Maternal and Child Health (MCH) in Wyoming (WY): Overview, Role, Funding, and Partnerships

The MCH Services Title V Block Grant is managed by the MCH Unit (WY MCH) within the Community Health Section (CHS) and Public Health Division (PHD) of the Wyoming Department of Health (WDH). WY MCH’s programs are structured according to the population domains they serve: women and infants, children, including children and youth with special health care needs (CYSHCN), and youth and young adults. WY MCH’s mission is to partner with communities and families to promote and advocate for optimal health and wellbeing, using a public health approach (mission updated in 2023).

WY MCH receives approximately $1.2 million in federal Title V funding annually, and employs nine full-time staff who are supported by two full-time WDH MCH epidemiologists. Title V funds, state matching funds, and other federal funding support programming for an estimated population of 581,381 (July 2022 estimate, United States [U.S.] Census) spanning 97,813 square miles.

Wyoming is a rural and frontier state with 23 counties. The Wind River Indian Reservation, located near the center of the state, within the boundaries of Fremont County, is home to two federally recognized tribes, the Eastern Shoshone and Northern Arapaho. Wyoming lacks Level III facilities for both neonatal and maternal levels of care, and lacks sufficient specialty care. This requires families, especially those with special health care needs, to travel long distances for health care, miss work for appointments, and potentially coordinate care for children left at home.

WY MCH and MCH Epi works closely with both state and county staff in all 23 counties to assure access to community-level MCH services, including genetics clinics in three counties; home visiting in all counties; and care coordination services for CYSHCN, high-risk pregnant people, and high-risk infants in all counties. WY MCH partners with the MCH Epidemiology Program (MCH Epi), other programs and divisions within WDH, such as Rural and Frontier Health Unit, Community Prevention Unit (CPU), which focuses on substance use, tobacco prevention, and injury and violence prevention, Cancer and Chronic Disease Prevention Unit, Immunization Unit, Public Health Nursing (PHN), Women, Infants, and Children (WIC) Unit, Wyoming Injury and Violence Prevention Program (WIVPP), Healthcare Financing Division, and the Behavioral Health Division (BHD), as well as other state agencies and statewide partners, such as the Department of Education (WDE), Department of Family Services (DFS), Department of Workforce Services (DWS), the University of Wyoming (UW), and Wyoming Health Council (the agency that administers the Title X grant).

WY MCH and PHN jointly receive Temporary Assistance for Needy Families (TANF) funding from Wyoming DFS to support implementation of the PHN “Hand in Hand” Infant Home Visitation Program. WY MCH also oversees $2,375,591 in state and other funds (i.e. newborn screening [NBS] program fees) which are required to meet the 1989 Maintenance of Effort (MOE). A majority of state funds allocated to WY MCH support delivery of home visitation and CYSHCN care coordination services by PHN or local health departments in all 23 counties. In addition, PHN addresses other Title V priorities within their communities through this joint agreement.

WY MCH currently receives and administers federal funding from the Rape Prevention and Education (RPE) grant, Personal Responsibility Education Program (PREP), State Systems Development Initiative (SSDI), Preventive Health and Health Services Block Grant (PHHSBG), Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASEMM), and Pregnancy Risk Assessment Monitoring System (PRAMS). WY MCH does not manage Wyoming’s Title X and Maternal, Infant, and Early Childhood Home Visiting (MIECHV) grants, however, WY MCH staff work closely with the grantees.

Federal Fiscal Year (FFY)21-FFY25 Needs Assessment Process

WY MCH based its needs assessment on the six-step Peterson and Alexander Needs Assessment Process and the John M. Bryson strategic planning process. The stages, which spanned November 2018 through August 2020, were: start-up planning, operational planning, data, needs analysis, program and policy development, and resource allocation. WY MCH utilized qualitative and quantitative data from WDH’s State Health Assessment, the MCH partner survey, the National Survey of Children’s Health (NSCH), Vital Statistics Services (VSS), and PRAMS--in consultation with the MCH Epidemiology Program--in the development of National Outcome Measures (NOM) and National Performance Measure (NPM) data dashboards. WY MCH involved a steering committee made up of WDH, government personnel, community members, and involved MCH stakeholder Priority Action Teams (PATs), in early decisions to identify priorities and strategies. Other resources included feasibility assessments and activity prioritization tools. A public input survey following initial strategy selection provided further community feedback to refine plans specific to communities.

Examination of Wyoming MCH data helped drive the chosen MCH priorities. High rates of adolescent suicide and motor vehicle accident rates, especially compared to U.S. rates, highlighted the need to focus more on teen driving safety, as well as strengthening adolescent preventive care, especially in providing mental health services. A current Maternal Mortality Review helped to drive the work on promoting well woman visits and preventive care, again with a focus on improving mental health services for women of reproductive age. PRAMS data demonstrated that improvements in safe sleep environments could be made, given that a leading cause of death of post-neonatal infants in Wyoming is sudden unexpected infant death (SUID). Examination of the NSCH showed that Wyoming is most lacking in the CYSHCN coordinated care component of receiving care in a medical home. While NSCH showed rates of physical activity among children were better in Wyoming compared to the U.S., increasing trends in childhood obesity indicated the need to continue to focus on physical activity promotion.
 

Wyoming’s identified population needs are outlined below, along with measures and strategies.

FFY21-FFY25 Priorities and FFY24 Proposed Strategies

WY MCH’s seven priorities for FFY21-FFY25, along with key examples of related strategies and performance measures for FFY24, are listed below.

1 - Promote healthy and safe children

Key strategies will include continuing to expand outreach to additional childcare facilities in policy development and implementation related to physical activity, developing further partnerships and collaborations on childhood physical activity and obesity prevention efforts, supporting state-level expansion of early childhood mental health services, continuing involvement in statewide childhood blood lead surveillance and prevention efforts, building on Bright Futures work with parent messaging and ongoing Toolkit distribution. Measures will include the percent of children ages 6-11 who are active at least one hour per day, the percent of children receiving at least one Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) visit as noted within the Centers for Medicare and Medicaid Services 416 Report, and Evidence-Based or -Informed Strategy Measures (ESMs): the number of providers receiving training and technical assistance (TA) on the Wyoming Healthy Policies Toolkit and the percentage that implement a physical activity policy.

2 - Improve systems of care for CYSHCN

Key strategies will include developing a comprehensive baseline understanding of needs, gaps, and opportunities to improve WY MCH efforts to serve the CYSHCN populations. In FFY24, the CYSHCN director anticipates moving from assessment to planning and implementation around strategic approach and improvements in the program. Measures will include the percent of children ages 0-17 with a medical home, the percent of Children’s Special Health Program (CSH) Advisory Council members with lived experience, and other temporary ESMs that support our efforts to align with national standards and the Blueprint.

3 - Prevent maternal mortality

Key strategies will include promotion of preventive annual visits in partnership with the Wyoming Cancer Program (WCP), continuing a joint Utah-Wyoming maternal mortality review committee (MMRC), which supports Wyoming-specific protocols and recommendations; and further developing capacity and infrastructure for the Wyoming Perinatal Quality Collaborative (WyPQC). WY MCH is pursuing additional grant funding to aid and complement efforts in this domain. Measures will include the percentage of women ages 18-44 with a preventive medical visit in the last year, and ESMs the percentage of women who receive services under the WCP partnership.

4 - Prevent infant mortality

Key strategies will include continuing to provide education and resources to PHNs on safe sleep, providing Quitkits to home-visiting programs as tools to give pregnant/postpartum people for driving usage of the Wyoming Quitline, offering funding opportunities to communities working to prevent infant mortality, and expanding and maintaining the WyPQC. Measures will include the percent of infants placed to sleep on their backs, on a separate approved sleep surface, without soft objects or loose bedding, and the percent of people who smoke during pregnancy.

5 - Promote adolescent motor vehicle safety

Key strategies will include continued facilitation and strengthening of collaborative efforts to implement evidence-based strategies, such as Teens in the Driver’s Seat, in high school settings. Measures will include the rate of hospitalization for non-fatal injury per 100,000 adolescents ages 10-19 and the percent of high schools providing teen driver safety programs for new and emerging drivers.

6 - Prevent adolescent suicide

Key strategies will include partnering with Community Prevention programs to expand and implement Sources of Strength (SOS) in Wyoming middle and high schools, suicide postvention training and protocol development in Wyoming schools, and administration of a young adult survey that further informs efforts to reach and address behavioral health issues and risk factors for young adults ages 18-24. Measures will include the rate of hospitalization for non-fatal injury per 100,000 adolescents ages 10-19 and the percent of Wyoming youth reporting increased youth-adult connectedness.

7 - Strengthen MCH workforce capacity to operationalize MCH core values

Key strategies will include goal setting and professional development centered on WY MCH core values: being data-driven, strengthening engagement, operationalizing health equity, taking a life-course perspective, and prioritizing systems-level approaches. WY MCH will strive to develop and maintain a diverse workforce and a culture of belonging and inclusion. Staff professional development opportunities will strengthen competencies and skills, promote and integrate core values across all MCH domains and state priority needs, and continue work to understand and leverage individual and team strengths. WY MCH will further align our workforce development efforts with the PHD strategic plan and workforce development efforts. The primary measure will be the percent of new WY MCH staff completing MCH orientation (including MCH Navigator self-assessment) within their first six months.