportunities to increase overall confidence in implementing nutrition-specific public health programming and provide peer-to-peer support.
Figure 1: Logic model developed for the evaluation of the Wisconsin Title V MCH and Association of State and Public Health Nutritionists Program Year 1
Based on evaluation findings from year one, there has been extensive growth as the collaborative and iterative feedback model utilized by this program is strengthening nutrition connections with other state government agencies, academic partners, statewide partners and local health departments. Wisconsin has learned how to leverage partners and other ongoing events and data gathering already occurring to incorporate iterative community level feedback.
Addressing gaps in nutrition-specific items in national surveillance data will be a long process, but we have made some initial gains. Additionally, Wisconsin is piloting a data collection tool for capturing out of school time nutrition for children. This data will provide state and county level nutrition data and will fill a needed and large gap of information for nutrition programs throughout the state. If the pilot is successful, this same process could be shared widely as a potential method to address the gap in nutrition data across other states, as well as provide an opportunity for states to collect, analyze, and share nutrition information.
Continue Title V representation in Healthy Early meetings to support statewide collaboration among stakeholders.
The Healthy Early Collaborative was formed in 2017 from the former Wisconsin Early Childhood Obesity Prevention Initiative. It is a team of over 90 multi-sector partners in Wisconsin whose work advances equitable eating and physical activity opportunities for all children and their families. Priorities include engagement of families, strengthening of resources, growing their network, and exploration of out-of-school time needs. The collaborative conducted an equity evaluation in 2021, which resulted in a plan for restructure to include more diverse partners. This plan will be in process in 2022. Engagement with this network of experts will help the Title V Program to align across sectors regarding physical activity and nutrition.
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