National Performance Measure 04: Percent of infants ever breastfed; percent of infants breastfed exclusively for 6 months

 

Work with local and tribal health agencies to increase lactation support in the workplace and early childhood settings. 

 

Agencies will continue to use Title V and Wisconsin Breastfeeding Coalition-supported resources and recommended strategies for outreaching to workplaces and offering support to employers. Agencies are encouraged to target workplaces in their communities who may need additional technical assistance in implementing policies and practices that better support lactating employees, particularly those that may offer lower wages, less robust benefit packages, or schedules and environments less conducive to ideal lactation accommodations. Some agencies may choose to publicly recognize workplaces as Breastfeeding Friendly if they meet specified criteria.

 

Agencies will use the Ten Steps to Breastfeeding Friendly Child Care Centers Resource Kit and associated training resources to work with childcare providers in their communities on improving policies and practices related to breastfeeding support. Local agencies are encouraged to provide outreach to childcare providers who serve families with limited incomes. Training resources have been updated to include current best practices, inclusive language, and more focus on equity. Childcare providers can choose to become recognized as Breastfeeding Friendly by training their staff and implementing changes in their programs to improve support for breastfeeding families. Local agencies provide technical assistance and resources to help programs meet the Ten Steps. State partnerships will continue with the Wisconsin Breastfeeding Coalition, the Department of Children and Families, Healthy Early, and the Wisconsin Technical College System. The Title V Program and local health agencies 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.

 

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.

 

Collaboration with a statewide partner will continue to offer technical assistance to local agencies interested in improving communication and coordination among stakeholders in their community. The statewide partner will provide tools and support to help agencies develop sustainable partnerships to better coordinate messaging, services, referral systems, and community resources, particularly for families experiencing inequities.

 

Support hospital use of quality improvement strategies that align with the Ten Steps to Successful Breastfeeding and/or Baby Friendly Hospital Initiative guidelines.

 

Collaboration will continue with statewide partners to support Human Milk Feeding quality improvement initiatives. Support will be offered to participating hospitals, health systems, and public health stakeholders related to strategy development and implementation, data collection, community engagement, and equity. Results from the 2022 CDC mPINC survey will be incorporated into this initiative, when available.

 

Identify and implement strategies for community engagement and local stakeholder activities. Implement funding opportunities to support community agencies to advance breastfeeding efforts within specific populations experiencing inequities in breastfeeding (initiation, duration).

 

Collaboration with a statewide partner will continue to develop opportunities to bring together local breastfeeding supporters within the Indigenous and African American populations to increase breastfeeding initiation, duration, and ongoing support for families. This work will be guided by the work taking place in 2022 focused on infrastructure development and community engagement within the state breastfeeding coalition. Community leadership and funding strategies will be developed for implementation and sustainability.

 

Provide training opportunities and technical assistance to the Family Foundations Home Visiting Program for Home Visitors, to increase breastfeeding support for Maternal, Infant, Early Childhood Home Visiting Grant-funded Family Foundations Home Visiting Programs.

 

The Home Visiting program will continue to provide trainings and information sharing about breastfeeding with more intentional support on communities of color. Coffective, WIC and Wisconsin Title V staff will partner to provide education with Family Foundation Home Visiting local implementing agencies about resources available with emphasis on supporting underserved. There will be emphasis on health equity through uplifting family voice and bringing in community partners from Black and Indigenous communities to share strategies in support of appropriate cultural response for lactating families.  We will also continue to encourage local implementing agencies to utilize the Michigan Breastfeeding network for continuing education. Title V, WIC and Family Foundations Home Visiting have continued in collaboration to contribute funding this as a resource for our programs. We will also encourage lactation training for staff. WIC will be promoting USDA breastfeeding training for their partners including Family Foundation Home Visiting.

 

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

 

Strengthen Prenatal Care Coordination as a resource and support during pregnancy through training, resource tools and quality improvement.

 

The Division of Medicaid Services plans to redesign the Prenatal Care Coordination benefit to improve birth outcomes. Title V representatives will be included in the process. Members will also provide input on their experience and barriers to accessing services. Policy changes that can occur within the current authority will be considered and opportunities to expand authority will be explored.

 

Support policy and practice changes to integrate doula services into Medicaid coverage.

 

The goal of the Prenatal Care Coordination Doula Pilot Project is both to demonstrate the value of adding doula services to the existing Prenatal Care Coordination benefit, but also to explore structural changes to Prenatal Care Coordination. These changes will help Prenatal Care Coordination better serve its target population and help providers serve that population more effectively. The Pilot Project, in addition to demonstrating the integration of Prenatal Care Coordination and doula services, will provide the opportunity to implement changes and evaluate their impact in anticipation of broader changes to the Prenatal Care Coordination benefit. The ultimate long-term goal is to create a sustainable model which can be replicated in other Prenatal Care Coordination and doula programs throughout the state of Wisconsin.

 

Support Fetal and Infant Mortality Review (FIMR) and Maternal Mortality Review (MMR) efforts throughout the state and facilitate the implementation of recommendations that emerge from the review teams.

 

A competitive funding opportunity is being released for work beginning in 2023 to form community action teams to implement recommendations that come out of local FIMR teams and the statewide MMR team. These community action teams will focus on local strategies to prevent future deaths.

 

In addition, the Wisconsin Maternal Mortality Review team is forming a statewide impact team to identify and advance policy initiatives that could prevent future pregnancy-associated deaths, based on the insights from the Maternal Mortality Reviews.

 

Title V staff will provide evaluation support for these action and impact teams to document implement and measure impact on severe morbidity and mortality for pregnant and recently pregnant people and for infants.

 

Support grassroots, community-based organizations serving African Americans of reproductive age.

 

An open-ended competitive funding opportunity is being released for work beginning in 2023. Community-based organizations are being asked to identify and implement promising practices, informed by their lived experience, to meet the needs of Black and Indigenous families. Focus areas for this funding opportunity include:

 

• Fostering positive mental health

 

• Developing and support a diverse perinatal care workforce

 

• Social Determinants of Health (such as food security, affordable housing, employment, social connections, etc.)

 

• Building responsive and equitable health care systems

 

• Connecting families to existing resources

 

The Title V and Maternal and Infant Mortality programs will also work with a contracted agency to provide technical assistance to grantees to help them grow their organizational capacity for sustainable funding. Training and support will be offered in the areas of grant writing, fiscal management, nonprofit management, and other topics as identified by grantees.

 

Implement health and racial equity trainings for internal staff and grantees.

Action-oriented health and racial equity trainings will be offered to funded partners to assist them with how to operationalize equity principles in their Title V-funded work.

 

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

* Quality is defined by those who report receiving these services according to the Wisconsin Pregnancy Risk Assessment Monitoring System (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 2019-2020 Pregnancy Risk Assessment Monitoring System data, 55% of non-Hispanic white women, 51% non-Hispanic Black Women, and 51% of women of other race received a high-quality postpartum visit. Root cause analyses identified barriers to early, high-quality prenatal care, high-quality labor and delivery care, high-quality postpartum care, and reintegration to primary care postpartum. Main themes related to these barriers include fear, mistrust, access, personal perception (of the woman), insurance/payment, and the interpretation/perception of the provider. SPM 2 was selected to address the Priority Need to Improve Perinatal Outcomes.

 

According to Guidelines for Perinatal Care 8th edition: A regionalized system of perinatal care with integrated delivery of services should address the care received by the woman before and during pregnancy, the management of labor and delivery, postpartum care, and neonatal care. A health care system that is responsive to the needs of families and especially women require strategies to:

 

• Ensure access to services

 

• Identify risks early

 

• Provide linkage to the appropriate level of care

 

• Ensure adherence, continuity, and comprehensiveness of care

 

• Promote efficient use of resources

 

Evidence-based intervention models are being reviewed to determine strategies to be implemented and adapted to support population/system levels of care. Ongoing and new program activities for 2023 are described below.

 

Support efforts to implement a revised level of perinatal care assessment in Wisconsin.

 

Title V Program will address the need for all hospitals in Wisconsin to have a level of care risk assessment for both the maternal and infant population.

 

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 continue to support/collaborate with partners including the Wisconsin Association for Perinatal Care, Wisconsin’s Perinatal Quality Collaborative, American College of Obstetricians and Gynecologists, and others to promote and implement national 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

 

• Ensure adherence, continuity, comprehensiveness of care at time of delivery through postpartum

 

Success of this work will be measured by the number of workgroup meetings attended by Title V Program staff and core partners to support collaboration and implement the risk assessment tool.

 

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 Collaborative Improvement and Innovation Network (CoIIN) that was 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 for future pregnancies

 

• Physical activity

 

• Breast health and breastfeeding

 

• Emotional and mental health

 

• Ongoing medical care

 

The Title V Program plans to recruit Wisconsin Medicaid HMO (health maintenance organization) partners in 2022 to expand this pilot in 2023. Success of this work will be measured by the number of Medicaid HMOs and clinics who participate in this quality improvement project.

 

Support Prenatal Care Coordination providers to strengthen postpartum Prenatal Care Coordination services to include depression screening, tobacco use, and reproductive life planning (contraception or birth spacing discussion).

 

The Medicaid Prenatal Care Coordination benefit is only available up to 60 days following delivery. It is important to maximize this time to ensure comprehensive education, support, and linkage to appropriate community resources. The Title V Program plans to support workforce development, specifically promoting the following resources:

 

• Optional Prenatal Care Coordination postpartum assessment tool

 

• Educational module on postpartum care developed by community partners

 

• Educational module on family planning developed by community partners

 

• Family Planning resources approved by the Wisconsin Title X Ad Hoc Advisory Committee

 

• Educational modules on perinatal mood and anxiety disorders developed by the Wisconsin Child Welfare Professional Development System

 

• First Breath smoking cessation program of the Wisconsin Women’s Health Foundation

 

Disrupt inequities in healthcare access and quality in historically underserved populations.

 

The Title V Program plans to identify a community partner for this new strategy based on an open-ended call for proposals.

 

Provide training and technical assistance to home visitors within the Family Foundations Home Visiting Program and collaborate with the program to connect non-Hispanic Black and Indigenous women to primary care providers.

 

Title V staff will continue to provide training and technical assistance to home visiting programs around to the state to improve client education on the importance of primary care and how to access it.

 

Collaborate with state and local partners to support screening, referral, and treatment for perinatal mental health disorders.

 

A project option for local and tribal health agencies will continue to be supporting the implementation of two practice changes to improve screening and follow-up services for perinatal mood and anxiety disorders.

 

Agencies can choose to improve existing services or implement new services within a program area that engages birthing people. Practice changes should relate to screening, referral and follow-up, support, or workforce development. To support these local efforts, a technical assistance provider will be identified through a competitive funding process to provide individual consultation, facilitate regular Learning Community sessions, and develop a toolkit to support policy development and practice changes.

 

Analyze and review the new PRAMS (Pregnancy Risk Assessment Monitoring System) questions on experiences of labor and delivery care in relation to social connection.

 

The 2020 Wisconsin Pregnancy Risk Assessment Monitoring System included a supplement on labor and delivery care, including a question about being able to have a support person of choice present during labor. Wisconsin PRAMS is collaborating with a doctoral candidate to analyze racial differences in labor and delivery care experiences, and the association between these experiences and postpartum outcomes, including postpartum visit receipt, postpartum depression symptoms, and breastfeeding initiation and maintenance. Results will be used to inform future strategies.

 

Newborn Screening

 

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 by the beginning of 2023.

 

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 increased efforts to assure access to newborn hearing screening, including 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

 

Title V continues to support staff who are responsible for administering the Wisconsin Birth Defects Registry and birth defects prevention efforts, and braided funding from the Wisconsin Birth Defects program and Title V are used to support a variety of surveillance and prevention initiatives.

 

Stillbirth Services - Children’s Health Alliance of Wisconsin Infant Death Center: The Infant Death Center, located at Children’s Health Alliance of Wisconsin, will continue work on supporting the needs of families who experience a stillbirth through grief and bereavement supports.

 

The Wisconsin Birth Defects Registry: The Title V Program will continue to enhance the Wisconsin Birth Defects Registry to improve functionality for reporters and data quality. The Wisconsin Birth Defects Registry, as a module to the Wisconsin Electronic Disease Surveillance System, became available in the spring of 2020.

 

Wisconsin Women’s Health Foundation, Well Badger Resource Center: With braided funding from the Wisconsin Birth Defects Prevention and Surveillance Program and Title V, the Well Badger Resource Center will provide educational messaging regarding folic acid, along with other topics related to birth defect prevention. In addition, the program will continue to support the folic acid module in the Behavioral Risk Factor Survey and will use Pregnancy Risk Assessment and Monitoring System data to foster partnerships to improve provider and public awareness of the importance of folic acid, and to drive policy change to increase the use of folic acid for all women of reproductive age.

 

The Birth Defects Prevention and Surveillance Program will continue partnerships with the Congenital Heart Disease Program’s Screening Hearts in Newborns (SHINE) Project, Environmental Public Health Tracking Program, Children and Youth with Special Health Care Needs Program’s five Regional Centers in Wisconsin, Wisconsin Newborn Blood Screening Program, Wisconsin Sound Beginnings – Early Hearing and Detection Program, First Breath, and the Well Badger Resource Center.