Perinatal/Infant Health – Application Year

 

National Performance Measure 04: A) Percent of infants who are ever breastfed and B) Percent of infants breastfed exclusively throughout six months. (Addresses MCH Priority: Healthy Behaviors)

 

In the coming year, 1.The MCH Program will continue to support workplaces to become breastfeeding friendly through contract objectives with local health departments (LHDs) and tribal health agencies.

 

Partnerships will continue with the Wisconsin Breastfeeding Coalition and will focus on improving worksites. REDCap data collection will continue to reflect quantitative data for worksites. Work will include assisting workplaces in completing a self-assessment of current policies, practices and the environment and aiding in making changes to improve support of breastfeeding. Agencies will continue to use the United States Breastfeeding Committee's “Supporting Nursing Mothers at Work” platform as well as the local worksite toolkit to improve breastfeeding rates.

 

2. Support child care sites to become breastfeeding friendly using the Ten Steps to Breastfeeding Child Care Centers Resource Kit.

 

Agencies will continue to use the Ten Steps to Breastfeeding Child Care Centers Resource Kit adopted from the Baby-Friendly Hospital Initiative. Partnerships will continue with the Wisconsin Breastfeeding Coalition. In 2020, we will continue to use Go NAP SACC’s online database to align with statewide adoption of the Go NAP SACC tools and resources. YoungStar technical consultants and child care providers across the state will continue to use this system to assess and track their efforts to improve nutrition and physical activity, in addition to breastfeeding support.

 

In the coming year, 3. The MCH Program will continue to support community groups to become breastfeeding friendly by promoting consistent messaging. Partnerships will continue with the Wisconsin Breastfeeding Coalition and will include community groups. REDCap data collection will continue to reflect quantitative data for community groups. Efforts will include assisting community groups in assessing knowledge base of breastfeeding friendly practices including current policies, practices and the environment. Agencies will be encouraged to form partnerships with community groups to promote consistent messaging related to breastfeeding and provide assistance in making changes to improve support.

 

 

4. Provide technical assistance to the statewide breastfeeding Learning Community for stakeholders, including funded MCH partners, the Wisconsin Breastfeeding Coalition, Chronic Disease Prevention Unit, and WIC.

 

Learning communities have been noted to help facilitate the work with the breastfeeding performance measure and will continue in 2020.  Learning Community calls will take place quarterly using Zoom as an online meeting platform. Learning Community calls will continue to offer topic presentations and discussion related to breastfeeding. LHDs and tribal agencies will participate in the learning communities, highlighting successes to facilitate the work and sharing tips to overcome barriers.

 

5. Collaboration with WIC to promote breastfeeding among CYSHCN through the Nourishing Special Needs (NSNN) Project.

 

Goals and strategies for providing breastfeeding support for special needs infants will be identified in the NSNN Project Action Plan. WIC, CYSHCN, and the Birth Defects programs will collaborate to provide webinars on breastfeeding for special needs infants that will be available to a broad group of providers. These webinars will be recorded for public access on the WIC-CYSHCN toolkit website at: https://wic.waisman.wisc.edu/training-resources/. Breastfeeding will continue as an option to focus on within the mentor/mentee relationship. NSNN mentors at WIC sites will support mentees to develop a plan to improve their skill level in providing education, support, and referral services to postpartum WIC participants who are breastfeeding special needs infants. MCH staff will provide technical assistance with trainings related to breastfeeding.

 

6. The MCH Program also collaborates with the Wisconsin Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program, known as the Family Foundations Home Visiting (FFHV) to promote breastfeeding.

 

Addressing breastfeeding in families involved with the home visitation program has been identified as an opportunity for future program integration and partnership development. For 2020, partnership will continue with providing technical assistance for breastfeeding within the home visiting programs. MIECHV funding supports a home visiting program nurse consultant that sits in the MCH unit. The nurse consultant aligns MCH priorities with MIECHV-funded programs. Home visiting will continue to expand services by addressing specific barriers to breastfeeding. Barriers noted from the recent Coffective-WI-Home Visiting-Survey include the following: having to return to work without access to space to pump, lack of breastfeeding education during prenatal time, breastfeeding messaging on social media, and contraceptive options that are appropriate while breastfeeding.

 

National Performance Measure 05: Percent of infants placed to sleep on their backs (Addresses MCH Priority: Safety and Injury Prevention)

 

Activities planned for 2020 related to safe sleep in Wisconsin will continue to involve 1. supporting local health departments and tribal health agencies to coordinate and provide learning sessions to implement safe sleep practices with community groups using common messaging. Guidelines from the AAP will be emphasized as the common messages. Learning sessions to promote safe sleep practices will continue with community groups to expand the reach to non-traditional organizations incorporating smoking and breastfeeding education in the trainings. There will also be a focus on increasing the engagement of family, community, and consumers with goals of addressing health equity, the social determinants of health, and moving community stakeholders into leadership roles.

 

In 2020, 2. local health departments and tribal health agencies will continue to have the option to coordinate and provide trainings to implement safe sleep practices with child care providers, using common messaging. Agencies will continue to collaborate with CHAW and utilize resources to expand the reach beyond licensed and certified childcare providers. They will be encouraged to promote breastfeeding and smoking cessation with safe sleep practices. Local health departments are encouraged to continue collaborating with regional Child Care Resource and Referral (CCR&R) agencies to promote and encourage a coordinated effort to implement safe sleep practices within child care settings using common messaging. There will also be a focus on increasing the engagement of family and consumers into the safe sleep strategies.

 

3. Local health departments and tribal health agencies will continue to have the option to promote the use of safe sleep policies and procedures developed for hospitals and health systems. In 2020, trainings will focus on supporting the adoption and implementation of safe sleep policies/procedures by pediatric/birthing hospitals, pediatric clinics, and health systems by utilizing the safe sleep webinars, and resources toolkit developed by Children’s Hospital of Wisconsin, Milwaukee.

 

In 2020, 4. CHAW will continue to provide technical assistance for a statewide safe sleep Learning Community for stakeholders, including funded MCH partners. The Learning Community will be offered quarterly and will build capacity through interagency collaboration, sharing of innovative approaches to promoting and implementing evidence-based, safe sleep practices.

 

MCH will continue to contract with 5. CHAW to provide trainings and ongoing technical assistance and support to partners and MCH-funded agencies working on safe sleep to promote and implement Sleep Baby Safe curriculum to home visitors, child care providers, community partners and hospitals and health systems. DHS and CHAW staff will build on the initiative implemented in 2019 with the Department of Children and Families (DCF). The Home Visiting Programs (Healthy Families America, Nurse Family Partnership, Early HeadStart – Home-Based Model, and Parents as Teachers) will continue to use the Infant Safe Sleep change package to promote policies for safe sleep practices; impart caregivers with knowledge skills and self-efficacy to practice safe sleep for every sleep; develop a competent and skilled workforce to support safe sleep; and create strong community linkages to support safe sleep.

 

Through the MCH contract, 6. CHAW will ensure all Wisconsin counties participating in a CDR team follow the Keeping Kids Alive in Wisconsin model, and that prevention recommendations are implemented. CHAW will continue to promote and support the use of a standardized data system for all local CDR/FIMR teams. Local CDR/FIMR teams will be assisted to analyze local data and use the data to move prevention recommendations to environmental and policy change. CHAW will continue surveillance of all sleep-related deaths in Wisconsin to update and report data.

 

State Performance Measure 02: Percent of women receiving perinatal depression screening. (Addresses MCH Priority: Mental Health Factors and Healthy Relationships)

 

To support perinatal depression screening, the MCH Program will continue to partner with the Medical College of Wisconsin and UW-Milwaukee on 1. The Periscope Project for perinatal psychiatric consultation services. The project will continue to receive partial funding from MCH and work toward a sustainable design that provides essential, timely access to primary providers who are working with women during pregnancy, postpartum, and between pregnancies. Medical College of Wisconsin plans to explore additional funding opportunities, a strategy for expansion, and linkages with the Child Psychiatric Consultation Program to promote efficiencies.

 

The MCH Program will continue to maintain 2. surveillance of maternal deaths through mortality and morbidity reviews to understand the scope of perinatal depression and inform strategy development. During 2019, the MMRT implemented changes including: restructuring the review by group cause of death, updating the policy and procedure, and receiving electronic vital records files. During 2020, the MMRT will continue to refine the process for case abstraction and review. The MMRT will continue to work on the Opioid Research Coordination Unit (ORCU) grant as well as look for other funding opportunities that may be available to increase capacity of the team. The team will continue to assess the members at the table and to increase necessary disciplines and diversity to enhance the review process. Also, the team will collaborate with partners to support changes in the care of women based on the recommendations report. Collaboration with WisPQC and WAPC will continue to identify ways to monitor maternal morbidity using shared data sources.

 

3. The online training modules to assist PNCC, home visiting, women’s health, public health and other providers in understanding and implementing screening will continue to be promoted and evaluated.    A key activity will be to review the maternal mental health modules that were developed in 2015 and 2016 to determine if updates are needed. Individual modules will be updated if new information is available and new evidence-based practices are identified. To accomplish this activity, the MCH Program will reconvene the state experts who developed, and delivered the series.  This includes Dr. Roseanne Clark, Associate Professor in the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health; Dr. Jennifer Doering, Associate Professor in the College of Nursing at the University of Wisconsin-Milwaukee; and Jennifer Perfetti, a Senior Counselor at the University of Wisconsin Department of Psychiatry and Founder of Luna Perinatal Counseling. Dr. Katherine Wisner, Professor of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology at Northwestern University will also be consulted as she contributed her expertise to the modules addressing psychotropic medications and breastfeeding. A second activity will be to plan and implement an evaluation of the maternal mental health modules. An MCH epidemiologist will design an evaluation plan to determine knowledge and practice changes for public health providers, PNCC providers and home visitors who view the modules.

 

A new strategy will be to 4.implement quality improvement initiatives to improve perinatal depression screening, referral and follow-up services.  In 2020, local health departments and tribal health agencies will have the option of using their MCH funding allocation to implement at least 2 practice changes to improve services related to perinatal depression. Agencies selecting this objective will choose to improve existing screening, referral and follow-up services or implement new services within a program area that engages pregnant and postpartum women but does not currently provide screening (i.e. WIC, immunization clinics, well-child services).  A Learning Community will be established for information sharing. Practice changes related to the following areas will be supported:

1. Screening

• Policy and procedures for screening that identify valid tools and periodicity schedule
• Guidance for initiating the screening process that focuses on building relationships and ongoing conversations
• Guidance for sharing screening results with families
• Reminder system for rescreens

 

2. Referral and Follow-up

• Policy and procedures for referral and linkage to services for women who screen positive
• Policy and procedures to assess and respond to suicide risk
• Tracking system for referrals

 

3. Support
   • Materials and discussion points related to identifying personal supports, scheduling breaks, getting sleep, and other support strategies

 

4. Workforce

• Staff education utilizing the Perinatal Mental Health Training Modules
• Staff enrollment in The Periscope Project to receive free consultation with a perinatal psychiatrist, information on community resources, and education

 

 

Newborn Screening Program

 

MCH Program staff, in partnership with the Wisconsin State Laboratory of Hygiene, will administer the Wisconsin Newborn Screening (NBS) Program within the Family Health Section at DHS. The NBS Program will continue to partner with Wisconsin Sound Beginnings (EHDI), Birth Defects, Vital Records, UW Pediatric Cardiology Department, and the CYSHCN Program.

 

The NBS Advisory Group Umbrella Committee and its eight subcommittees will meet biannually to advise DHS on emerging issues, quality assurance, and technology in NBS and make recommendations to add or delete conditions to or from the NBS panel. The Secretary’s Advisory Committee on Newborn Screening (SACNBS) will advise the Secretary of the Department of Health Services (DHS) on policy issues related to newborn screening, including making recommendations for additions to and deletions from the mandatory panel of newborn screening conditions. Quality assurance measures will be monitored and the NBS Program, WSLH, Wisconsin Sound Beginnings, Vital Records, and MCH/CYSHCN Programs will continue to work collaboratively to link newborn screening data with other birth data.

 

The NBS Program Coordinator will maintain collaboration with the contracted agencies to promote ongoing clinical services, care coordination with the medical home, links to services, and transitions to adult care as well as work with the contracted agencies for the coordination and tracking of special dietary products for patients with congenital disorders. The contracted agencies will continue to provide data and reporting to DHS.

 

The NBS Program will provide outreach and education for providers and families and work with the NBS Education Subcommittee to educate the public and medical providers about NBS (blood, hearing, and CCHD). NBS information will be provided during the prenatal period using the three-screen fact sheet, providing information on blood, hearing, and heart screening. NBS websites will provide hospitals and health care providers up-to-date information. Educational webinars for hospitals and health care providers will continue with new provider education modules under development.

 

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

 

The Office of Health Informatics within the Division of Public Health has received funding to plan, design, and implement a system to consolidate the storage and analysis of blood, heart, and hearing screening data collected as part of the NBS Program. An integrated NBS data system will allow the program to better coordinate data collection and reporting while centralizing access to relevant screening data.

 

Birth Defects

 

The MCH/CYSHCN Programs will continue to support the program management, coordination, budget, registry administration, data analysis, Council over-site, and supervision and medical consultation for the Wisconsin Birth Defect Prevention and Surveillance Program (WBDPSP).

 

The WBDPSP plan will maintain the Birth Defects Nutrition Education and Training Program located at the UW Waisman Center, supported by braided funding from WIC and the surcharge on birth certificates. This partnership with WIC and the CYSHCN Program continues to support the Nourishing Special Needs Network (NSNN) consisting of over 40 Wisconsin Dieticians as mentors/mentees, including over 50 other professionals who have listened to the training webinars. The program consists of mentees selecting any of the following workforce development learning competencies to work on with their mentors:

 

• Competency 1: Increase knowledge and skills to facilitate appropriate referrals for infants, children, and youth with special health care needs by gaining a functional knowledge of CYSHCN and the local, regional, and state organizations providing services to CYSHCN. This objective includes appropriate breastfeeding support, information, and tools from WIC or other providers
• Competency 2: Increase knowledge and skill to determine if a participant with special needs is receiving the appropriate formula and medical foods from WIC or other providers
• Competency 3: Increase leadership and mentoring skills

 

The Infant Death Center, housed at CHAW, will continue work on supporting the needs of families who experience a stillbirth through grief and bereavement supports. CHAW will partner with Parent to Parent to better support parents who have experienced a stillbirth.

 

PRAMS data will be used 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. Folic Acid remains an area of interest for the program.

 

Through the Screening Hearts in Newborns (SHINE) program in partnership with the University of Wisconsin, Department of Pediatrics, pulse oximetry screening will continue to serve as a safety net for all babies born in Wisconsin through provider education, improving access to screening and diagnostic technology, and overseeing a statewide CCHD screening and data collection system (https://wisconsinshine.org/).

 

The Birth Defects Council will continue to generate a list of reportable conditions, annually review the list, provide a unanimous vote of agreement, and provide that list to the Secretary of the Department of Health Services. New policy allows the Council to make changes to the list at any time in response to an emerging condition of concern to public health. This follows much of the work completed by the Registry's collaboration with the Zika initiative. The Council will be completing a facilitated strategic plan to move the program forward for the next several years. The Wisconsin Birth Defects Registry is migrating to a new data platform to better capture birth defects according to statute. The Birth Defects Program will better align with a number of new initiatives (i.e. BCHP Infant Mortality Strategic Workgroup and DHS Healthy Wisconsin's 2020 five priority areas for improving health - alcohol, nutrition and physical activity, opioids, suicide, tobacco).