The Wisconsin Title V program is housed within the Family Health Section of the Bureau of Community Health Promotion in the Division of Public Health, which is a part of the Wisconsin Department of Health Services. The Wisconsin Division of Public Health achieved national accreditation in 2018, an accomplishment that demonstrates Wisconsin’s commitment to our mission of protecting and promoting the health and safety of people throughout the state.

The goal of Wisconsin’s Title V program is to ensure that all families have access to a coordinated, integrated, and sustainable system of services and supports focused on health promotion and prevention. This is accomplished through collaboration with local and Tribal health agencies, community-based organizations, statewide organizations, and other partners, assuring quality health services are delivered to parents, children, and families. Title V funds are directed toward building systems that better coordinate and integrate services across programs and providers, while investing in community-based prevention, health promotion, and support services. Wisconsin also works with many maternal and child health-focused initiatives and programs beyond those funded by the Title V Block Grant, including: the Maternal, Infant, and Early Childhood Home Visiting program; the Maternal Health Innovations grant; the Title X Reproductive Health Family Planning program; Rape Prevention Education; the Adolescent Health program; the Pediatric Mental Health Care Access grant, and others.

The United Health Foundation State Health Rankings (2023) place Wisconsin 22nd overall and 34th for health outcomes. The two measures Wisconsin is faring the worst (both ranked 49th) relative to other states are low per capita public health funding and low birthweight racial gap. Other challenges highlighted in Wisconsin’s rankings include residential segregation (ranked 48th), high prevalence of excessive drinking (47th), and a high prevalence of obesity (40th).  Positive trends indicate a low prevalence of non-medical drug use, a high prevalence of high school completion, and a high voter participation rate.

Wisconsin ranked tenth in the nation for overall child well-being by the Annie E. Casey Foundation, based on the 2022 Kids Count Profile. However, this relatively high-ranking masks significant racial and ethnic disparities throughout the state, and progress has stalled on many indicators related to health, education, economic well-being, and family and community factors. Disparities in birth outcomes also persist. In 2020, Wisconsin’s Black infant mortality rate was 14.0 deaths per 1,000 live births, ranking second highest in the nation among the 35 states and District of Columbia reporting 2020 Black infant mortality rates.

The COVID-19 pandemic brought inequities in maternal and child health to the forefront. Health inequities are “systematic differences in the opportunities groups have to achieve optimal health, leading to unfair and avoidable differences in health outcomes” (Braveman, 2006; WHO, 2011). To disrupt these health inequities, Wisconsin identified State Performance Measures focusing on African American infant mortality prevention and representative participation to assure that populations experiencing the greatest health disparities have a voice in program planning and policy development. A newly identified State Performance Measure directly focused on increasing social connectivity has become critically important in the wake of the COVID-19 pandemic as well.

Wisconsin’s 2021-2025 maternal and child health priority needs were determined based on findings of the 2020 MCH Needs Assessment:

•  Advance Equity and Racial Justice

• Assure Access to Quality Health Services

• Cultivate Supportive Social Connections and Community Environment

• Enhance Identification, Access, and Support for Individuals with Special Health Care Needs and their Families

• Foster Positive Mental Health and Associated Factors

• Improve Perinatal Outcomes

• Promote Optimal Nutrition and Physical Activity

Key Wisconsin Characteristics

• Number of births: 60,032

• Ratio of black to white infant mortality: 2.8

• Percent of births covered by Medicaid: 34.1%

• Percent of children under 19 years old without health insurance: 6.5%

• Percent of children under 19 years old living below the federal poverty level: 12.7

• Percent of children under 5 years old living below the federal poverty level: 13.8%

• Percent of Wisconsinites living in rural areas: 32.9%

Activity Update

National Performance Measures (NPMs) and State Performance Measures (SPMs) are identified across six population domains to address the priority needs identified in the 2020 MCH Needs Assessment.

Women/Maternal

Annual Preventive Medical Visit (NPM 01): Only 73.1 percent of women in Wisconsin between 18 and 44 years old receive an annual preventive medical visit, according to 2019 Behavioral Risk Factor Surveillance System data. The Title V program works closely with the state’s Title X team to support women establishing a medical home and getting an annual well-woman visit. Activities include promotion and education for patients and clinicians, addressing relevant health inequities, providing training and education opportunities for clinicians within the Reproductive Health and Family Planning network, and developing marketing and promotional tools for dissemination. This team collaborates closely with home visiting programs across the state to promote and disseminate information. Equity gaps are addressed through implementation of internal health equity initiatives and identifying best practices for data collection.

Infant/Perinatal

African American Infant Mortality Prevention (SPM 01): Infants born to non-Hispanic Black mothers are dying preventable deaths. The Maternal and Infant Mortality Prevention Unit within the Family Health Section is working to identify strategies related to community partnerships, collaboration, data capacity, and policy and systems changes. Collaboration with Medicaid supports efforts to strengthen the Prenatal Care Coordination benefit and integrate reimbursement for doula services. Local and Tribal health agencies are supported to make practice changes to advance health equity and enhance community engagement. Data from Fetal Infant Mortality Review, Maternal Mortality Review, Pregnancy Risk Assessment Monitoring System, and other data sources inform this work.

High-Quality Perinatal Care (SPM 02): Wisconsin lacks a comprehensive, high-quality, regionalized perinatal care system that successfully engages women throughout the continuum of care, from preconception through the postpartum transition to ongoing well-woman care. The 2018-2019 Pregnancy Risk Assessment Monitoring System data show 54 percent of non-Hispanic white, 53 percent of Hispanic and non-Hispanic Black, and 58 percent of women of other races received a high-quality postpartum visit (high-quality: those who report receiving postpartum depression screening, tobacco use, and either contraceptive or birth spacing discussion on question 70 of the Wisconsin Pregnancy Risk Assessment Monitoring System). The Title V program continues to collaborate with partners including maternal psychiatric teleconsultation program The Periscope Project and Moms Mental Health Initiative. Additional work is being done to support efforts to implement revised levels of perinatal care assessment for hospitals, and collaboration with Medicaid which strives to schedule postpartum visits before delivery.

Breastfeeding (NPM 04): Wisconsin’s social and physical environment does not support all families to meet their human milk feeding goals, and disparities exist within breastfeeding initiation and duration. About 87.5 percent of Wisconsin infants are ever breastfed, yet only 31.3 percent are breastfed exclusively through six months (2019; National Immunization Survey). Wisconsin aims to address disparities within non-Hispanic Black and indigenous populations, focused on policy development, local interventions, and community partnership development. Statewide partners including Coffective and the Wisconsin Association for Perinatal Care focus on hospital practices to increase breastfeeding initiation rates and to support better coordination between clinical and community stakeholders. Additional partners include Supporting Families Together Association and the African American Breastfeeding Network, who are advancing lactation support in childcare settings with a particular emphasis on Milwaukee.

Children

Developmental Screening (NPM 06): Only 38 percent of children in Wisconsin ages 10 through 35 months receive a developmental screening using a parent-completed tool (2018-2019 combined, National Survey of Children’s Health). The Wisconsin Medical Home Initiative continues to offer virtual and in-person developmental screening training and technical assistance opportunities. Staff trained two large health systems in Northeast Wisconsin in partnership with Help Me Grow First Five Fox Valley. Wisconsin’s Title V program is working to forge and strengthen partnerships with local WIC and public health agencies to increase the number of children who are offered CDC’s Learn the Signs developmental monitoring checklist, screen if there is a concern, and refer to appropriate services.

Physical Activity, 6 through 11 years (NPM 08.1): Too many children in Wisconsin are considered overweight (15.0%) or obese (13.7%) by Body Mass Index standards, which is a strong predictor of poor health outcomes throughout their lives. The Wisconsin Title V team successfully piloted a training and technical assistance opportunity for local and Tribal health agencies, empowering them to develop action plans unique to their local communities to address physical activity and nutrition concerns in children. The University of Minnesota’s School of Public Health, healthTIDE Network, Wisconsin Title V staff, the Wisconsin Department of Children and Families, and the University of Wisconsin-Madison Extension lead this work to encourage a constant feedback loop from participants to make their projects as effective as possible.

Adolescents

Adolescent Injury Hospitalization, 10 through 19 years (NPM 07.2) and Adolescent Well Visit (NPM 10): These two performance measures were removed beyond 2021, though much of the work continues under SPM 05.

Adolescent Mental Health (SPM 05): In Wisconsin, 27 percent of adolescents feel so sad or hopeless almost every day that they stop doing some usual activities according to the Wisconsin Youth Risk Behavior Surveillance Survey. The Title V program supports Providers and Teens Communicating for Health, a teen-delivered program that targets barriers that interfere with the ability of health care providers and teens to communicate effectively with one another about sensitive health topics. Local and Tribal health agencies work with local school districts, health care organizations, and community organizations to train adults and peers to recognize signs of mental distress, bolster protective factors, prevent bullying, and improve social-emotional learning. Local agencies also work to limit adolescent access to firearms and prescription medications. The University of Wisconsin Division of Extension Institute for Health and Well-Being provides training support and technical assistance to these local efforts. Partnership with the Wisconsin Department of Public Instruction supports the administration and dissemination of the Youth Risk Behavior Survey and School Health Profiles. Title V staff also assist in the administration of some innovative models of mental health care, including the Child Psychiatric Consultation Program, a provider teleconsultation program.

Children and Youth with Special Health Care Needs

Medical Home (NPM 11): Only 46.6 percent of children with special health care needs in Wisconsin receive medical care within the context of a medical home, defined as accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally effective (according to 2020-2021 National Survey of Children’s Health data). The Title V program promotes the medical home using a common set of messages and tools for families and providers, promotes care coordination best practices such as a Shared Plan of Care with healthcare systems, and supports youth and family engagement and leadership – especially for families disproportionately impacted – at the individual, community, policy, and system levels.

Youth Health Transition (NPM 12): Only 34.6 percent of children with special health care needs in Wisconsin ages 12 through 17 receive the services and supports necessary to transition to adult health care, according to 2020-2021 National Survey of Children’s Health data. To address this, the Wisconsin Title V program works to develop and disseminate consistent strategies and tools with common messaging and promote best practices in transition planning. Presentations and trainings are implemented, and technical assistance opportunities are available for key systems and professional associations. The Title V program also implements transition planning for youth with special health care needs and their families to have planned transitions to adult health care, care coordination and family supports, and an increasing reach to underserved populations.

Cross-Cutting/Systems Building

Social Connection (SPM 03): Due to environmental and social barriers, too many Wisconsinites are lacking meaningful social connection, which can lead to increased risk of adverse health outcomes. Social connections were one of the most common needs identified in the 2020 MCH Needs Assessment. According to 2022 data from the CDC’s Behavioral Risk Factor Surveillance System (BRFSS),currently, 76.4 percent of adults report that they usually or always get the social and emotional support they need. In addition, 69.4 percent of adults report that they rarely or never feel socially isolated from others. According to the 2021 Wisconsin Youth Risk Behavior Survey, in Wisconsin, 60.8 percent of high school students agreed or strongly agreed that they belong at their school. Wisconsin’s Title V program aims to incorporate work addressing social connection and access to informal and formal resources throughout the national and state performance measure strategies. Activities include offering social connection as a project option for local and Tribal health Tribal agencies to address, providing expertise on social connections, continuing to review existing efforts, aligning with the work of other Wisconsin performance measure teams, and developing a tool to organize current and potential efforts by leveraging existing data sources.

Representative Participation (SPM 04): The Wisconsin Title V program does not consistently and effectively embed family, youth, and community member perspectives into programs, policies, and practices. Engaging the voice of communities – representative of Wisconsin’s population – is the base of advancing any equitable work. To support Representative Participation, partnership with Smith Research and Consulting provides support to local and Tribal health agencies as they assess and support community member engagement. Best practices are developed and implemented for reporting data to stakeholders and the public, for advancing health equity and supporting staff competencies at the state and local levels related to the Foundational Practices for Health Equity.