The Maternal and Child Health (MCH) Services Title V Block Grant is managed by the MCH Unit within the Community Health Section (CHS) and Public Health Division (PHD) of the Wyoming Department of Health (WDH). Structurally, the Unit’s programs are divided according to the population groups they serve: women and infants, children, youth and young adults, and children and youth with special health care needs (CYSHCN). This structure addresses all Title V population domains.

The MCH Unit receives approximately $1,100,000 in federal Title V funding annually and employs nine full-time staff. Title V, state matching funds, and other federal funding support programming for an estimated population of 577,737 (2018 estimate, American FactFinder, U.S. Census) spanning 97,813 square miles. Wyoming is a rural/frontier state with 23 counties ranging from the Great Plains to the Rocky Mountains. The Wind River Indian Reservation (WRIR), located toward the center of the state in Fremont County, is home to two federally recognized tribes, the Eastern Shoshone and Northern Arapaho. Wyoming’s public health system is mixed (centralized and decentralized), with four independently run county health departments and the remaining 19 counties utilizing both state and county staff. 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, and coordinate care for children left at home.

According to America’s Health Rankings (2018), Wyoming’s strengths include low levels of air pollution and a low proportion of children in poverty. Challenges include a high percentage of uninsured and low rates of primary care physicians.

The most recent five-year needs assessment resulted in the selection of seven MCH state priorities for 2016-2020.  They include:  

• Prevent infant mortality
• Improve breastfeeding duration
• Improve access to and promote use of effective family planning
• Reduce and prevent childhood obesity
• Promote preventive and quality care for children and adolescents
• Promote healthy and safe relationships in adolescents
• Prevent injury in children

The mission of the Wyoming MCH Unit is to improve the health and well-being of Wyoming families and communities by supporting and collaborating on public health activities that benefit the health of mothers, infants, children, youth, and young adults, including those with special health care needs. 

The MCH Unit leverages partnerships and both federal and non-federal funding to address Wyoming state priority needs. Although the MCH Unit receives a small Title V award, matching state and other funds, as well as the work and resources of our partners, increases our capacity to achieve outcomes related to state priority needs. The MCH Unit works closely with both state and county staff in all 23 counties to assure access to community-level MCH services including home visiting, care coordination services for CYSHCN, high risk pregnant women, and high risk infants, and genetics clinics (in 3 counties).

Through statutory requirement, the MCH Unit and Public Health Nursing (PHN) jointly receive Temporary Assistance for Needy Families (TANF) funding from the Wyoming Department of Family Services to support the implementation of home visiting. The MCH Unit also benefits from $2,375,591 in state funds required to meet 1989 maintenance of effort. These state funds primarily support delivery of home visitation and CYSHCN care coordination services by PHN in all 23 Wyoming counties.

The MCH Unit currently receives and/or utilizes federal funding from the Rape Prevention Education (RPE) grant, Personal Responsibility Education Program (PREP), State Systems Development Initiative (SSDI), Preventive Health and Health Services Block Grant (PHHSBG), and Pregnancy Risk Assessment Monitoring System (PRAMS). The MCH Unit does not manage Wyoming’s Title X and Maternal Infant Early Childhood Home Visiting (MIECHV) grants; however, MCH staff partner closely with the grantees. In 2016, the Early Childhood Comprehensive Systems (ECCS) grant was awarded to a reduced number of states and Wyoming was not funded.  

Summary of Priority Needs, National/State Performance Measures (NPM/SPM) Status, and Related Activities by Population Domain

Through an MCH contract with all counties, MCH requires PHNs to ask about smoking status at every home visit, and provide appropriate cessation education and referrals to the Wyoming Quitline as appropriate. The Women and Infant Health Program (WIHP) is available to provide training on the evidence-based Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) program. 

The WIHP, MCH Epidemiology Program, Wyoming Medicaid, and a provider champion participated in the Association of State and Territorial Health Officials (ASTHO) Learning Community on Increasing Access to Contraception from 2016 to 2018. In FFY19, the WIHP shifted its focus to address long-acting reversible contraception (LARC) reimbursement challenges in Rural Health Clinics (RHC), Federally Qualified Health Centers (FQHC), and Indian Health Service with the goal of changing Medicaid policies. A grant from the National Institute for Reproductive Health supported completion of a cost analysis comparing the cost of LARCs compared to costs related to unintended pregnancy. A request for a State Plan Amendment changing reimbursement policies for FQHCs and FHCs is anticipated in 2019.

In 2019, the MCH Unit partnered with the Utah Department of Health to apply for Centers for Disease Control and Prevention (CDC) funding to review Wyoming maternal deaths as part of the Utah Perinatal Mortality Review Program. This application addresses an emerging need and topic of interest identified by the Wyoming Perinatal Quality Collaborative (WYPQC).

In FFY18, the WIHP officially launched the WYPQC. See MCH Success Story for additional details.

The Levels of Care Assessment Tool (LOCATe) continued to inform the work of the WIHP in 2017 and 2018. Assessment results revealed opportunities for quality improvement efforts with hospitals (e.g. implementation of patient safety bundles). In 2017 and 2018, six Wyoming hospitals participated in a Utah Project Extension for Community Healthcare Outcomes (ECHO) focused on maternal hypertension. In 2019, up to five hospitals will receive mini-grants to join an opioid-focused safety bundle ECHO. 

In 2018, the WIHP leveraged Title V and ASTHO funding to offer four mini-grants to hospitals participating in the Wyoming 5-Steps to Breastfeeding Success Program. All hospitals demonstrated improvement in breastfeeding practices from baseline. 

In FFY18, the Child Health Program (CHP) continued implementation of two strategies to increase developmental screenings: implementation of the Help Me Grow (HMG) model and Ages and Stages Questionnaire (ASQ) training and resource distribution. In partnership with key stakeholders and funders, the CHP evaluated the progress of the HMG pilot project and decided to end the program as of June 30, 2019 and shift resources towards building an effective early childhood system in preparation for the 2021-2025 MCH Needs Assessment and new priority selection. The CHP will work closely with early childhood system partners, in particular the Wyoming MIECHV program grantee, Parents as Teachers National Center (PATNC), to identify needs and gaps within the early childhood system. In July 2019, the early childhood system partners will participate in a MCH Workforce Development Center Learning Institute. 

The Prevent Childhood Injury priority expanded in 2018 to include a broader age group, ages 0-19, due to high rates of injury hospitalizations across many age groups. Together, all MCH program managers worked together to release a mini-grant for community organizations to address the top causes of childhood injury using evidence-based or –informed strategies. In FFY20, nine organizations will implement projects with TA provided by all MCH program managers depending on topic/age of focus.  

The CHP worked closely with the Wyoming Chronic Disease Prevention Program (CDPP) to fund training and certification of 45 University of Wyoming Extension Office nutrition educators as child obesity prevention educators. In addition, the CHP will continue a partnership with the Head Start State Collaboration Office to develop and release a Wyoming Healthy Policies Toolkit for early childcare providers.

The Youth and Young Adult Health Program (YAYAHP), in partnership with the PREP Program, continues to provide training on Making Proud Choices and Reducing the Risk curricula to promote healthy and safe relationships in adolescents through youth-serving organization programming. 

During FFY18 and FFY19, four pilot clinics participated in the University of Michigan’s Adolescent Centered Environment Assessment Process (ACE-AP) as a strategy to improve the quality of the adolescent clinical environment. The clinics received mini-grants from the Adolescent and Young Adult Health Collaborative Improvement and Innovation Network (AYAH CoIIN) budget to support practice/clinic environment improvements and technical assistance from the University of Michigan to identify and respond to opportunities to improve adolescent well visits. Four new clinics will begin work with University of Michigan in FFY20. 

The MCH Unit continued implementation of the Wyoming Parent Partner Program (PPP) as a strategy to increase access to medical home. In FFY18, the PPP served 189 unique families and 233 unique children. Parent Partners serve clinics in Cheyenne, Casper, Riverton, and the F.E. Warren Air Force Base (Cheyenne, Wyoming). 

In FFY18, the YAYAHP and CSH program staff presented a comprehensive training on transition for PHNs and Tribal MCH Nurses. As a result of their work, all CSH clients ages 14 and up and their parents will complete a transition readiness assessment tool annually and will receive customized evidence-based teaching on how to prepare for transition to adult health care services.

In FFY18, the Wyoming Genetics Clinics Program, CSH Program, PHN, Rural and Frontier Health Unit, and MCH Epidemiology Program partnered to implement and evaluate a telegenetics pilot to address a gap in specialty genetics services in Wyoming. As of December 31, 2018, the Wyoming Genetics Clinics Program enrolled 69 clients with services provided to 63 individuals. Of these, 24 patients had a telehealth visit. Those receiving telehealth services (n=24) felt that telegenetics made it easier for them or their child to receive services and that telemedicine was more convenient than traveling out-of-state. All were satisfied with the quality of services received and said their questions were answered. It was the first time that most families had used telemedicine.