Ongoing Needs Assessment Activities

WY MCH leadership and MCH Epi staff will work closely to identify and implement interim activities to occur between 5-year needs assessments (NA).

Current and planned ongoing NA activities include:

• Cross-Domain Efforts:
  • MCH Epi maintains dashboards to monitor key indicators from birth certificate data, PRAMS, and Title V NOMs and NPMs for ongoing assessment, to identify trends and disparities, and makes data more accessible to partners.
  • MCH Epi creates data briefs focused on the selected MCH priorities and selected NPMs.
  • WY MCH will begin planning for the next five-year needs assessment. This will involve developing a framework that will incorporate social determinants of health and plan for community and family engagement throughout the entire process.
  • In spring 2023, WY MCH released an online public input survey to gather input on recent and planned activities and identify emerging needs. For each domain, the survey asked, “What are the unmet needs in your community?” WY MCH will use the results to inform ongoing action planning and implementation.
  • WY MCH will annually convene MCH/Title V Steering Committee (SC) to gather feedback on state action plan progress and address challenges/barriers.
• Children/CYSHCN:
  • The CYSHCN Director is undertaking assessment and planning activities to inform future strategic direction for the program. This will involve reviewing program data, analyzing key indicators from the NSCH, reviewing CYSHCN expenditure data, collecting staff and public health nurses’ perspectives, and reviewing previous CYSHCN national standards assessment and other frameworks and guides (e.g., Blueprint). As this work progresses, these efforts will engage communities/families.
  • WY MCH has invested in NSCH oversampling for two years. The first full completion of oversampling occurred for NSCH 2022, with 1,250 responses (double the baseline number of responses for Wyoming). This is anticipated to provide Wyoming a larger data set to further assess CYSHCN population needs and identify disparities by demographic characteristics.
• Women and Infant Health:
  • The WIHP continues to engage in maternal mortality review to identify contributing factors and inform prevention recommendations.
• Youth and Young Adult Health:
  • WY MCH will leverage Title V and SSDI funds and partner with the CPU to survey young adults. The first iteration occurred in 2022. The survey focuses on 18-29 year olds and asks about attitudes and behaviors related to substance use, mental health, motor vehicle safety, healthcare access, sexual health, and interpersonal violence. The data will further inform current and future strategies. In addition to the standard report at the state and county level, WY MCH has applied for an intern through the Graduate Student Epidemiology Program (GSEP) for more detailed analysis across demographic stratifiers.
  • WY MCH leveraged other federal funds to support a comprehensive sexual violence needs assessment and economic impact report, released in March 2023, that will inform shared risk and protective factors with other MCH priorities.

Health Status and Needs Update

Women’s/Maternal Health

Maternal Mortality and Morbidity

The Wyoming MMRC has completed reviews of 2018-2021 pregnancy-associated deaths. From 2018-2021, 16 women died during pregnancy or within one year after the end of their pregnancy. Most of these deaths occurred after the end of their pregnancy. Fifteen of these deaths were reviewed and seven were determined by the committee to be pregnancy-related. Mental health conditions were the most common cause of pregnancy-related deaths. Substance use was involved in six of the seven pregnancy-related deaths. All but one of the pregnancy-related deaths were deemed to be preventable.

From 2017-2021, WY’s severe maternal morbidity rate was 86.3 per 10,000 delivery hospitalizations. The most common severe maternal morbidity in WY is transfusion, followed by eclampsia.

Maternal Mental Health

In WY, 20.3% of new moms reported pre-pregnancy depression, 19.4% reported depression during pregnancy, and 14.5% reported postpartum depression (PPD). PPD was highest among women ages 15-24 years, and also significantly higher for women in the lowest FPL, as well as among American Indian/Alaska Native (AI/AN) women compared to White women, and women with less than a high school education or equivalent compared to those with more than a high school education. A majority (87.4%) of women reported their providers discussed depression with them at a postpartum visit (PRAMS, 2016-2021).

Preconception Health

According to the 2021 Behavioral Risk Factor Surveillance System (BRFSS), 68% of WY women reported having a preventive medical visit in the past year, the first time in over a decade this prevalence was not significantly less than the U.S. prevalence. In 2021, the prevalence of women reporting having a well women visit in the past year continued to be highest for those with a college degree or more (77%), and those with a household income of $75,000 or more (79%). A higher prevalence of women with health insurance (76%) compared to uninsured women (35%) report having a preventive medical visit in the past year.

Maternal Smoking

Significant reductions in the prevalence of women smoking during pregnancy continue to be seen in the U.S. and WY. While the WY 2021 prevalence (10%) was significantly less than the WY 2020 prevalence (13%), it is still significantly higher than the U.S. 2021 prevalence of 5% (National Vital Statistics System [NVSS]). The prevalence of smoking during pregnancy was significantly higher among WY women with less than a high school education (26%) compared to those with at least a high school education (18%), those with some college education (8%), and those who graduated from college (1%), and significantly higher among women on Medicaid (23%) compared to those who are uninsured (12%) and those with private insurance (4%) (NVSS). WY still needs to increase the percentage of women giving birth who did not smoke during pregnancy by 5% to reach the HP2030 goal of 96% of women giving birth not reporting smoking during pregnancy.

Family Planning

In 2021, 21.5% of women reported having an unintended pregnancy, compared to 33% in 2012. The rate of unintended pregnancies did not differ by race, but differences were seen by income level. Women living with incomes ≤100% FPL reported having an unintended pregnancy significantly more (38.9%) compared to women living with incomes 201-300% FPL (16.3%) and 301%+ FPL (12.9%).

In 2021, 54% of WY women at risk of pregnancy/not actively trying to become pregnant reported use of the most/moderately effective form of contraception. The prevalence has not changed significantly since 2015. No differences were seen by race/ethnicity, income, or Medicaid status. While not currently a Title V priority, MCH Epi will continue to monitor contraceptive use (PRAMS).

Perinatal/Infant Health

Births

From 2018-2022, there were a total of 31,348 births of WY residents, an average of 6,297/year. Of those births, 89% occurred within WY, and 11% occurred out-of-state. Among in-state births, 73% occurred in seven facilities. Two of those seven facilities accounted for 35% of in-state births.

Infant Mortality

WY’s 2018-2022 infant mortality rate (IMR) was 5.7 deaths/1,000 live births; with a majority of deaths (74%) occurring among neonatal infants (WY VSS), compared to the national rate of 5.4 deaths/1,000 live births in 2020. Both met the HP2020 objective (6.0 deaths/1,000 live births); but not the HP2030 objective of 5.0. From 2018-2022, the WY IMR among white women from urban counties was 7.0 deaths/1,000 live births, compared to 5.9/1,000 for women from rural counties, and 4.5/1,000 for women from frontier counties (VSS 2018-2022).

Both neonatal and postneonatal mortality rates in WY have been similar to U.S. rates over the past 10 years. From 2018-2022, the leading causes of death among WY neonates were congenital malformation, deformations, and chromosomal abnormalities, followed by disorders related to short gestation and low birth weight. The leading causes of postneonatal infant death were SUID, congenital malformation, deformations, and chromosomal abnormalities (VSS).

Preterm and Low Birth Weight (LBW) Births

In 2021, 11% of WY infants were born preterm, the same as the 2021 U.S. prevalence. Since 2009, WY’s preterm prevalence has fluctuated from a high of 11% in 2014 and a low of 9% in 2017. The 2021 prevalence was comparable to the 2009 prevalence. The 2021 prevalence of LBW births in WY was 9%. The WY prevalence has been significantly higher than the U.S. since 2018. WY has not met the HP2020 preterm goal of 9%, or the HP2020 LBW goal of 8%. MCH Epi will continue to monitor changes in preterm and LBW deliveries and will examine the LBW increase in more detail.

Infant Sleep Environment

The leading cause of postneonatal infant death in WY from 2018 to 2022 was SUID. Over 84% of WY women reported their infants are put to sleep on their backs only (PRAMS, 2016-2021), exceeding the HP2020 goal of 76%. However, less than one third of women reported their infants always or often were placed to sleep on a separate approved sleep surface; 36.6% reported their infants were usually placed to sleep with no soft bedding. Disparities in sleep environments were seen by race, age, and income.

Breastfeeding

The WY breastfeeding initiation rate (91.2%) exceeds the HP2020 Goal (82%) (PRAMS, 2016-2021). According to the National Immunization Survey (NIS), in 2018 30% of infants in WY were breastfed exclusively through six months compared to 26% in the U.S. To reach the HP2030 goal of 42% of infants breastfed exclusively through six months, WY needs to increase its percentage in 2018 by 41% (NIS). Breastfeeding is currently not a Title V priority, and while WY continues to show good breastfeeding rates, monitoring will continue.

Child Health

Child Mortality

In 2021, the WY child mortality rate (CMR) among children ages 1-9 years was 30.4/100,000, significantly higher than the U.S. rate of 17.5/100,000. The WY CMR has not changed significantly since 2009. The 2017-2019 CMR is significantly higher for children ages 1-4 (25.3/100,000) than for children ages 5-9 (20.3/100,000). Rates for 2020 are not available.

Unintentional Injury

Between 2012 and 2022, unintentional injury (UI) remained the leading cause of death among WY children ages 1-9 and accounted for 44% of deaths in this age group. Motor vehicle traffic injuries (23%) and drowning (21%) were the most common mechanisms of UI fatal injuries (VSS). Childhood mortality and injury hospitalization are not currently a WY Title V priority, but MCH Epi continues to monitor this topic.

Overall Health and Preventive Care

According to the 2020-2021 NSCH, 91% of WY children ages 0-11 were reported to be in excellent or very good health, 49.0% received care in a medical home, 56% had adequate and continuous insurance, and 17% received care in a well-functioning system. A significantly higher prevalence of children who received care in a medical home were reported to be in excellent or very good health, compared to children who did not receive care in a medical home.

In 2020, 45% of eligible, Medicaid-enrolled children ages 1-9 who should receive at least one initial or periodic EPSDT screening received at least one screening, a drop from 65% the previous year. This was the first decrease in the percent of eligible children receiving at least one EPSDT screening since 2015. In both WY and the U.S., decreases were seen for almost all ages in 2020 (WY Centers for Medicare & Medicaid Services [CMS] 416 Report).

Obesity and Physical Activity

In 2020-2021, 12% of WY children ages 10-13 were obese, significantly less than 17% in the U.S. (NSCH). In 2020-2021, 40% of WY children ages 6-11 were active for 60 minutes every day, significantly higher than the U.S. prevalence of 26% (NSCH). Small numbers continue to make any noted disparities in physical activity between different groups of children difficult to evaluate.

Adolescent Health

Adolescent Mortality

The WY adolescent (ages 10-19) mortality rate (AMR) increased from 43.1/100,000 in 2020 to 62.6/100,000 in 2021, significantly higher than the U.S. rate of 39.5/100,000. From 2012-2022, the leading cause of death among 10-19 year olds in WY was UI (42% of deaths) and suicide (34% of deaths) (VSS).

The 2019-2021 AMR was significantly higher among ages 15-19 (82.3/100,000) compared to ages 10-14 (25.2/100,000), males (74.7/100,000) compared to females (29.5/100,000). Due to small numbers in 2019-2021, disparities by race/ethnicity are not able to be observed.

Motor Vehicle Mortality

The 2019-2021 adolescent (ages 15-19) motor vehicle mortality rate in WY was 22.4/100,000, similar to the rate reported for 2018-2020 (21.9/100,000), and still significantly higher than the U.S. 2019-2021 rate of 12.0/100,00 (NVSS, 2019-2021). While the U.S. male rate for 2017-2021 of 15.4/100,000 was again significantly higher than the U.S. female rate of 8.1/100,000, there was still no significant difference between WY male rate (25.0/100,000) and the female rate (17.0/100,000) for 2017-2021.

The YAYAHP continues to focus on injury hospitalization among 10-19 year olds as an NPM for decreasing motor vehicle mortality. The WY injury hospitalization rate for 10-19 years old in 2020 (235.0/100,000 10-19 year olds) was no longer significantly higher than the 2020 U.S. rate (210.0/100,000), which was the case in 2019. The YAYAHP is working on expanding Teens in the Driver’s Seat to more schools to tackle motor vehicle mortality and injury hospitalizations by focusing on seat belt use among adolescents. In 2022, initial data was collected on seatbelt use from a new question in WY Prevention Needs Assessment (PNA), added via a partnership with MCH Epi and the YAYAHP. Initial data show that just over half (52%) of middle and high schoolers in Wyoming reported to “always” wear their seatbelt when riding in a car.

Suicide, Self-Harm, and Risk and Protective Factors

The 2019-2021 WY adolescent suicide rate was 30.4/100,000, continuing to be significantly higher than the U.S. rate of 10.6 in 2019-2021. Suicides made up 34% of all deaths among adolescents ages 10-19 in WY from 2012 to 2022 (VSS). The 2017-2021  suicide rate for adolescent males was 45.8/100,000, continuing to be significantly higher than the adolescent female rate of 13.6/100,000 (NVSS).

Children with Special Health Care Needs

Approximately 20% of WY children ages 0-17 years (26,199) have a special health care need. In 2020/2021, 52% of WY CYSHCN had insurance that was considered adequate for a child’s health needs, again, significantly less than the U.S. percentage of 64% of CYSHCN. In WY, 18% of CYSHCN reported receiving care in a well-functioning system compared to 14% of CYSHCN in the U.S. (NSCH).

In 2020/2021, 48% of WY CYSHCN reported having a medical home, similar to the 49% of non-Children with Special Health Care Needs (CSHCN) children in WY, and 42% of CYSHCN in the U.S. WY’s CYSHCN Program is currently taking a closer look at data from the NSCH to assist in planning the next steps for the program. As part of this effort, WY is currently participating in a three- year oversample for the NSCH to ensure enough data is available to be able to help drive decisions for future programmatic efforts.

Emerging Needs Update

Childhood Lead Poisoning Prevention

Blood lead test results are a reportable condition in WY. In 2022, only 5% of WY children under the age of six were tested for lead, and 2% of those tested had elevated blood lead levels. In comparison, in the U.S. in 2018 (the most recent year available for comparison), 18% of children under the age of six were tested for lead, and 3% of those tested had elevated blood lead level. The WDH PHD historically lacked capacity and funding for a lead surveillance and prevention program; however, WDH PHD was awarded the CDC Childhood Lead grant in August 2021. MCH is an implementation partner on this grant.

COVID-19

In 2023, MCH Epi is planning to conclude the initial linkage of COVID-19 cases in women of reproductive age to birth/fetal death records from 2020-2022 to describe the pregnant population who also had COVID-19 and monitor the outcomes of both the infant and mother. MCH Epi continues to monitor for potential maternal mortality cases who also were diagnosed with COVID-19. To date, there have been no maternal mortality cases linked to COVID-19 cases.

WY PRAMS added two COVID-19 supplements. The general COVID-19 supplement began in October 2020 with the July 2020 births. The COVID-19 Vaccine Supplement, asking about vaccine administration and hesitancy, began data collection in April 2021 with the January 2021 births. Both supplements are no longer being collected starting with 2023 births, and MCH Epi should have the final datasets for these in late 2023 to conduct analyses.

Oral Health

The WDH PHD Oral Health Program was eliminated in 2016 due to budget cuts. The unit participates in a statewide WY Oral Health Coalition led by the Wyoming Primary Care Association (WYPCA). WY MCH will consider how to incorporate oral health as part of the next five-year needs assessment health, determine our capacity to address needs, and assess if including it as a priority is feasible.

An important policy decision related to oral health was made during the 2023 legislative session. The approved supplemental budget included a Medicaid dental reimbursements rate increase. This increase is expected to improve access to dental care for Medicaid patients. Over half of Medicaid patients are children.

Child and Adolescent Health Insurance

In 2020/2021, the prevalence of children ages 0-17 who were adequately insured in the past year in WY (56%) continued to be significantly less than the U.S. prevalence (68%). According to the 2021 American Community Survey, about 1 in 10 (10%) of WY children (ages 0-17) were not currently insured, significantly higher than the U.S. prevalence (5%). When examined by race, the highest prevalence of uninsured children was among non-Hispanic AI/AN (26%), followed by Hispanic children (23%) (ACS). In 2020/2021, only 55% of uninsured children (ages 1-17) in WY were reported as having a preventive dental visit in the past year compared to 84% of insured children, and only  21% of uninsured children received care within a medical home compared to 50% of insured children (NSCH). These numbers, coupled with the uninsured statistics from the CYSHCN population, clearly show there is much work left to do in these areas.

While child health insurance (NOM 21) was identified as an emerging need during the 2020 NA, it was not selected as a priority due to capacity challenges and concerns over the impact WY MCH is actually positioned to make. WY MCH will continue to monitor child health insurance measures and will work to promote access to health insurance among clients served through WY MCH programs.

Capacity Update

In early 2022, the WY MCH team underwent leadership changes. The WY MCH Unit Manager/Title V Director assumed the role in February 2022, followed by a new CYSHCN Program Manager/CYSHCN Director in April 2022. However, the remainder of the year, the WY MCH team experienced relatively few changes in capacity or staff turnover. In March 2023, the Title V Coordinator resigned, leaving a vacancy. The position was refilled by the end of April 2023.

WY MCH continues to allocate state funding to local PHN offices or local health departments to support local MCH programming. Due to the economic downturn, state funding reductions will impact county funding in biennium fiscal year 2023-2024. PHN offices also experience staffing challenges, especially in the most rural/frontier counties. WY MCH has since integrated Title V 2021-2025 priorities and strategies into contracts with local PHN under the contract renewal process.

Title V Partnerships and Collaborations Update

WY MCH partners with MCH Epi for epidemiology and evaluation support. MCH Epi manages the SSDI grant for Wyoming. WY MCH also collaborates with other Maternal and Child Health Bureau (MCHB) investments, such as the Family to Family Health Information Center (F2FHIC) (housed in the UW WIND). In 2022, WY MCH also participated in the Region VII Tribal Relations Community of Practice.

WY MCH partners with other state agencies and programs to improve MCH population health, including: Health Care Financing (HCF); DWS; DFS; WDE; WDH BHD; WDH PHD programs (e.g., WIC, WIVPP, Public Health Preparedness and Response (PHPR), State office of Rural Health (SORH), Communicable Disease Unit); UW; WY Health Council (Title X grantee); the federal MIECHV grant, administered by DFS; and other statewide organizations and associations (e.g., WY Medical Society, WY Hospital Association, Uplift, WYPCA, WY American Academy of Pediatrics (AAP) Chapter, WY American College of Obstetricians and Gynecologists Chapter, WY Kids First, WY Afterschool Alliance, WY 211, WY Community Foundation).

WY MCH representatives sit on the following statewide councils:

• WY Governor’s Council on Developmental Disabilities
• WY Governor’s Early Childhood State Advisory Council
• WY Early Intervention Council
• WY Preschool Development Grant Executive Leadership Committee

In 2022, WY MCH executed new two-year contracts with all 23 counties using TANF and state funds provided for reimbursement of MCH services. These funds support an estimated 47 full-time employees across WY in support of MCH services. Although no formal funding agreements exist, WY MCH also works with the Northern Arapaho and Eastern Shoshone Tribes to promote and provide gap-filling financial assistance and care coordination services as part of the CYSHCN Program. CYSHCN staff provide training and support to tribal nurses to improve and sustain programming.

In the coming year, WY MCH will continue to establish and build partnerships with state and local organizations that serve the state’s MCH population or otherwise have a vested interest in health, social, and economic outcomes facing families in our state.

Efforts to Operationalize Five-Year Needs Assessment Findings

The WY MCH NA framework was not designed to be static or time-defined. Many elements will persist throughout the five-year grant cycle.

Steering Committee and Partner Involvement

The WY MCH/Title V SC formed in 2019 to drive NA activities, approve priorities, and hold WY MCH accountable to its developed state action plan (SAP). This SC met in January 2020 to approve draft Title V priorities. Due to COVID, the SC did not meet again until June 2021, at which time the SC approved the final WY MCH SAP. The SC met again in June 2022 and 2023 to hear implementation updates, offer guidance and feedback, and assure accountability to the plan. The committee is expected to meet annually to receive implementation updates and offer feedback and recommendations to support WY MCH accountability, increase leadership buy-in, and provide opportunities for ongoing feedback and Quality Improvement (QI).

After convening MCH PATs in spring 2020 to gather input on the selected priorities and strategies for the 2021-2025 NA, the PATs were unable to meet as planned to formally launch the 2021-2025 five-year cycle due to COVID. Program managers worked to move toward virtual PAT meetings, and have found other ways to plug into existing groups that are working toward similar priorities.

Strategic Plan Implementation

In January 2021, WY MCH released a Request for Proposal (RFP) for strategic planning, strategic implementation, workforce development, and leadership consultation services. Seven proposals were received and Lolina, Inc. was selected for an initial two-year contract, with options for renewals throughout the 2021-2025 Title V cycle. This contract has since been renewed to continue consultation and Title V support.

In partnership with Lolina, WY MCH has engaged in performance management activities. Formerly, we conducted 60/60s to discuss implementation by domain every 60 days; however in 2022, WY MCH moved toward quarterly QI workshops to begin in spring 2023. This process is designed to support individual and team accountability for implementation of strategies and improve capabilities to operationalize our values.

WY MCH will revisit and revise its SAP and ESMs/State Performance Measures (SPMs) before FFY24, and will receive TA from the MCH Evidence Center and Lolina, Inc. throughout summer 2023. WY MCH will then focus on resource allocation and structure its budget to align with updates to the SAP.

Organizational Structure and Leadership Updates

WY MCH administers the Title V MCH Services Block Grant and provides leadership for state and local efforts that improve the health of MCH populations. The table below outlines MCH and MCH Epi staff. With the exception of the MCH-Chronic Disease Epidemiology Unit Manager (.25 Full-time Employee [FTE]), all staff are full-time (1 FTE).

Staff Member	Title/Role	Title V Domain	Tenure with WY MCH/ MCH Epi (Tenure with State of WY)
Feliciana Turner, BS	MCH Unit Manager, Title V Director	All	1 (17)
Carleigh Soule, MS	CYSHCN Program Manager, Title V CSHCN Director	Child; CYSHCN; Cross- Cutting	17 (17)
Megan Selheim, BS, MFA	Youth and Young Adult Health Program Manager	Adolescent; Cross- Cutting	3 (10)
Kelly Belz, MPH	Women and Infant Health Program Manager	Women/ Maternal; Perinatal/ Infant; Cross- Cutting	1.5 (1.5)
Jaycie Gutierrez, AS	Grants and Contracts Specialist, Title V Block Grant Coordinator	All	<1 (<1)
Meg Callahan, BS	Newborn Screening and Genetics Coordinator	Perinatal/ Infant; CYSHCN; Cross- Cutting	<1 (<1)
Natalie Hudanick, MPH	Women and Infant Health Program Coordinator	Women/ Maternal; Perinatal/ Infant; Child; Cross- Cutting	2 (2)
Denise Robinson	Benefits and Eligibility Specialist	CYSHCN; Cross- Cutting	3 (16)
Sheli Gonzales	Benefits and Eligibility Specialist	CYSHCN; Cross- Cutting	17 (21)
William Nolan, BS	WIC/MCH Data Management Specialist	All	<1 (<1)
Quinn Brophy, BA	CDC PHAP Associate	Adolescent	<1 (<1)
Joseph Grandpre, PhD	Chronic Disease/MCH Epi Unit Manager	All	10 (21)
Moira Lewis, MPH	MCH Epidemiology Program Manager	All	4 (4)
Neva Ruso, MPH	PRAMS Coordinator/MCH Epidemiologist	All	3 (3)
Michelle Azar, MPH	CSTE Applied Epidemiology Fellow	Women/ Maternal; Perinatal/ Infant;	1 (1)

 

Key organizational/staffing changes since last report’s submission include:

• Unable to successfully recruit a Pediatric Mental Health Care Access (PMHCA) grant coordinator; seeking coordination services through a request for applications
• Matched with a Council of State and Territorial Epidemiologists (CSTE) fellow in May 2022
• Filled the newborn screening and genetics program coordinator in July 2022
• Hired an at-will employee contract (AWEC) data specialist, in partnership with WIC, in July 2022
• The CDC-assigned senior MCH epidemiologist vacated the position in August 2022
• Onboarded a CDC PHAP in October 2022
• The Title V coordinator/grants and contract specialist vacated the position in March 2023, and was refilled by the end of April 2023

 See below for an updated WY MCH organizational chart as of April 2023.

 

WY MCH Organizational Chart as of April 2023

WY MCH benefits from a strong MCH Epi team, housed within the Public Health Sciences Section of the WDH PHD. Program staff include a Program Manager, MCH Epi/PRAMS Coordinator, CSTE Fellow, and Chronic Disease/MCH Epi Unit Manager (0.25 FTE support for MCH Epi). WY MCH and MCH Epi plan to apply for another CDC-assigned epi advisor. See below for an updated WY MCH Epi organizational chart as of April 2023.

WY MCH Epi Organizational Chart as of April 2023

Finally, WY MCH continues to partner closely with PHN Unit leadership and two full-time PHN staff to implement a statewide home visiting program and support implementation of local MCH services, including CYSHCN care coordination services.