State Performance Measure 03: Percent of Wisconsin adults who report that they “usually” or “always” get the social and emotional support that they need

 

Despite the Wisconsin Title V team’s passion for this subject, social connection efforts were delayed through much of 2022 due to staff turnover and capacity. Efforts mainly focused on onboarding staff – such as the newly created Title v evaluator and epidemiologist position and health equity coordinator position – to support this work.

 

Develop a tool to organize current and potential social connection efforts throughout the state by leveraging existing data sources, identifying new and innovative opportunities for data collection.

 

This strategy was developed with the intention of using such information in further strategic development of this overall State Performance Measure, including the exploration of how to financially support social connection work for Title V populations.

 

In 2022, the State Systems Development Initiative project director implemented ongoing needs assessment activities to capture shifts in public health concerns and identify any major changes to the 2020 MCH Needs Assessment findings. This was especially critical as all data collection and assessment implementation for the 2020 MCH Needs Assessment was conducted in 2019, prior to the COVID-19 pandemic.

 

The Title V team prioritized the topic of social connection in the 2022 Mid-Cycle Needs Assessment and sought input from community members and agencies serving maternal and child health populations in Wisconsin – including agencies that were and were not receiving funding from the Wisconsin Title V program – on their perception of social connections within their communities. Of the 153 respondents, 40% were community members, 45% were agencies receiving funds from the Wisconsin Title V program, and 15% were agencies who were not currently receiving funds from the Wisconsin Title V program. While the number of community members who engaged was relatively high, the people who were engaging were not representative of the diverse populations that the Title V program serves in Wisconsin. Instead of just looking at how many people were engaging, it is important to also look at who was engaging. Most community member respondents identified as white (75%), female (93%), and the parents or caregivers of someone with a disability or special healthcare need (66%). Most agency respondents were local health agencies (43%) or local and state-wide non-profits (21%).

 

Community members were asked a series of closed- and open-ended questions specific to their experiences and needs for social connection in their communities. Additionally, they were asked general questions such as, “What makes your community a good place to live?” and “If you could change one thing in your community to make it a healthier place to live, what would you change?”. In these general and topic-specific questions, themes of social connections and mental health were clear. Community members shared that social connection is important in making their communities a good place to live and wanted to increase this in their communities. They highlighted a variety of ways to make it easier to build social connections in their communities. Some of the most consistent suggestions to come up included:

 

• Physical spaces to gather for events and the need for indoor areas because of the weather in Wisconsin

 

• Events with an emphasis on activities inclusive of all ages, that are accessible for people with various schedules

 

• Support groups of all kinds – especially for parents, children with similar disabilities, teens, and adolescents

 

• Inclusive programming with an emphasis on language, age, and ability inclusivity

 

Community members also shared how much they agreed or disagreed with statements that addressed aspects of social connection in their community (see Figure 1). Many community members agreed or strongly agreed with certain statements such as “My community has a safe place for me to gather with friends” (84%) and “My community has a safe place for children to play” (82%). However, half of community members (50%) were unsure or disagreed that they knew where to go for help during stressful times.

 

FIGURE 1

Agencies were asked one open-ended question around social connections, “When people have a sense of belonging (they feel valued and included), their health and well-being are positively influenced. How does your organization or program work to increase social connections for the people you serve?” Responding agencies highlighted a variety of ways they promote social connections among the people they serve. Some of the most consistent responses among agencies included:

 

• Connecting individuals through programming, events, and peer support groups, with an emphasis on connecting people with similar experiences or needs

 

• Integrating community need into strategic planning

 

• Interacting and serving clients in a way that centers their needs and makes them most comfortable

 

Following the MCH Mid-Cycle Needs Assessment, in 2022 staff developed a new reporting instrument, “Title V MCH Objectives: Social Connections, 2023”.  The instrument will be implemented quarterly among the local and tribal health agencies that choose to use their annual Title V funding to support projects addressing social connections within MCH populations in 2023 in order to gather local-level data. This will help to inform state-level work to better understand and support the unique needs for social connection across Wisconsin communities.

 

Align with and support the work of other performance measures and programs to incorporate Social Connection within their Title V work.

 

The following goals were the focus of this strategy:

 

• Develop a project option for local and tribal health agencies to use their annual Title V funding on in 2023

 

• Create a workplan or summary for a request for applications or a request for proposals to fund a statewide partner in 2023

 

• Convene all leads periodically to discuss overlap and cross-over of projects

 

• Identify a method to collaborate across leads and to track progress to incorporate social connections into their work plans and to draw on a team of experts for social connections to build this into their programmatic work

 

The first goal for this strategy was to create a social connection-specific project option for local and tribal health agencies to have the option of using their annual Title V funding to work on. To make this goal a 2023 reality, planning and development were priorities in 2022. Mid-year reviews with local and tribal health agencies showed a strong interest in using Title V funding to address social connections at the local level. Agencies expressed interest in working on social connections as it relates to mental health, adolescent wellness, and community wellness projects.

 

A funding opportunity was created for a statewide partner to support local and tribal health agencies implementing social connection projects with their annual Title V funding by providing technical assistance to local health and tribal agencies. Applications and interviews did not result in finding an appropriate match for the statewide partner role. Staff planned to continue to offer this project option to local and tribal health agencies in 2023 with staff lead taking on the role as technical assistance provider.

 

The Title V staff lead convened staff quarterly to network and provide technical assistance for local and tribal health agencies working on a Title V project with a social connection component included (the project options with social connection components included were black infant mortality prevention, high-quality perinatal care, adolescent well-being, breastfeeding and CYSHCN medical home). Planning to support the Wisconsin Maternal, Infant, and Early Childhood Home Visiting program quality improvement project was also prioritized.

 

The Home Visiting program led a State Home Visiting Continuous Quality Improvement Team on Client Mental Health and Staff Wellness project. There were nine local Home Visiting programs that participated in the Client Mental Health and Staff Wellness project; three teams focused on client mental health and six teams focused on staff wellness. Between July 1 and November 30, 2022, these nine teams collectively ran 64 Plan-Do-Study-Act (PDSA) cycles to test change ideas that might help them improve client mental health or staff wellness. At the end of the project, the nine teams adopted 21 of these change ideas, meaning that they found that the ideas worked so well during the project that they were ready to fully implement them into their program practice. Some examples of change ideas that were implemented include staff self-care plans, a conversation guide to support depression screening with Spanish-speaking families and sharing self-care tips that worked well for staff with families through a regular newsletter and home visits. A key takeaway from multiple teams that focused on staff wellness was that doing self-care activities in a group was most beneficial to staff wellness, as opposed to doing self-care activities alone.

 

Within the fourth quarter, the Title V Social Connection team began a standing weekly check in specific to social connection. The team worked on revising the SPM03 action plan strategies for 2023, with a special emphasis on strategy mapping (identifying objectives for each strategy, specific milestones or goals for 2023, quarterly goals, etc.) and determining a standardized way of measuring social connection based on the Title V program’s definition, which was also updated for 2023 (Social connection may include a variety of terms that describe the ways people are socially physically, and emotionally connected to others.).

 

Collaboration with The Office of Children’s Mental Health began in December 2022. Regular meeting times were set up to further networking and alignment. The Office of Children’s Mental Health’s data collection was reviewed with special intention of supporting the local and tribal health agencies working to advance social connection through their Title V funding.

 

Support and provide education and awareness efforts to increase Family Health Section staff knowledge, understanding, and importance of Social Connections.

 

Due to limited staff capacity, work with this strategy pivoted to creating a PowerPoint presentation on how the Title V program is working to improve social connections for maternal and child populations that could be used for all future presentation and training needs. The presentation discussed why social connection was identified as a State Performance Measure, the Wisconsin Title V program’s definition of social connections, and information about each local and tribal health agency project option that has a social connection component. This presentation went through a formal, internal approval process and was used for the home visiting continuous quality improvement project and shared in other collaborative settings.

 

State Performance Measure 04: Percent of performance measures with family, youth, and community engagement embedded into program and policies 

 

Executive Order On Advancing Racial Equity and Support for Underserved Communities Through the Federal Government – Executive Order 13985 – defines equity as “the consistent and systematic fair, just, and impartial treatment of all individuals, including individuals who belong to underserved communities that have been denied such treatment, such as Black, Latino, and Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons; persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality.”

 

Identify roadblocks to engagement and address in future training opportunities. 

 

Local and tribal health agencies requested more support as they work to implement the Community Engagement Assessment Tool (a Wisconsin Title V-developed resource) with the communities they serve. A handout was created as a supplement to the seven video modules created in 2021 that outline steps for partners on how to use the Community Engagement Assessment Tool. In addition, in 2022 the MCH National Workforce Development Center posted a workbook on Successful Engagement with people who have lived experience.

 

Increase family, youth, and community member participation in MCH efforts including but not limited to ongoing MCH Needs Assessment activities. 

 

The Title V program released a youth, caregiver and family engagement funding opportunity to support engagement in maternal and child health efforts. Starting in January 2023, three agencies were selected to receive $50,000 annually through the end of 2025.

 

Family Voices of Wisconsin is a community-based non-profit agency serving children and youth with special health care needs, their families, and the professionals that support them. They received a funding award to host learning opportunities to support parents to develop confidence in leadership skills including the Wisconsin Family Leadership Institute.

 

Public Health Madison Dane County is a local health department with experience implementing practice changes to enhance community engagement and advance health equity. In July of 2022, this agency applied for funding from a competitive funding process awarding a combination of Title V and American Rescue Plan Act funding. They were awarded funding for their proposal to elevate the voice of participants and graduates of their Nurse Family Partnership home visiting program and Medicaid Prenatal Care Coordination services through participation in a Community Advisory Board, educational sessions, and social opportunities. This work began in January of 2023.

 

Cia Siab, Inc. is a nonprofit agency providing culturally and linguistically appropriate domestic violence/sexual assault services to the Hmoob (Hmong) community in La Crosse. In July of 2022, this organization applied for funding from a competitive funding process awarding a combination of Title V and American Rescue Plan Act funding. They were awarded funding for their proposal to utilize three programs (Paj Ntaub Circle, She Hlub, and Youth Ambassadors) to gather information from youth and women of reproductive age about their experiences and needs while participating in traditional Hmoob pastimes such as gardening and sewing. This work began in January of 2023.

 

Incorporate the Community Engagement Assessment Tool within local and tribal health agency maternal and child health, CYSHCN Network partners, adolescent health programs, and Reproductive Health Family Planning Programs.

 

Implementing the Community Engagement Assessment Tool supports participating programs to identify areas for improvement, develop action plans, and implement practice changes to enhance engagement. Twenty-eight local and tribal health agencies and CYSHCN programs integrated community engagement activities into their Title V-funded activities. Several local agencies implemented practice changes that expanded community voice in their Community Health Assessment process.

 

The Title V program continues to track progress for the aim and process measures below.

 

Aim

 

Aim	2019 Data	2020 Data	2021 Data	2022 Data
75% of programs are making progress or have embedded concepts of engagement on at least three indicators of the tool	71%	69%	95%	75%

 

Process Measures

 

Process Measures	2019 Data	2020 Data	2021 Data	2022 Data
Percent of programs that have a totally score greater than 35. (Aim is 75%)	57%	88%	100%	86%
Percent of programs that assess overall work at the level of discuss, involve, or partner. (Aim is 60%)	14%	50%	63%	61%

 

In its fourth year, the Title V program noticed that agencies completing the Community Engagement Assessment Tool reported a drop in the number of indicators where programs are making progress compared to the previous year (Figure 2). Twenty-one of the 34 programs that completed the Community Engagement Assessment Tool were new to this process in 2022. Historically programs score themselves lower in their first assessment.

 

Programs continue to have autonomy in selecting an indicator for improvement and the indicators selected are across the board. Some activities proposed for completion in 2022 include:

 

• “We plan to do more activities to engage those populations that can be difficult to reach to get their feedback through group discussion settings. Early discussions include the potential of hosting a community baby shower or engaging in an existing event to reach these families. We will partner with our Multicultural Outreach advocate and the community health workers assigned to Green County.”

 

• In Marathon County, “each program team member will participate in professional development opportunities focused on increasing understanding of equity and diversity as related to breastfeeding and program service delivery. Trainings and sharing of learning outcomes with other team members will be completed by the end of 2022.”

 

• “We have strategized on new ways to seek community member feedback beyond our Community Health Assessment & Improvement process, including holding focus groups to gather feedback on the development of a new home visiting program. We have also supported brainstorming on ways Walworth County Health & Human Services as an agency can better incorporate consumer voice into programming, including discussions on surveying & evaluating the use and success of our Mobile Health Hub.”

 

Figure 2 depicts the various components of engagement programs chose to advance in 2022 along with the level that they were engaging community at in this process.

 

FIGURE 2

 

Note: Figure 1 depicts complete data from programs reporting in the ”Family, Youth, and Community Member Engagement” Survey in REDCap.