National Performance Measure 04: A) percent of infants who are ever breastfed and B) percent of infants breastfed exclusively throughout six months

NPM 04 addresses the 2020 priority need Improve Perinatal Outcomes as well as the 2020 priority need Advance Equity and Racial Justice.

1. Work with local and tribal health agencies to increase lactation support in the workplace. Agencies will continue to use Title V-supported resources and recommended strategies for reaching workplaces. Collaboration will continue with the Wisconsin Breastfeeding Coalition, which houses a toolkit for workplaces to improve breastfeeding-friendly practices.

2. Work with local and tribal health agencies to increase lactation support in early childhood settings. Agencies will continue to use the Ten Steps to Breastfeeding Friendly Child Care Centers Resource Kit and associated training resources. Partnership will continue with the Wisconsin Breastfeeding Coalition and the Department of Children and Families. The Title V Program will continue to use the Nutrition and Physical Activity Self-Assessment for Child Care (Go NAPSACC) online database to align with statewide adoption of Go NAPSACC tools and resources. YoungStar technical consultants and child care providers across the state use this system to assess and track their efforts to improve nutrition and physical activity, including breastfeeding support.

3. Work with local and tribal health agencies to enhance local community coordination to improve continuity of care by strengthening consistent implementation of prenatal, maternity care, and postpartum practices that support breastfeeding. Wisconsin’s use of Coffective’s Community Match platform will continue with collaboration from WIC. Coffective is an organization that focuses on strengthening local maternal and child health systems through community coordination and collaboration to enhance local and state partnership-building efforts by identifying key stakeholders and collaborative activities of interest, particularly between public health, WIC, hospitals, outpatient clinics, and community organizations. REDCap data collection will continue to track the number of community partners within the Community Match online platform, and number of collaborative activities that occur. The Well Badger Resource Center, will also be utilized as a source of information and referrals for local agencies. The Title V Program and the Wisconsin Breastfeeding Coalition will help maintain and promote the directory’s breastfeeding services, including healthcare providers, community-based providers, peer counselors, and support groups.

These first three strategies will include an activity to enhance community engagement to inform breastfeeding strategies and activities. Local and tribal health agencies will complete the Community Engagement Assessment Tool and, when possible, include family, youth and/or community representatives in the assessment process. Agencies will also develop and implement an action plan focused on improving one indicator from the assessment to enhance family, youth and community engagement.

4. Support hospital use of quality improvement strategies that align with the Ten Steps to Successful Breastfeeding and/or Baby-Friendly Hospital Initiative guidelines. Our partnerships will continue with the Wisconsin Association for Perinatal Care, Wisconsin Perinatal Quality Collaborative, and Coffective to improve breastfeeding initiation rates within the Black and Indigenous communities by improving hospital maternity care practices that support breastfeeding.

5. Develop grant opportunities for community agencies to advance breastfeeding efforts within specific populations experiencing disparities in breastfeeding (initiation, duration). The Title V Program plans to develop direct funding opportunities for community agencies working within Black and Indigenous communities to improve breastfeeding initiation and duration rates. Specific measures of impact will be developed in collaboration with community agencies receiving funding.

6. Align crosswalks and measures to promote and support the increase of the percentage of families enrolled in the Family Foundations Home Visiting Program who have social connections for breastfeeding families participating in programming. The Title V Program will support and facilitate professional development, including sharing information and trainings with the Department of Children and Families’ statewide home visiting programs. The goal of increasing breastfeeding rates of initiation and duration will continue for caregivers within the home visiting programs, especially those within communities identified as disproportionately affected throughout the state. The Family Foundations Home Visiting Program will be responsible for accountability measures below.

Figure 1: Family Foundations Home Visiting Program measures used to promote and support the increase of families enrolled in home visiting programs to increase social connections for breastfeeding families

State Performance Measure 01: percent reduction in infant mortality in babies born to non-Hispanic Black mothers

SPM 01 primarily addresses the 2020 Priority Need Advance Equity and Racial Justice, and also addresses the 2020 Priority Needs Improve Perinatal Outcomes and Assure Access to Quality Health Services. Infants born to Black mothers in Wisconsin are nearly three times as likely to die before their first birthday compared to infants born to White mothers, and this inequity has remained largely unchanged for decades. Related outcomes such as preterm birth, low birthweight, maternal complications, and maternal death are also more common for Black and other non-White mothers in the state compared to White mothers.

The leading causes of Black infant deaths in Wisconsin are prematurity and low birthweight, other perinatal conditions, and birth defects. A Perinatal Periods of Risk analysis conducted in 2015 found that from 2006 to 2010, the leading themes contributing to excess Black deaths in Kenosha, Milwaukee, Racine, and Rock Counties were maternal health and prematurity (45%), infant health (31%), maternal care (17%), and newborn care (7%).

1. Strengthen Prenatal Care Coordination as a resource and support during pregnancy through training, resource tools and quality improvement. Prenatal Care Coordination is a Wisconsin Medicaid benefit that helps pregnant women and their families gain access to medical, social, educational and other services related to pregnancy. Prenatal Care Coordination services are provided through local and tribal health departments, clinics and HMOs, and community-based agencies. Studies have found that Prenatal Care Coordination protects against low birthweight, preterm birth, and Neonatal Intensive Care Unit admission.

The Title V program will develop enhanced educational sessions to support program providers to deliver a consistent core set of information and support services, beginning with understanding the Medicaid benefit. The existing recorded Prenatal Care Coordination Overview module will continue to be promoted as an orientation or refresher on the key components of Prenatal Care Coordination: outreach, initial assessment, care plan development, ongoing care coordination and monitoring, and health education and nutrition counseling services.

New educational modules will be developed to provide training on topics related to Prenatal Care Coordination services in collaboration with the Wisconsin Association for Perinatal Care. Modules developed in 2021 by people with lived experience address substance use and pregnancy, and will be disseminated in 2022. Modules include:

1. Overview

2. Substance Use Screening Tools

3. The Screening Conversation

4. Screening, Brief Intervention and Referral to Treatment

5. Finding Local Resources

6. Referral Guidelines

7. Wisconsin Reporting Laws

8. Stigma and Support

9. Medication Assisted Treatment

10. Effects on the Baby

Another series of modules will be developed in collaboration with community partners who provide Prenatal Care Coordination and doula services within Black communities to address:

1. Perinatal Health Equity

2. Pregnancy Health

3. Breastfeeding

4. Social Support

5. Housing

6. Reproductive Health

7. Postpartum Care

A series of weekly webinars is planned and recordings of the sessions will be available for viewing free to Prenatal Care Coordination providers.

The Title V Program will also support Prenatal Care Coordination providers to attend the Fulfilling the Promise Home Visiting conference organized by the Wisconsin Child Welfare Professional Development System. This opportunity supports ongoing learning on critical core concepts such as cultural humility, poverty, trauma, and motivational interviewing.

Other activities will focus on standardized resource development and quality improvement initiatives to support best practices, and an optional postpartum assessment tool and postpartum checklist will be pilot tested in 2022. A Task Force with providers from across the state will be convened to provide input on tools and resources, the reimbursement structure, continuing education requirements, and other topics.

In addition to the Prenatal Care Coordination benefit, Wisconsin Medicaid supports the Obstetric Medical Home initiative with HMOs in select areas of the state. HMOs receive an incentive payment for healthy birth outcomes, and providers are encouraged to implement strategies to identify birthing people early in pregnancy and to implement comprehensive care coordination and innovations such as Centering Pregnancy.

Title V and Medicaid will explore integration of Prenatal Care Coordination and the Obstetric Medical Home to maximize Medicaid benefits and provide more support to birthing people in Wisconsin. Potential benefits include increased accessibility to services; improved coordination between community based providers, medical providers and HMOs; stronger focus on social determinants of health to complement medical prenatal care; and focused efforts to address recommendations identified in the Wisconsin Maternal Mortality Review Recommendations Report.

2. Support policy and practice changes to integrate doula services into Medicaid coverage. The Title V Program is working with the Division of Medicaid Services on two pilot projects that would provide reimbursement to doulas through integration with the Prenatal Care Coordination benefit. Work began in 2021 and will continue in 2022. Public Health Madison Dane County and Harambee Village Doulas will implement “Prenatal Care Coordination at the Village,” a community-based model led by members of the communities they serve. With a focus on Black women, they provide community-based, peer-to-peer support for pregnancy, birth, breastfeeding, and early parenting. The local health department currently provides Prenatal Care Coordination and will support doulas to add this component to their services.

The City of Milwaukee Health Department and African American Breastfeeding Network will support integrated services in Milwaukee. Doulas with the African American Breastfeeding Network will collaborate with community-based Prenatal Care Coordination providers to increase collaboration and strive to expand breadth and depth of Prenatal Care Coordination and doula services for Black women.

Doulas will be crossed-trained to facilitate Prenatal Care Coordination services to better support the mitigation of stressors that create barriers to a healthy birth and birthing experience. The Community Pathways Hub model will support connections and other community resources and services. Care Coordination Systems Software will be utilized to track outcomes.

Medicaid policy changes will be considered to support this integration of services, such as billing codes, length of service, or reimbursement levels. Coverage for certified doula services under Medicaid is included in Governor Evers’ proposed budget for 2021-2023.

3. Develop and implement best practices to increase data capacity of existing data sources and expand partners’ capacity to use and leverage data to demonstrate impact and increase funding. PRAMS data will be integrated into the Prenatal Care Coordination educational module series on topics of interest to Prenatal Care Coordination providers as described in strategy 1. PRAMS data will provide background information and frame the topics of perinatal health equity, pregnancy health, breastfeeding, social support, housing, reproductive health, and postpartum care. In addition to supporting Prenatal Care Coordination providers, the modules will be disseminated to home visitors.

The Title V Program looks forward to having additional PRAMS data available following the implementation of a survey supplement focusing on social determinants of health. PRAMS respondents who gave birth in 2020 were asked about housing quality and stability, labor and delivery experiences, and economic and health care experiences related to COVID-19. Also in 2020, there was an oversample of women who self-identify as American Indian or Alaska Native on the birth record, a population for which there is scarce data. As additional PRAMS data become available, it will be disseminated to key partners, and data-to-action activities will be identified for health promotion.

The Wisconsin PRAMS program will continue collaborating with a data linkage project at the University of Wisconsin-Madison led by Dr. Deborah Ehrenthal. Wisconsin Department of Health Services has approved a linkage of 2007-2016 Wisconsin PRAMS with the other data in the Big Data for Little Kids data set including vital records, Medicaid, social services, and educational data. The Data Use Agreements for this linkage have been executed and data have been delivered to the researchers. Knowledge gained from this data linkage will inform Title V Program planning.

Training and technical assistance will be provided to community-based partners regarding utilization of publically available data from state and federal agencies and designing and implementing evaluation and monitoring plans for community-based programs.

4. Align with and support work of the Maternal and Infant Mortality Prevention Unit and Community Partnership Specialists. The Family Health Section established a new unit in 2020 focused on maternal and infant mortality prevention. A strategic planning process was implemented in 2021 and the work plan will be implemented in 2022.

Community Partnerships: The new unit will strengthen overall community capacity, support community leadership on relevant issues, and connect families to available services. It will also foster community innovation and assist with scaling up successful local efforts. Partner mapping and a review of infant mortality reduction plans from other states and previous Wisconsin initiatives are planned. Community Partnership Specialists representing and serving Black and Indigenous communities will advance this work.

Coordination and Communication: Internal coordination efforts will identify opportunities for integration and alignment across program areas. Coordination with external stakeholders across multiple sectors and alignment with internal and external partners will advance this work, as will the recently-hired Family Health Section Health Equity Coordinator, the Division of Medicaid Services, and local Fetal Infant Mortality Review teams. A communications-focused needs assessment is planned for 2021 to identify new and innovative ways to share information internally and with the public.

Data: Data and evaluation plans will be developed by an epidemiologist in collaboration with the Family Health Section data team, community input, and external partners. The Perinatal Periods of Risk analysis will be updated to focus efforts on identifying periods of risk that account for excess infant deaths among Wisconsin’s Black mothers: maternal health and prematurity, maternal care, newborn care, or infant health. Relevant analytic results will be provided to communities and partners to enhance data capacity and support their work. A strategic data team will identify and implement additional short-term and long-term projects.

Policy and Systems Change: The complex nature of inequities in infant health requires policy and systems-level change. The Family Health Section is examining policies within its control that can be modified to support widespread change. Recent efforts include the use of Medicaid benefits to fund doula service integration and a thorough review of Family Health Section (which includes Title V) contracting practices in order to determine more equitable processes that can shift the section’s focus to primarily funding maternal, child, and family health work in community-based organizations.

The Maternal and Infant Mortality Prevention Unit, which is funded by state General Purpose Revenue, represents a significant increase in state dollars supporting maternal and child health efforts at the state level.

5. Support Fetal Infant Mortality Review and Maternal Mortality Review. The Title V Program will continue to support the Keeping Kids Alive initiative, which focuses on building and supporting local and regional Child Death Review and Fetal and Infant Mortality Review teams to systematically review fetal, infant, and child deaths, and make recommendations for prevention strategies that can be translated into evidence-based interventions and implemented by Community/Regional Action Prevention Teams or other community coalitions. Collaboration and evidence-based efforts will be strengthened with the Fetal and Infant Mortality Review teams in the following counties and cities: Milwaukee, Madison/Dane, Marathon, Kenosha, Marinette, Racine, Rock, Wood, Clark, and Portage.

The Title V Program will continue to support the Maternal Mortality Review Team. The team plans to hire a Community Advocate and a Community Member, persons with lived experience who understand the barriers women face on a daily basis. Diversity within the Maternal Mortality Review Team will continue to be expanded. The expertise and community connections of the new Maternal and Infant Mortality Prevention Unit Supervisor and of the Black and Native American Community Patnership Specialists will increase community perspective in this important work.

Other mortality review activities will be explored in 2022: reports with a health equity focus; recognizing the disproportion of Black, Indigenous, and other persons of color affected by the COVID-19 pandemic; family interviews to identify the context and/or factors that may have contributed to the death and to identify opportunities that are not captured in the abstracted records; collaboration between Maternal Mortality Review and Fetal Infant Mortality Review.

6. Implement implicit bias and equity trainings for internal staff and grantees. Workgroups within the Bureau of Community Health Promotion were established in 2021 to support the implementation of recommendations from the Health Equity Advisory Team, and the Title V Program will advance this work in 2022. One recommendation is to create infrastructure to “build and sustain capacity for equity work.” Activities to address this recommendation will include:

• Requiring engagement through equity learning opportunities in the annual staff review process of Performance, Expectations and Planning

• Encouraging inclusion of equity development in Individual Development Plans and encouraging leadership to follow up with staff on goals at regular intervals

• Providing inclusive outreach and engagement or facilitation training for individuals who regularly engage with the public, ensuring that historical trauma is included in these trainings

• Developing language that staff may leverage to simplify the approval process for pursuing professional development around skills that promote health equity

A book circle was piloted in 2021 with facilitated discussion regarding Up from Slavery by Booker T. Washington. The Book Circle will continue with a focus on different communities experiencing disadvantage. Book discussions will be extended into actionable steps and participants will have the opportunity to serve as Ambassadors of Change. An MCH Summit will provide grantees with training opportunities related to equity. Additional training opportunities will be researched, identified and implemented.

In addition, the Reproductive Health Family Planning Unit plans to conduct implicit bias training with staff and grantees. Practice changes following the training will be identified.

7. Support social connections for Black women who have experienced an infant loss. The Title V Program will foster social connections for Black families who have experienced the loss of an infant by providing culturally-appropriate grief and bereavement programming. Collaboration with Healing Our Hearts began in 2021 with plans for full implementation in 2022. The Healing Our Hearts Foundation is a community-based grief support organization and education service supporting families who have experienced a loss. The founder, a person with lived experience, noticed that there were not any groups that offered support aimed to handle different experiences that Black women had related to a loss. Services include a monthly grief support group, one-on-one support from a Grief Support Specialist, support kits with handmade items from small minority owned businesses, grief resources and referrals to wraparound services.

8. Support local and tribal health agencies to advance health equity in Title V Program-funded activities and enhance representative participation using the Community Engagement Assessment Tool. Local and tribal health agencies will continue to have the option to use their Title V allocation for Health Equity and Community Engagement. Participating agencies will complete the Health Equity Checklist based on the Foundational Practices for Health Equity, as well as the Community Engagement Assessment Tool. Participating agencies will identify and implement practice changes to advance health equity and enhance community engagement in their work. Education and technical assistance to support local and state efforts will be provided by the Mobilizing Action Toward Community Health Group, a program of the University of Wisconsin Population Health Institute.

State Performance Measure 02: A) percent of women receiving prenatal care within the first trimester; B) percent of women receiving a quality* postpartum visit

*Quality is defined by those who report receiving a postpartum visit that includes the following services on the Wisconsin PRAMS survey Question 70: postpartum depression screening, tobacco use, and EITHER contraception OR Birth spacing discussion.

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. According to 2018-2019 PRAMS data, 54% of non-Hispanic White women, 53% of Hispanic and non-Hispanic Black women, and 58% of non-Hispanic women of other races received a high-quality postpartum visit. Root cause analyses revealed barriers to early, high-quality prenatal care, high-quality labor and delivery care, high-quality postpartum care, and reintegration to primary care postpartum. Key themes related to these barriers include fear, mistrust, access, personal perception (of the woman), insurance/payment, and the interpretation/perception of the provider. SPM 02 was selected to address the Priority Need Improve Perinatal Outcomes, and also addresses the 2020 Priority Needs Advance Equity and Racial Justice and Assure Access to Quality Health Services.

Figure 5: Title V staff identified four key areas of perinatal care to address during a root cause analysis activity in late 2019.

A health care system that is responsive to the needs of families, and especially women, requires strategies to ensure access to services, identify risks early, provide linkage to the appropriate level of care, ensure adherence, continuity, and comprehensiveness of care, and promote efficient use of resources. Evidence-based intervention models are being reviewed to determine how best to support population or system levels of care.

1. Support efforts to implement a revised level of perinatal care assessment in Wisconsin to address the need for all hospitals in Wisconsin to have a level of care risk assessment for both the maternal and infant populations.  The goal of levels of maternal care is to reduce maternal morbidity and mortality, by assuring access to risk-appropriate care, specific to maternal health needs. The Title V Program will support partners including the Wisconsin Association for Perinatal Care, Wisconsin’s Perinatal Quality Collaborative, American College of Obstetricians and Gynecologists, and others to promote the use of a risk assessment tool with health systems and facilities to: designate their level of perinatal care; ensure all women have access to services; identify risks early; provide linkage to the appropriate level of care facility at time of delivery; promote efficient use of resources; and ensure adherence, continuity, comprehensiveness of care at time of delivery through postpartum.

The Wisconsin Association for Perinatal Care has worked for a number of years with a risk assessment document and toolkit for Wisconsin hospitals to self-assess their level of neonatal and maternal care. To date, only about half of hospitals have completed the Wisconsin Association for Perinatal Care’s self-assessment, and a newly-established workgroup will explore opportunities for increasing uptake. The workgroup is also exploring a shift to a standardized, national tool that would be updated quickly with the most recent guidelines and policy statements issued, and allow review of data from bordering states where Wisconsin women and infants might receive care.

2. Collaborate with Medicaid on a quality improvement project to schedule postpartum visits in advance of delivery. The Title V Program plans to expand a quality improvement project implemented for the Preconception CoIIN completed in 2018. This project was implemented to improve rates of postpartum visits through clinic messaging efforts and was a collaboration between the Title V Program and Medicaid. A script and patient tools were developed to describe the importance of the postpartum visit emphasizing post-delivery care, contraception and planning future pregnancies, physical activity, breast health/breastfeeding, emotional/mental health, and ongoing medical care. Success of this work will be measured by the number of Medicaid HMOs who participate in this quality improvement project.

3. Support Prenatal Care Coordination providers to strengthen postpartum Prenatal Care Coordination services to include depression screening, tobacco use, and reproductive life planning. The Medicaid Prenatal Care Coordination benefit continues during the postpartum period, through 60 days after delivery. To strengthen Prenatal Care Coordination postpartum services, the Title V Program will provide resource tools and education, including a postpartum visit checklist and an assessment tool addressing psychosocial, health and nutrition needs, and reproductive planning. A group of Prenatal Care Coordination providers will be recruited to test these tools and make recommendations for adaptions. The Title V Program will work with these early adopters to share and promote the tools with others throughout the state.

An educational module addressing Prenatal Care Coordination postpartum services will also be developed by community-based Prenatal Care Coordination providers in 2021, and a recording will be widely disseminated in 2022. Topics include:

• PRAMS data related to postpartum care

• Perinatal mood disorders

• Tobacco use; Cessation and maintenance

• Reproductive life planning, contraception methods, and birth spacing

• Attending the postpartum medical visit/Reconnecting with primary care/Insurance
• Breastfeeding

• Continued intake of folic acid

• Weight – nutrition and physical activity

• Social support

• Choosing a primary care provider for baby; Importance of immunizations and regular well-child check-ups for baby

4. Promote Text4Baby to providers and partners serving pregnant and postpartum women. Text4Baby is a free digital support service offered in English and Spanish for pregnancy and parenting moms via interactive text, app, web and video messaging regarding their pregnancy and baby’s first year. The goal for 2022 is to increase enrollment for eligible participants in Text4Baby when applying for Medicaid services. The Text4Baby service helps mothers of all races, ethnicities, education, and income levels obtain better health information and faster access to care, and is one tool in addressing poor birth outcomes. The Title V Program will promote Text4Baby evidence-based materials to all Medicaid providers, HMOs, and facilities that serve pregnant and postpartum women. Work will be measured by the number of outreach activities that occurred to promote Text4Baby.

5. Continue to collaborate with Wisconsin Women’s Health Foundation to connect pregnant/postpartum people and other caregivers throughout the state to community resources.

Wisconsin Women’s Health Foundation, which houses the Well Badger Resource Center, will continue to conduct outreach to medical and social service providers to increase utilization of their service directory and other resources. They will also strategically identify and integrate new resources related to priority needs, such as mental health and substance use, into their Resource Center.

6. The Title V Program will continue to align efforts with the Family Foundations Home Visiting Program to increase enrollment and promote services related to smoking cessation, depression, mental health and postpartum visits. The Wisconsin Department of Health Services’ Title V Program and the Department of Children and Families’ Family Foundations Home Visiting Program will collaborate and consistently communicate to align efforts to increase the percent of primary caregivers screened for depression at appropriate intervals, increase percent of mothers who receive a timely postpartum visit, and increase percentage of tobacco-using caregivers who are referred to cessation services, especially for Black and Indigenous caregivers.

7. Collaborate with The Periscope Project to provide maternal psychiatric teleconsultation and resources. The Periscope (Perinatal Specialty Consult Psychiatric Extension) Project is a free resource for health care providers caring for pregnant and postpartum women with mental health or substance use disorders. Services include real-time teleconsultations with a perinatal psychiatrist, educational presentations, and information on community resources. Outreach efforts will expand the utilization of services to additional providers in more areas of the state. It is expected that the provision of Periscope services will continue to increase since utilization has yet to plateau. There is utilization of Periscope services in all public health regions of the state, with 69% of the utilization in the Southeastern region. A new outreach strategy will be to host 10-minute program introduction sessions to reach new health care providers.

8. Support the ongoing development of Wisconsin’s Perinatal Quality Collaborative through MCH participation and technical assistance, and support of Alliance for Innovation on Maternal Health implementation. The Title V Program will continue to work with and support the Wisconsin Association for Perinatal Care and Wisconsin Perinatal Quality Collaborative’s quality improvement efforts through participation and engagement in multiple committees and workgroups. These efforts include key strategies such as the implementation of the Alliance for Innovation on Maternal Health bundles and the implementation of recommendations identified through the Maternal Mortality Review process. Work will be measured by the number of staff within the Wisconsin Department of Health Services who participate in the Wisconsin Association for Perinatal Care and Wisconsin Perinatal Quality Collaborative’s workgroups and steering committees.

Newborn Screening Program

Title V Program staff, in partnership with the Wisconsin State Laboratory of Hygiene, will administer the Wisconsin Newborn Screening Program within the Wisconsin Department of Health Services. The Newborn Screening Program consists of blood screening, hearing screening, and heart screening. The Newborn Screening Program will continue to partner with the Birth Defects Program, the Title V Program, the State Vital Records Office and WIC. In addition, the Birth to 3 (Early Intervention) Program, local health departments, the University of Wisconsin Waisman Center, University of Wisconsin Pediatric Cardiology Department, and the Cooperative Education Service Agency #1 enable the Newborn Screening Program to expand reach to local providers and families.

The Newborn Screening Advisory Umbrella Committee and its eight subcommittees will meet biannually to advise the Wisconsin Department of Health Services on emerging issues, quality assurance, and technology in newborn screening and make recommendations to add or delete conditions to or from the panel. The Secretary’s Advisory Committee on Newborn Screening will advise the Secretary of the Wisconsin Department of Health Services on policy issues related to newborn screening. Quality assurance measures will be monitored and the Newborn Screening Program, Wisconsin State Laboratory of Hygiene, Wisconsin Sound Beginnings, Screening Hearts in Newborns Project, Vital Records, and Title V Program will continue to work collaboratively to improve data collection, tracking and integration with other birth data and data systems.

The Newborn Screening Program will maintain collaboration with contracted agencies to promote ongoing clinical services, care coordination with the medical home, prevention of loss to follow-up, links to services including early intervention, and transitions for youth with special health care needs to adult care, as well as coordination and tracking of special dietary products for patients with congenital disorders. The contracted agencies will continue to provide data and reporting to the Wisconsin Department of Health Services. The Newborn Screening Program is working with Medicaid to determine best practices for the implementation of the new policy for oral nutrition formula coverage.

Outreach and education will continue to be provided for data submitters, providers, and families about newborn screening. Newborn screening information will be provided to families during the prenatal period using the three-screen fact sheet, on blood, hearing, and heart screening. Newborn screening websites and educational webinars will provide hospitals and health care providers up-to-date information.

The Wisconsin Newborn Screening Program will maintain participation in state workgroups and the Midwest Genetic Network with Wisconsin representatives serving on workgroups and sharing presentations at meetings. Collaborations with other state newborn screening programs and participation in national conferences will continue.

The Wisconsin Early Hearing Detection and Intervention Tracking Referral and Coordination data system is undergoing modernization and enhancements. The Office of Health Informatics within the Division of Public Health has received funding to plan, design, and implement an integrated newborn screening data system, which will allow the program to better coordinate data collection and reporting while centralizing access to relevant screening data. Development of the integrated newborn screening data system continues with a planned debut in early 2022.

The Newborn Screening Program is dedicated to health equity by ensuring all babies born in Wisconsin have the opportunity to access critical newborn screening services. System enhancements are underway and will enable the program to complete more in-depth analyses of social determinants of health, allowing for better identification and addressing of disparities in access and outcomes.

The Wisconsin Sound Beginnings Program has a new focus on increasing access to newborn hearing screening, including timely initial and follow-up screening. This includes outreach and training to home visiting programs across the state, placing otoacoustic emission screeners in five tribal home visitation programs, and creating pediatric tele-audiology programs in two tribal health clinics.

Birth Defects Prevention and Surveillance Program

In support of the Birth Defects Council’s strategic plan and the prevention strategies of the Title V Program, the Birth Defects Prevention and Surveillance Program will continue collaborating with programs whose goals align with the identification, prevention, and early intervention of birth defects.

Nourishing Special Needs Network: The Birth Defects Nutrition Education and Training Program administered by the University of Wisconsin Waisman Center is supported by braided funding from the Birth Defects Prevention and Surveillance Program, WIC, and the surcharge on birth certificates. The network consists of trained mentors paired with mentees who develop a mentoring plan that addresses individual workforce development competencies to work on with their mentors.

Stillbirth Services - Children’s Health Alliance of Wisconsin Infant Death Center: The Infant Death Center, led by the Children’s Health Alliance of Wisconsin, will continue supporting the needs of families who experience a stillbirth through grief and bereavement supports. “Count the Kicks,” an evidence-based practice for the prevention of stillbirth, is being explored for statewide implementation.

The Title V Program will continue to enhance the Wisconsin Birth Defects Registry to improve functionality for reporters and data quality. To facilitate data entry to the registry, a module to the Wisconsin Electronic Disease Surveillance System, a widely used disease reporting system, became available in the spring of 2020 and will continue to be promoted in 2022 as public health activities shift away from pandemic response.

The Birth Defects Prevention and Surveillance Program will continue partnerships with the Congenital Heart Disease Program’s Screening Hearts in Newborns Project, Environmental Public Health Tracking Program, Regional Centers in Wisconsin for children and youth with special health care needs, Wisconsin Newborn Blood Screening Program, Wisconsin Sound Beginnings – Early Hearing and Detection Intervention Program, First Breath, and the Well Badger Resource Center.