The 2015 MCH Needs Assessment identified that family, youth, and community member participation in Title V Program activities and strategies is insufficient. The Needs Assessment also found that infrastructure for data-informed policy, systems, and environmental strategies is needed for meaningful improvements in MCH outcomes. The Title V Program identified SPMs related to health equity and infrastructure to assure data-informed policy, systems, and environmental strategies, as a response to these gaps.

 

State Performance Measure 4: Percent of MCH Program State Action Plan Strategies that Engage Family Member, Youth, and/or Community Members.

Health equity emerged as a Title V Priority Need for Wisconsin during the 2015 Needs Assessment. The need for a focus on health equity was also highlighted in a CDC report on State Variations in Infant Mortality by Race and Hispanic Origin of Mother, 2013-2015. Infant mortality has long been recognized as a measure of the health of a population. The CDC report identified Wisconsin as having the highest mortality rate for infants of non-Hispanic Black women at 14.28 per 1,000 live births.

 

The MCH Advisory Committee provided input for the SPM 1 and related strategies, agreeing that a focus on engaging the voice of the community would be a starting point for health equity work. This approach responds to the sentiment expressed over the years, “nothing about us, without us,” by members of groups that have experienced challenges and barriers to health historically linked to discrimination or exclusion.

 

1. Develop and implement a tool for MCH Program staff to assess and support family member, youth, and/or community member participation across all State Action Plan strategies. The Community Engagement Assessment Tool was implemented in 2019 by seven pilot sites (Figure 1) including local and tribal health agencies, CYSHCN partner agencies, Reproductive Health Family Planning clinics, and Adolescent Health Programs. The tool assesses work through indicators and activities that demonstrate best practices in engagement within the following domains:

 

1. Program leadership
2. Continuous improvement
3. Professional development
4. Program environment
5. Family and community partnership
6. Culture of respect, inclusion and equity.

 

14 indicators of engagement exist within these six domains, where participants rate how well they are meeting each indicator on a scale from 1 (not well at all) to 5 (very well). Resources were created to support these sites in accomplishing family, youth and community engagement including an orientation training, REDCap database and manual, electronic survey to assess effectiveness, resources for each component of engagement, and quarterly Learning Communities.

 

By December 31, 2025, Wisconsin aims to have 75% of Title V-funded programs making progress on or embedding concepts (score of 4 or 5) of family, youth and/or community member engagement on at least three indicators of the Community Engagement Assessment Tool, because programs that respond to participants’ experiences are more effective. As seen in Table 2, five of seven (71%) pilot sites rated at least 3 indicators with a score of 4 or 5.

The Title V Program also aims to have 75% of programs achieve a total score (sum of all indicators) greater than 35 on the Community Engagement Assessment Tool (Table 2). This measure was created to ensure that programs are making progress in enhancing family, youth, and community engagement. Four of seven (57%) pilot sites had a total score greater than 35.

 

Finally, The Title V Program is working to increase the number programs assessing overall work in the engagement categories of Discuss, Involve or Partner to 60% (Table 3). This measure supports the Title V Program’s work toward family, youth, and community engagement beyond the traditional survey implementation. One pilot site (14%) rated their category of engagement at the level of Discuss.

 

Table 4: The 14 Indicators of the Community Engagement Assessment Tool

#	Component	Indicator
1	Family, Youth, and Community Partnership	Respectful, Trusting Relationships Between Staff and the People They Serve
2	Family, Youth, and Community Partnership	Family, Youth, and Community Members Working in a Cooperative Way and Having Shared Goals
3	Family, Youth, and Community Partnership	A Commitment to Social Support Systems Within the Program and Larger Community
4	Culture of Inclusion and Equity	A Commitment to Health Equity
5	Culture of Inclusion and Equity	Cultural and Language-Based Responsiveness
6	Culture of Inclusion and Equity	A System of Regular Communication with Families, Youth and Communities
7	Culture of Inclusion and Equity	A Welcoming and Inviting Setting (Physical Space and Online)
8	Program Leadership	Family, Youth and Community Engagement as a Shared Priority
9	Program Leadership	Increasing Success in Engaging Families, Youth and Communities
10	Program Leadership	Group Decision-Making
11	Program Leadership	Support for Developing New Skills
12	Professional Development	High-Quality Training for All Staff
13	Professional Development	Career Pathways and Leadership Opportunities
14	Continuous Improvement	Data About Engagement Efforts and Results Driving Decision-Making

 

The Title V Program also created a balancing measure so that family, youth, and community engagement work will compliment programs’ contracted activities, with the goal of 80% of Wisconsin’s Title V-funded programs agreeing that the work of family, youth, and community engagement complements other Title V-contracted activities. Results will be reviewed at the one year mark. Based on the 14 indicators of engagement within the six components of engagement (Table 4), the seven pilot programs had the following average scores (Figure 2). Initial feedback from the pilot programs included:

One area of concern following this pilot was that none of the sites were successful at incorporating the voice of family, youth, or community members when conducting their initial assessments. In preparation for its second pilot year, the Community Engagement Assessment Tool was redesigned to focus on impact rather than effort. That is, the measure of success within the 14 indicators was based on the impact the site’s efforts had on the community members it served.

 

Before: “Program managers, supervisors and administration demonstrate family, youth and community engagement by example,”

 

After being revised: “Family, youth, and community members are equal members of the team and are treated as fellow workers by program staff.”

 

By making this change throughout the assessment, family, youth, and community members are now able to reflect on their experience with the program, as a measure of the program’s success in engagement.

 

2. Incorporate strategies for family, youth, and community member participation into MCH program contracts. The CYSHCN Network has a long history of supporting family engagement and leadership. CYSHCN Regional Centers have been required to have parents with CYSHCN on staff, as do Family Voices of Wisconsin and Parent-to-Parent Wisconsin. The scope of work for these Title V-funded projects is well defined in a Family Engagement and Leadership Work Plan developed by the CYSHCN Network with goals to identify, connect and sustain family leaders. Additional information can be found in the NPM 11 Report section.

 

The Adolescent Health Program is another area that has embraced this strategy. Starting in 2016, all sub-grantees involved in the Adolescent Health Program were required to incorporate a youth leadership and engagement opportunity into their work plan. While the opportunity itself is up to the sites, all sites must offer an opportunity and pay youth for their time. In 2019, the Title V Program supported health-focused youth councils at the local level, and added youth voice and youth-led initiatives to existing prevention programming.

 

Furthermore, the Wisconsin Alliance for Women’s Health was contracted to focus directly on engagement statewide. The alliance works with teen educators in two counties as a part of the Providers and Teens Communicating for Health (PATCH) Program. This is an innovative, teen-delivered program that targets barriers interfering with the ability of health care providers and teens to communicate effectively with one another about sensitive health topics. Teen educators deliver provider trainings and also work with their peers to support patient-provider communication, thereby improving the quality of adolescent care. PATCH also hosts the Adolescent Health Program’s statewide youth leadership council and the PATCH Youth Health Advocacy Fellowship. Teens are paid to conduct needs assessments in their local communities, collaborate on state and local work groups, and to ensure the teen voice is present in program-level decision making. Fellows complete a community advocacy project as the culmination of their experience. Ten to 15 fellows serve at one time. The fourth cohort of fellows began in 2019. PATCH is identified in a strategy to support NPM 10. Please refer to the Adolescent Health NPM 10 narrative for more information.

 

Title V contract objectives with all local and tribal health agencies include a core activity to collaborate with community partners. At the local level, community partners are supporting strategies related to breastfeeding, safe sleep, developmental screening, suicide prevention, and health equity. Contracts with statewide partners support the implementation of the Title V objectives with local agencies. For example, Children’s Health Alliance of Wisconsin and the Wisconsin Women’s Health Foundation have held focus groups to inform program development related to safe sleep and smoking. Mental Health America of Wisconsin, along with local and tribal health agencies, supports parents and youth on local suicide prevention coalitions.

 

Wisconsin participates on the Collaborative Improvement and Innovation Network (CoIIN) to Advance Care for Children with Medical Complexity, which aims to: improve the quality of life for children with medical complex condition; improve the wellbeing of their families; and to increase the cost-effectiveness of the care. The Wisconsin CoIIN Team created and is now piloting goal cards in English and Spanish for families of children with medical complexity at American Family Children’s Hospital and Children’s Wisconsin. This CoIIN is part of the national quality improvement project led by Boston University.

 

3. Develop and implement best practices for reporting data to stakeholders and the public to promote action to advance health equity. The Title V Program staff worked with several student interns and fellows to disseminate Wisconsin Pregnancy Risk Assessment Monitoring System (PRAMS) data to partners and the public. Specifically, a surveillance report for 2016-2017 data was developed and published, illustrating the health factors and outcomes measured by PRAMS throughout the preconception, perinatal, and postpartum periods. Additionally, Title V Program staff, in partnership with researchers at the University of Wisconsin-Madison, received funding to implement a supplement to PRAMS with modules covering housing quality and instability, food access, and experiences with labor and delivery care. PRAMS was also funded to conduct an oversample of Native American women giving birth in Wisconsin, a population for which there is scarce data. The oversample was planned in partnership with the Great Lakes Intertribal Epidemiology Center with approval from the Tribal leadership.

4. Restructure the MCH Advisory Committee to assure adequate representation of populations affected by health inequities. The 2015 MCH Needs Assessment process identified a need to restructure the MCH Advisory Committee. At the time of the needs assessment, the Committee was expanded to over 250 invitees to gain broad input. However, most invitees had not continued to participate or participated sporadically, resulting in different stakeholders at each meeting. Many community and stakeholder groups were invited, yet there was underrepresentation for select performance measures, including health equity. Also, representatives were missing from sectors such as the medical community, education, child care, EMS, and others. The Title V Program identified a need to engage and support active participation of community members and populations affected by the work of the Title V Block Grant. These gaps in representation, along with input collected from a survey conducted fall 2017, led to the decision to restructure the MCH Advisory Committee, by building a Core Advisory Committee and a Community of Practice.

 

The Core Team consists of approximately 30 individuals, with an ultimate goal of 25% of the 30 individuals being family, youth or community members. Core Team members are required to attend all three to four meetings a year, or to send a representative if they cannot attend a meeting. Each non-community member on the committee is eligible to serve a one-, two-, or three-year term with the option to renew, to ensure representation of different points of view. The Community of Practice is made up of others that want to be involved with the MCH Advisory Committee, but do not have the same level of decision-making responsibility as the Core Team. In 2019, the second round of applications was disseminated for the Core Team and Community of Practice. Applications were reviewed and 10 new members were accepted to the Core Team based on region served, population served, and NPM/SPM engagement. Remaining applicants were invited to join the Community of Practice. Two Core Team members were also nominated and voted in to assist in the planning of the MCH Advisory Committee meetings. This ensures that the Title V Program, at the state level, is not only representing its own interests. The planning committee meets immediately following each MCH Advisory Committee meeting.

 

5. Promote and support staff competencies at the state and local level related to the Foundational Practices for Health Equity. The Title V Program worked on the AMCHP-facilitated Infant Mortality Social Determinants of Health CoIIN continued throughout 2019 with a focus on action steps to build capacity of the Title V Program and local partners to advance health equity. Key questions posed under each Foundational Practice informed agencies of potential action steps. Action steps were planned, tested and evaluated. A reassessment utilizing the survey tool will track improvements and changes in capabilities and practices.

 

The Title V Program implemented activities within a quality improvement framework to address three of the Foundational Practices for Health Equity: 1) support successful partnerships and strengthen community capacity; 2) use data to advance health equity; 3) assure strategic and targeted use of resources. Two practice changes for the AMCHP-facilitated Infant Mortality Social Determinants of Health CoIIN work have been described in other health equity strategies and include the restructuring of the MCH Advisory Committee in addition to the revision of the Phase 9 PRAMS survey to include further questions related to Social Determinants of Health. Another practice change was to involve more local and tribal health agencies in the Title V-funded objective related to health equity.

 

The 2019 Health Equity Objective supported local agencies to utilize a self-assessment and a quality improvement process to increase health equity effectiveness in Title V objectives and activities. Local agencies were asked to complete the Foundational Practices self-assessment of organizational strengths and weaknesses as well as the the Bay Area Regional Health Inequities Initiative assessment. Based on assessment findings, they selected two areas for improvement. The local agencies worked with impacted stakeholders to outline and implement two practice changes to advance the health equity strategy. Throughout the process, agencies participated in quarterly Learning Community sessions. Aligning with the CoIIN work and the selected Foundational Practices, the plan was to utilize Title V funds to advance health equity at the local level, support moving from assessment to action with policy or practice changes, and encourage engagement of community partners.

 

Education and technical assistance to support local and state efforts were provided by the Mobilizing Action Toward Community Health Group, a program of the University of Wisconsin Population Health Institute. Paula Tran Inzeo, MPH, leads this group and contributed to the development of the Foundational Practices for Health Equity. The Division of Public Health formed a Health Equity Advisory Team to develop and recommend an approach for strategic implementation of health equity principles across the division. Representatives from the Title V Program both serve on the advisory team, as well as on sub-committees to further the team’s efforts. The key pieces of this initiative were to look at the division’s ongoing health equity activities, the current staff climate around health equity, develop a Community of Practice and resource guide to promote and support staff competencies, and to provide information on concerns, areas of strength, and recommendations for improvement as it pertains to health equity in the division.

 

State Performance Measure 5: Percent of MCH Program State Action Plan Strategies that have a policy-level intended outcome

 

1. Participate in a Perinatal Quality Collaborative to support efforts related to 1) Postpartum visits, 2) Breastfeeding, 3) Perinatal depression screening, 4) Smoking during pregnancy, and 5) Safe sleep. The Wisconsin Perinatal Quality Collaborative began forming in 2014. In 2015, the Wisconsin Association for Perinatal Care was awarded a competitive grant to establish the structure and processes, identify measures, evaluate an agreed-upon quality improvement initiative, and seek sustainable funds. The Wisconsin Perinatal Quality Collaborative was built on lessons learned through the Maternal Mortality Reviews and Fetal and Infant Mortality Reviews. Sixty-eight member organizations have signed on since its launch. The initial project addressed maternal hypertension through two cohorts, and the quality improvement work has since expanded to include an initiative on Human Milk Feeding, and Neonatal Abstinence Syndrome and Neonatal Opioid Withdrawal Syndrome. Wisconsin Association for Perinatal Care staff arranged for meetings virtually and face-to-face (quarterly). Staff developed meeting agendas, kept meeting minutes, sent reminders to submit data, processed data and sent graphic representations of data to Wisconsin Perinatal Quality Collaborative participants before monthly learning collaborative meetings.

As a main component of 2019’s educational programming, the Wisconsin Association for Perinatal Care offered a Safe Sleep webinar series spanning a range of topics and perspectives on safe sleep. Over the course of 4 webinars, the series faculty shared current research and practice on safe sleep guidelines in both clinical and home settings. Through the support available from the Title V Block Grant, the Wisconsin Association for Perinatal Care was able to offer these opportunities for free, including continuing education credit, which contributed to this series being one of the Wisconsin Association for Perinatal Care’s most successful educational opportunities in recent years. This series met the continuing educational needs of between 2 and 4 times as many registrants than any other offering in recent years, ultimately reaching a total of 352 registrants for the series. (The actual number of participants is likely larger, because many people register under one name and participate as a group.)

In addition to the webinar series on safe sleep, the Wisconsin Association for Perinatal Care continued to promote and sell postcard-sized safe sleep cards, which hospitals placed in bassinets and sent home with parents to remind them of safe sleep best practices. These cards were developed originally with support from the Title V Block Grant, and over 1000 cards were distributed in 2019.

 

2. Participate in an MCH Quality Network to engage health systems in quality improvement that addresses perinatal, child and adolescent health. 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 and clinics to improve developmental screening and adolescent well visit rates. In 2019, participation in the project included 14 health systems, 11 other partners and a total of 39 individuals. The majority of the 14 participating health systems reported monthly rates of adolescent well care visits to the Wisconsin Collaborative for Healthcare Quality. The Wisconsin Collaborative for Healthcare Quality compiled submitted data on this metric and shared data with the steering team to examine progress over time. The Wisconsin Collaborative for Healthcare Quality 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.

 

3. Support information and referral services. Continuing since January 1, 2018, the Wisconsin DHS partnered with the Wisconsin Women’s Health Foundation to administer a Wisconsin Public Health Referral and Access to Information Services and Resources program named “WellBadger Resource Center.” Services were provided in English, Hmong, and Spanish by staff and the language line was used for other language interpretation needs. This program is supported through braided funding from:

 

• Wisconsin Title V Program, including reproductive health

 

• Wisconsin CYSHCN Program

 

• Wisconsin Supplemental Nutrition Program for Women, Infants, and Children (WIC)

 

• Wisconsin Division of Medicaid Services (Medicaid), including HealthCheck/Healthy Start and Medicaid Pregnancy Outreach

 

• Wisconsin Well Woman Program

 

• Services Access Line for Women, Children, and Families–Wis. Stat. § 253.10 Voluntary and informed consent for abortions

 

Beginning in 2019, additional funding was provided to add enhancements to WellBadger Resource Center to support the Child Psychiatric Consultation Program expansion, requiring comprehensive access to mental health information and referral and to promote and provide specialty resources for providers and families after a concerning developmental screening result.

 

Parents, caregivers, families, and health and human services agency providers are connected to resources through a toll‐free call‐in voice information and referral service directory line at: 1-800-642-7837. To assure access to services, WellBadger has language line and Telecommunications Relay Service accessibility. In addition, WellBadger provides Text Message at: 608-360-9328; Web and live chat at: www.wellbadger.org; email at help@wellbadger.org, and Facebook Messenger. WellBadger also provides the Services Access Line - Informed Consent at: 877-835-7296 for the Title V Program per the statute cited above.

 

Referral outcomes: Seventy-five percent (75%) of participants consented to a follow-up call and 59% of those consenting were reached for follow-up; 76% of individuals surveyed had successfully secured resources.

 

Satisfaction: Among those who completed a brief satisfaction survey as part of their follow-up call, 100% reported that the I&R specialist was helpful, 98% felt listened to, 92% said an appropriate referral was made, 98% said they would use the services again, and 100% said they would recommend the service to others.

 

4. Convene the Family Health Section Data Team to provide comprehensive analytic support to assure data‐informed decision making. The Family Health Section Data Team led by the Senior MCH Epidemiologist, the CDC Assignee to the Wisconsin Department of Health Services, is comprised of five full‐time epidemiologists, an evaluator, fellows, and other key analytic staff that provide comprehensive analytic support to ensure data‐informed decision making. The group met every two weeks to discuss data analysis questions, review and provide feedback on data products, deliver technical assistance to program staff, and support other data‐related needs within the Family Health Section as they arise. In 2019, the data team supported the publication of the inaugural biennial PRAMS surveillance report, published three fact sheets using PRAMS and birth data, and submitted more than 10 abstracts to local and national public health conferences. The data team also provided regular technical assistance to Local and Tribal Health Departments, organized a division-wide SAS user group, and led indicator development and data analysis for the State Health Assessment. The Family Health Section Data Team also led the data analysis for the 2015 MCH Needs Assessment, incorporating both quantitative and qualitative data, and using data placemats to engage leadership and partners in conversations about the data. Additionally, the team provides ongoing support to the Section’s performance monitoring system and ensured representation on and input into data infrastructure committees (e.g., Behavioral Risk Factor Surveillance System Advisory Team, Family Health Survey Advisory Team, Data Management Advisory Team, and Early Childhood Integrated Data System Advisory Team).

 

5. Conduct public health surveillance of key MCH topics (e.g., severe maternal morbidity, mental health hospitalizations, birth defects, abusive head trauma, and critical congenital heart disease). In 2019, key Family Health Section surveillance activities included: 1) monitoring hospitalizations related to injury among children and adolescents; 2) breastfeeding initiation and hospital practices among racial minority women 3) dental health care utilization for moms and babies using PRAMS data to inform the oral health program planning (‘Healthy Smiles for Mom and Baby’); 4) safe infant sleep practices and provider counseling; 5) perinatal depression screening and symptoms; 6) folic acid intake in the month before pregnancy; 7) effects of racial discrimination on maternal and infant health; 8) improving identification of pregnancy-associated deaths and 9) assessing pregnancy-related factors present in drug- and injury- related maternal deaths.

 

6. Support ongoing needs assessment, program evaluation, strategic planning, performance measurement, and data access through The State Systems Development Initiative. The SSDI continues to support the data needs of the Title V Program, including support of the Title V Program’s performance measure tracking, 2020 MCH Needs Assessment activities, program evaluation, quality improvement, data analyses, increasing data capacity, and more. Throughout 2019, the SSDI Coordinator participated in planning, implementation, analyses, and results dissemination communication planning of the 2020 MCH Needs Assessment. Much of SSDI time and effort in the coming year will focus on ensuring results of the 2020 MCH Needs Assessment inform the planning and coordination of the 2021 Application Year’s strategies and objectives.

 

7. Collect quarterly data on implementation of local and tribal health agencies’ strategies to inform programmatic decision making (e.g., breastfeeding, safe sleep, developmental screening, smoking, adolescent injury, health equity). In 2019, Wisconsin entered its fourth year of utilizing a new data collection system housed within the REDCap software system. Data collection forms were updated for the 2019 objectives and activities. An annual user training was developed and hosted, and an accompanied manual was created to expand local agencies’ comfort with the system overall. Specifically, this training was designed to guide local agencies on how to document activities and demographic characteristics of the populations served by participating agencies, as well as how to run their own reports to view any missing data and overall trends in successes for their activities. A single‐page performance sheet summarizing progress made by local agencies, the geographical reach of their work, the number of people reached by the work, and baseline data on the NPM/SPMs were updated and disseminated at the mid-year point.

 

8. Adopt implementation science and performance management principles to inform internal programmatic decision-making. Implementation science was utilized to advance the Family, Youth and Community Engagement Project. An Implementation Team, consisting of Title V Program staff along with representatives from Family Voices of Wisconsin and the PATCH Youth Program, were trained on implementation science by the National MCH Workforce Development Center. The project began 2019 in the installation phase, with 7 sites participating in a pilot project. By the end of 2019, the project moved toward initial implementation. There was a strong focus on the Implementation Drivers:

 

• Competency - Training and coaching for the participating sites was provided on the Community Engagement Assessment Tool, Implementation Science, and action planning.

 

• Leadership – The Title V Program committed to a common approach for community engagement for all grantees including local and tribal health agencies, the CYSHCN Network, family planning/reproductive health sites, and adolescent health programs. The Implementation Team planned and built supports, developed measures, made improvements, and communicated about the Community Engagement Assessment Tool and the Family, Youth, and Community Engagement Project.

 

• Organizational – The Community Engagement Assessment Tool was developed and made available in a survey format to support input from community partners. The REDCap data platform captured assessment results. Learning Community sessions were established to bring participating sites together. Project activities were included in contract objectives and work plans with participating sites.

 

9. Increase staff capacity to incorporate policy‐level strategies. Consultants incorporated policy‐level strategies into the 2019 contracts with state and local partners to improve select performance measures. The Title V Program supports local and tribal health agencies to include policy-level strategies for breastfeeding friendly worksites, child care sites and community groups, as well as safe sleep policies with child care sites and health care systems. The Children’s Health Alliance of Wisconsin was contracted to ensure all Wisconsin counties participating in a Child Death Review team were following the Keeping Kids Alive in Wisconsin model and that the Child Death Review and Fetal Infant Mortality Review teams utilized a standardized data system. The Wisconsin Perinatal Quality Collaborative and the MCH Quality Network were established to support policy-level strategies to improve perinatal, child and adolescent health. The UW Mobilizing Action Toward Community Health Group was contracted to provide technical assistance to state staff and contracted local agencies on institutionalizing health equity. In each case, Title V Program staff worked with the partner organizations to plan the policy-level strategies and reach agreement on the scope of work. Title V Program staff also collaborated with Medicaid to support implementing clinical best practice guidelines through funding reimbursement and policy changes related to women’s health and adolescent health.

 

10. Develop and maintain data capture systems (e.g. REDCap, Wisconsin Early Hearing Detection, and Intervention Tracking And Coordination System, Wisconsin Birth Defects Registry, Pregnancy Risk Assessment Monitoring System, Maternal Mortality Review, Wisconsin Violent Death Reporting System, and Newborn Screening Program). Local and tribal health agencies used REDCap, an online data capture platform, to report on 2019 Title V Program-contracted activities. Title V Program epidemiologists worked to design additional REDCap data capture forms and projects to meet programmatic needs as they emerged and evolved. REDCap was utilized in organizing abstracted results for the Maternal Mortality Review, which are recorded in the Maternal Mortality Review Information Application for surveillance efforts. REDCap was also employed in 2019 for the data capture of the Wisconsin Newborn Blood Screening Program – Ongoing Care. The Title V Program uses Wisconsin Early Hearing Detection and Intervention Tracking, Referral and Coordination for newborn hearing screening results and follow‐up as well as Critical Congenital Heart Disease screening results. Both hearing and Critical Congenital Heart Disease screening results are collected on the newborn screening blood card. Data are entered into a data system at the Wisconsin State Lab of Hygiene, and hearing and Critical Congenital Heart Disease screening data are messaged daily to the Wisconsin Early Hearing Detection and Intervention Tracking, Referral and Coordination. Since the blood card number is collected on the birth certificate and the Wisconsin State Lab of Hygiene now requires a blood card for every baby, the Wisconsin Early Hearing Detection and Intervention Tracking, Referral and Coordination is evolving into an integrated newborn data system for all Wisconsin births.

 

The Wisconsin Birth Defects Registry has collected statewide birth defects records since 2004 but, as a passive opt‐in system, struggled to obtain complete and useful data. Based on Wisconsin’s work with the Birth Defects Council, the state legislature passed an administrative rule to change the system to an opt-out surveillance system. Wisconsin is updating this system to an opt-out surveillance system and working to operationalize this change and anticipates this change will lead to a great improvement in data quality. More information on the Birth Defects Registry is available in the Perinatal/Infant Health narrative section.

 

A Title V Maternal and Child Health epidemiologist served as the project director for the Wisconsin PRAMS, and a Title V-supported perinatal nurse consultant was a Project Coordinator for PRAMS. Title V staff oversaw contracted data collection activities, which resulted in successful data collection for the year, meeting the CDC’s weighted response threshold of 55%. In 2019, the Wisconsin PRAMS also conducted cognitive interviewing on a new set of questions capturing social determinants of health including housing stability and adequacy, food access, and respectful maternity care. Additionally, in partnership with researchers from the University of Wisconsin, Title V staff secured supplementary funds to conduct an oversample of Indigenous births in Wisconsin for data year 2020.

 

In 2019, Title V epidemiologists and the University of Wisconsin Survey Center created the first surveillance report specific to Wisconsin, utilizing the PRAMS Report. This surveillance report is publically available for interested partners and program planning. Wisconsin is hopeful to have the surveillance report updated and available annually through increased investment in data collection and analysis.

 

The Wisconsin Violent Death Reporting System collected surveillance data on violent deaths in Wisconsin throughout 2019, and is maintained and updated in partnership with the Medical College of Wisconsin. The Wisconsin Violent Death Reporting System continually updates surveillance data on violent deaths in Wisconsin and created and disseminated a two-page information sheet relaying the top causes of death by suicide, stratified by age and race/ethnicity.