National Performance Measure 06: Percent of children, ages 9 through 35 months, receiving a developmental screening using a parent-completed screening tool

Based on outcomes from the 2020 MCH Needs Assessment, NPM 06 was selected to address the Priority Need Enhance Identification, Access, and Support for Individuals with Special Health Care Needs and their Families. Too few children ages 9 months through 35 months receive a developmental screening using a standardized parent-completed tool (37% in 2019; National Survey of Child Health). The American Academy of Pediatrics Bright Futures recommends screening children for developmental problems using a standardized screening tool, and referring at-risk patients to early intervention or subspecialists. Adoption of these guidelines has been gradual with research showing many children still not being screened and referred. There have been some gains as noted from the Trends in Pediatricians’ Developmental Screening: 2002-2016 article. Results show pediatricians’ use of developmental screening tools tripled from 2002 to 2016, and they self-reported making more referrals for early intervention. To sustain progress, additional efforts are needed to improve early identification.  Wisconsin’s Title V Program remains committed to addressing the problem through established partnerships with statewide and local programs. Community support is necessary to increase the rate of developmental screening.

1. Promote HealthCheck (developmental screening and lead screening) resources to result in greater knowledge and utilization of HealthCheck services within Title V and other programs serving qualified children. The Title V Program will continue to collaborate with the Wisconsin Division of Medicaid Services and HealthCheck to promote HealthCheck and HealthCheck Other Services Medicaid benefits to providers and families. The Title V Program will collaborate with ABC for Health to complete an environmental scan and implement best practices identified from other states that utilize HealthCheck to support access and benefits management. ABC for Health will continue to convene key partners to discuss findings and make recommendations to inform joint efforts among partner groups.  Local health and tribal agencies that select the developmental screening objective in 2022 will promote and share new HealthCheck resources with scheduled community, childcare, and provider trainings. The Title V Program will continue to promote and advance conversations around the Child Health Core Set Measures that will become mandatory beginning in 2024.

2. Collaborate with the Wisconsin Lead Program to align and support activities with medical providers, childcare providers and others. The Title V Program will continue to convene quarterly meetings with the Wisconsin Lead Program to share, plan, and identify cross-promotion activities for 2022. These mutually beneficial meetings will help the Title V Program to identify and implement cross-promotional activities to programs and partners throughout the state, including education around lead testing and the need for ongoing developmental monitoring and screening. The Title V Program plans to offer training and educational opportunities from the Lead-Safe Homes Program to Title V partners working on developmental screening.

The Title V Program will continue to support the current state lead program, in which staff go to homes of selected children who have lead poisoning to collect environmental samples throughout the home. Samples are analyzed to identify whether the isotopic signature of the lead in the samples matches isotopic signatures from the child’s blood, which can help pinpoint the source of poisoning. The Title V Program will resume collaboration with the Lead Program’s Meet-N-Greets Pilot Program, which increases networking opportunities for local health and tribal agencies and child care centers across the state to revive awareness of commonalities in each program’s work. Agencies selecting developmental screening objectives in 2022 and other projects promoting developmental screening will also be encouraged to promote and share lead resources during scheduled community, childcare, provider trainings and other venues.

3. Plan and coordinate the implementation of the CDC WIC Developmental Milestone Checklist Program. The Wisconsin WIC Program received a Tufts University Telehealth Innovation Grant to deliver nutrition education and breastfeeding support to WIC participants to overcome access barriers, especially in rural settings.  The Title V Program will continue to coordinate with WIC as they develop a multifaceted mobile-optimized website through the ONE System to include the CDC WIC Developmental Milestone Checklist Program. This innovative tool will combine videoconferencing, online education including developmental milestones, lessons supporting secondary material, a message center and a link to the WIC App. The goal is that trusted WIC professionals will be able to share key information and implement the developmental screening checklist with participants enrolled in WIC.

The Title V Program will continue to offer the CDC WIC Developmental Milestone Checklist Program to local WIC projects as in-person WIC visits resume. The Title V Program will partner with the WIC Nourishing Special Needs Network to increase engagement and promote participation in the project. Interested sites will be offered CDC tools, technical assistance, and evaluation of implementation. Information from this program will be used to improve, revise, and spread delivery of the Title V/WIC Developmental Milestone Project in Wisconsin beyond 2022.

4. Collaborate with the Wisconsin Department of Public Instruction, Department of Children and Families, and the American Academy of Pediatrics to produce a Wisconsin mini-screening guide adapted from Bright Futures for children 0 to 5 years. Once completed, the mini developmental screening guide will be promoted as a standard of care for Wisconsin. The Title V Program will lead the screening guide work groups, and coordinate with other programs regarding new recommendations. Guidance and expertise will be provided to create a shortened version of the old Blueprint. The need for a shorter version stems from stakeholder requests and comments to simplify standards and messaging across child-serving agencies.

5. Coordinate and provide developmental screening to medical providers throughout Wisconsin. The Wisconsin Medical Home Initiative will offer trainings to medical providers, and promote them through targeted outreach and the Children’s Health Alliance of Wisconsin website. The trainings will integrate resources from other community programs, promoting a coordinated approach to increasing developmental screenings. Activities will encourage and enhance the use of a valid standardized developmental screening tool, such as the ASQ-3, to ensure adoption of the American Academy of Pediatrics’ Bright Futures (4th Edition) recommendations. The Title V Program will promote and integrate Medical Home tools, lead screening recommendations, HealthCheck awareness, and common messaging throughout the state. The Title V Program will utilize the lessons learned from the Birth to 3 Program Public Outreach Campaign online family survey to improve and expand provider knowledge.

7. Promote awareness and education on the importance of developmental monitoring and screening among community groups and partners.

Local and tribal health agencies will choose at least one community outreach strategy to increase awareness of importance and standards of developmental screening, as well as awareness of other resources such as WIC, the Lead Program, Medical Home, Regional Centers for CYSHCN, the Birth to 3 Program, and HealthCheck. Outreach strategies could include:

• Building relationship with local WIC projects to increase awareness of developmental screening tools and resources
• Hosting a developmental screening awareness event for families, and a community developmental screening event for children
• Using local media and social media to educate families and providers
• Promoting the Learn the Signs Act Early app
• Organizing a professional training event with Brooks Professional Development Coordinator to increase the number of staff and partners trained to teach participants the fundamentals of ASQ-3 and empower them to administer effectively.

Through partnership with the Wisconsin Medical Home Initiative, the Title V Program will continue to provide technical assistance to local and tribal health agencies, while fostering connections with other state and local resources. Communicating a common message about the importance of children having a developmental screening across community members, medical providers, and child care providers over time will help solidify a universal understanding.

9. Coordinate with the Wisconsin Medical Home Initiative to provide technical assistance (i.e., learning calls and one-to-one meetings) related to developmental screening to local and tribal health agencies. Local and tribal health agencies will receive ongoing technical assistance to identify and assess current practice around developmental screening and receive training to promote local capacity and professional development opportunities. Ongoing quality improvement strategies and evaluation will guide updates to technical assistance provided to agencies. Programming will strive to implement and align activities with the Medical Home State Plan, First Five Fox Valley, Learn the Signs Act Early Grant State Plan, CDC's Learn the Signs Act Early, Birth to 5: Watch Me Thrive resources, and any other new resources that may be developed. Local and tribal health agencies will continue to focus on ensuring adoption of American Academy of Pediatrics’ Bright Futures (4th Edition) recommendations, and ensure consistent and common messaging to families. Developmental screening Learning Community calls will be planned for 2022. The Wisconsin Medical Home Initiative will coordinate and facilitate Learning Community calls or one-to-one meetings to bring agencies together. Learning Community calls provide an opportunity to share innovative approaches to build capacity within communities across the state. Call agendas will be created to offer tips on organizing, celebrating successes, troubleshooting barriers, and promoting common and consistent messaging for communities, families, medical providers, and child care agencies.

10. Partner with Supporting Families Together, Child Care Resources & Referral Agencies and Family Resource Centers to increase staff knowledge and awareness of the importance of developmental monitoring and screening. The Title V Program will continue to align with Wisconsin's statewide system of Child Care Resource and Referrals and Family Resource Centers to support similar goals for developmental screening and maintain/improve linkages to local early intervention services. Child care agencies are overwhelmed with requests to become trained to complete developmental screenings with the children they serve, and Wisconsin Child Care Resource and Referrals lack resources to effectively support child care agencies in becoming trained to complete developmental screenings for the children they serve. The Title V Program will collaborate with the Wisconsin Medical Home Initiative to coordinate and convene a child care work group with Supporting Families Together, Child Care Resource and Referrals, and Family Resource Centers to develop a plan for how to work with and support child care agencies to improve developmental screening awareness and training opportunities. Regional outreach activities and events in Wisconsin will promote awareness, alignment, and collaboration with Supporting Families Together, Child Care Resource and Referrals, and Family Resource Centers. Collaboration will also be maintained with state agencies such as the Wisconsin Department of Children and Families to promote and encourage a coordinated approach to increasing developmental screenings within child care settings. The Title V Program will continue to advocate for child care agencies and early educational settings to select and implement developmental screening as part of the YoungStar quality rating system. Community and family education about the benefits of developmental screening and early intervention will also be promoted and provided.

11. Facilitate and promote social and emotional health and access to mental health services through administration of the Wisconsin Child Psychiatry Consultation Program and HRSA Pediatric Mental Health Access Program, collaboration with the Office of Children’s Mental Health, and partnerships with  Well Badger Children’s Mental Health Navigator and the Wisconsin Medical Home Initiative to conduct mental health screening trainings. Social‐emotional developmental screening and pediatric mental health screening trainings will be sustained, supported, and promoted through Wisconsin’s Title V Program. Trainings are promoted through multiple venues such as websites, the Child Psychiatry Consultation Program, and other medical providers. The Wisconsin Medical Home Initiative will provide trainings and ongoing technical assistance to encourage use of social and emotional developmental screening and advancing a system of care that uses the ASQ‐SE 3 to help children reach their fullest potential during their early years. Infant/Early Childhood Mental Health Consultation will also be sustained. Collaboration with the Office of Children’s Mental Health Executive Council will promote linkages to Title V work and vice versa, including Office of Children’s Mental Health groups, such as the Access Workgroup, Resilience Workgroup, Trauma‐Informed Care Workgroup, Parent & Youth Partners, and Infant Mental Health.

The Child Psychiatry Consultation Program for primary care providers will remain committed to increasing program reach across the state. The Medical College of Wisconsin will collect encounter data, promote and evaluate provider trainings, and track referrals and recommendations to community resources and services. There will also be targeted outreach to pediatric and family medicine practices to enroll new providers and to engage providers who may not be utilizing the program. The current Child Psychiatry Consultation Program infrastructure will be sustained to expand services to all of Wisconsin, including the southern hub funded by the Pediatric Mental Health Access Program grant. Due to COVID-19 delaying many 2020 and 2021 activities, some of the 2021 activities will require catch up in 2022. Coordination and collaboration with existing and new partners will advance work toward building a statewide system of care for Wisconsin children and adolescents struggling with behavioral health needs. The Child Psychiatry Consultation Program outcomes will be collected, assessed, and reported to track progress and ensure programmatic goals are attained. The Child Psychiatry Consultation Program logo branding and marketing will be implemented to ensure stakeholders know this is a state-funded program. A yearly report will be prepared, approved by the Department of Health Services and shared with statewide constituents. Federal reporting will be completed for Year 4 of the Pediatric Mental Health Access Program.

12. Strengthen collaboration with other programs and grant-funded projects to promote and improve developmental screening rates, referrals, and early intervention. The Title V Program will continue to collaborate, align, and promote local and regional activities related to promoting and conducting developmental screenings locally and regionally, such as with the First Five Fox Valley Organization. Launching Help Me Grow Fox Valley in 2021, First Five is the Wisconsin affiliate of Help Me Grow National Center and, the program plans to leverage impact on a larger more sustainable scale for the important work of cultivating a community that empowers and supports every family in building a solid foundation for young children. The establishment of the Help Me Grow project in Wisconsin is the next step in creating a community hub for linking early childhood resources and expanding developmental screening and assessment. We will continue to assess and gather data for identifying best practice, sharing innovation, identifying potential gaps and integrating cross-promotion of tools and resources. The Title V Program will continue to support the Department of Public Instruction, Wisconsin Early Childhood Collaborating Partners through braided funding, participation, and promotion of outreach and resources for children.

The Act Early State Team remains committed to reducing disparities and determining which families are not accessing the network of family supports offered through the Title V Program and its partners. Through collaboration with CDC’s Act Early Ambassador for Wisconsin, the Act Early State Plan efforts will be implemented. Meetings in 2022 will support the Act Early Ambassador and other team members in successfully implementing activities identified in the "Innovation in Care Integration for Children and Youth with Autism Spectrum Disorders and other Developmental Disabilities" grant and supporting quality improvement initiatives to increase early access to diagnosis and early intervention among medically underserved children in Wisconsin. Activities will be integrated with ongoing state efforts related to family and youth engagement, developmental screening, resource and referral database, and quality improvement work.

CYSHCN Regional Centers will continue to provide information, referral, and assistance to families, providers, and community agencies, link individual families to a medical home or other supports and services, and follow up with families regarding outcomes of referrals. Outcomes on referral and follow up will be tracked.

The Well Badger Resource Center will sustain its reach across Wisconsin by offering phone, email and online chat options, as well as a comprehensive, searchable database. The Title V Program will provide financial support and technical assistance to ongoing developmental enhancements, statewide marketing, and promotion of the Well Badger Resource Center, especially related to developmental screening resources.  Monthly participation in information and referral network calls to enhance professional supports and services will continue, as will improvement of the referral and feedback process between primary care clinicians and early intervention professionals, especially for children and families who are ineligible for or opt out of early intervention services. Promotion and use of Wisconsin’s two underutilized referral forms will continue to be revitalized. Agencies will continue to expand reach using these referral forms. Work will continue to reduce stigma of developmental delays by educating and empowering families on the value of early identification, early intervention, and treatment by utilizing and incorporating family feedback learned from the Birth to 3 Program survey completed in 2021.   

13. Partner with the Wisconsin Collaborative for Healthcare Quality to lead and facilitate the Adolescent and Child Health Collaborative to improve developmental screening and adolescent well visit rates within medical groups and clinics across Wisconsin. The Title V Program will collaborate with the Wisconsin Collaborative for Healthcare Quality to lead the adolescent and child health quality improvement initiative, expand interest and participation, and promote continued learning events for members. This steering team guides the development, dissemination, and monitoring of goals, strategies, and tools to improve adolescent and child health outcomes across Wisconsin. The Title V Program will continue working with Wisconsin Collaborative for Healthcare Quality staff to collect evidence for advancing public reporting and alignment with the forthcoming mandatory Child Health Core Set, and promote developmental screening and adolescent well visits and other child health measures with the Wisconsin Collaborative for Healthcare Quality’s board. This collaboration will identify improvement resources to consider, test, and track, as well as identify barriers to future success. There will be continued coordination and recruitment of health systems to participate in the Adolescent and Child Health Collaborative in Wisconsin. Monthly steering team planning calls and the Wisconsin Collaborative for Healthcare Quality’s Adolescent and Child Health Quality Improvement Steering Team calls will facilitate sharing and learning, and child health-specific agenda items will be recommended for discussion. Measures of improvement will include: percent of children ages 9 to 71 months receiving a developmental screening using a parent‐completed screening tool; percent of adolescents 12-21 years of age who received at least one comprehensive well-care visit with a primary care provider in the last year. The Title V Program will continue to ensure alignment with the Maternal Child Health Quality Network and other quality improvement efforts.

14. Collaborate with the Family Foundations Home Visiting Program to promote developmental screening and referral. The Wisconsin Department of Children and Families MIECHV Home Visiting Program directly interacts with marginalized women, infants, children, and families across the state. The Title V Program will maintain this partnership through regular meetings to increase awareness of similar work and opportunities for alignment when applicable. Title V Program staff will also continue to share technical assistance and trainings when agencies participate in common measures, objectives and initiatives, and seek out opportunities to strengthen collaboration particularly around developmental screening and referrals to services. The Title V Program will continue to provide support and collaboration through sharing of information and trainings with the Department of Children and Families MIECHV funded Family Foundation Home Visiting Statewide programs. Alignment will continue with the MIECHV Performance and Systems Outcome Measures: percent of children ages 9 through 35 months who received a developmental screening using a parent-completed screening tool in the past year; percent of children with a timely developmental screen; percent of home visits where primary caregivers were asked if they have any concerns regarding their child’s development, behavior, or learning; and percent of children with positive screens for developmental delays (using a validated tool) who receive services in a timely manner.

National Performance Measure 8.1: Percent of children, ages 6 through 11, who are physically active at least 60 minutes per day.

Too many children in Wisconsin are considered overweight (15.0%) or obese (13.7%) by Body Mass Index standards, which is a strong predictor of poor health outcomes throughout their lives. Based on outcomes from the 2020 MCH Needs Assessment, NPM 8.1 was selected to address the Priority Need Promote Optimal Nutrition and Physical Activity. The need to coordinate efforts around the state to better address children's physical activity and nutrition was identified as a top theme throughout multiple assessments from community members and stakeholders across the state. Rural and urban areas in Wisconsin face different challenges related to food security, safe neighborhoods, transportation, economic equity, and accessible spaces, all of which decrease opportunities for healthy living. As the Wisconsin Title V Program explores this NPM in the new cycle, we have begun to cultivate relationships with external statewide programs (healthTIDE, Department of Children and Families, Young Star, Farm to Early Childhood Education, WI afterschool network, etc.) and are utilizing this new network of organizations that work with children to develop infrastructure at the state level to align efforts occurring throughout the state. By engaging with partners, we were able to survey their interests and gather useful information regarding their needs. This will help the Title V Program develop a more comprehensive and integrated physical activity and nutrition program for children in Wisconsin. Subsequent years will build upon survey results as well as information collected through continuous feedback and conversations from partners and baseline strategies developed for implementation in 2022. Cultivating relationships with key partners throughout the state and nation will be essential for ensuring equity and effectiveness of Title V efforts related to physical activity and nutrition, social justice, and climate change. Forming strong relationships with community partners that honor historical trauma and foster trust, community input will be used to inform future strategies within the Title V Program; strategies which advance opportunity at the local level and transform policy to equitably shape the health and wellbeing of school-age children in Wisconsin.  

1. Collaborate with the Department of Health Servives’ Chronic Disease Prevention Unit on the Physical Activity and Nutrition State Engagement Model, and State Road Map. Being physically active and having nutrition security (access to sufficient and nutritious food options) are critical to the health of our communities and individuals, especially during this time when many are suffering from the impacts of COVID-19. The Wisconsin Department of Health Services (Chronic Disease Prevention Program and Title V Program) along with healthTIDE are engaging stakeholders around the creation and funding of a statewide Physical Activity and Nutrition (PAN) roadmap that is community-centered, community-driven, and equity-focused. The roadmap will serve as a guide for the integration of key data, community needs, evidence-based strategies, and infrastructure needed to implement physical activity and nutrition initiatives statewide. As we continue to engage with communities about physical activity and nutrition, we will use this to demonstrate our commitment to equity and community voice. The collaboration and roadmap is the umbrella initiative that Title V NPM 8.1 falls under. Through listening sessions with community members, community leaders, and statewide stakeholders, major themes were identified as supports needed to sustain progress. They are listed below.

Figure 1. Major themes from Wisconsin Physical Activity and Nutrition Assessment

The intention of this roadmap is to be in service and support of Wisconsin communities and their efforts to create healthier places and spaces that promote optimal health. For communities to be healthier, significant investments and equitable policy, systems, and environmental (PSE) changes will be needed. The roadmap will outline how to build and center these necessary supports that are in alignment with what communities’ needs are.  To support communities in these efforts, statewide infrastructure, systems change, and funding is also needed. The roadmap action areas below outline the broad and evolving goals for 2022 and beyond. Specific strategies will be added and completed through workgroups comprised of community members and statewide stakeholders. The strategies will change as the needs of Wisconsin communities change.

Action Area: Local-Level Policy, Systems, and Environmental Change

Aim: Collectively advance evidence-based and practice-based, culturally-appropriate strategies in various settings, including local policies and systems level changes.

Action Area: State-Level Policy, Systems, and Environmental Change

Aim: Collectively advance state policies and systems level change strategies that support healthy eating and active living.

Action Area: Infrastructure

Aim: Establish sustainable funding for:

    1) Local healthy communities investment and

    2) A centralized, statewide infrastructure including dedicated staff and capacity 

     building for physical activity and nutrition work at state and local levels.

The roadmap and associated action areas include the maternal and child health populations but also extend to all populations in Wisconsin. It will provide tangible strategies for local communities, and justification for the investment and funding needed to support community-led innovation.

2. Collaborate with community partners to implement strategies for local and tribal health agencies for 2022 which incorporate physical activity and nutrition. healthTIDE is a statewide network of organizations dedicated to advancing health equity in Wisconsin, specifically around food, nutrition, and physical activity. healthTIDE has developed strong working relationships with communities and organizations in Wisconsin. Their mission is to align and leverage these relationships to create sustainable change in policies, systems, and environmental factors to advance health equity. The Title V Program will partner with healthTIDE to gather community input, analyze data, and determine strategies needed to address the top priorities of nutrition and physical activity in school-age youth. healthTIDE assisted Title V in identifying and mapping potential partners in sectors that work either with children or are heavily invested in physical activity or nutrition efforts, such as before and after school care, mentorship programs, community wide organizations, and school farm and gardening programs. These 65 community organizations were identified as key partners and were asked to help distribute a survey gathering high level information on the current efforts and potential areas of need or interest in 2022. With over 300 responses and 125 people indicating interest in providing ongoing feedback, Title V was able to gather useful information around physical activity and nutrition programming needs to guide collaborations for 2022. healthTIDE will assist the Title V Program in building relationships with community organizations and seeking connections to content experts, local communities, and success stories to provide support for local and tribal health agencies. Title V match funds will be used by healthTIDE to conduct and compensate participants for their contributions to community conversations, to incorporate a health equity lens and include community members’ voices to shape future efforts. These conversations are facilitated by leaders and trusted members of communities affected by systemic racism, police brutality, and mass incarceration of young men including fathers.

3. Continue Title V representation in Healthy Early meetings to support statewide collaboration among stakeholders. The Healthy Early Collaborative was formed in 2017 from the former Wisconsin Early Childhood Obesity Prevention Initiative. It is a team of over 90 multi-sector partners in Wisconsin whose work advances equitable eating and physical activity opportunities for all children and their families. Priorities include engagement of families, strengthening of resources, growing their network, and exploration of out-of-school time needs. The collaborative conducted an equity evaluation in 2021, which resulted in a plan for restructure to include more diverse partners. This plan will be in process in 2022. Engagement with this network of experts will help the Title V Program to align across sectors regarding physical activity and nutrition.

4. Build and establish nutrition capacity in Title V work through the Children's Healthy Weight State Capacity Building Program, led by the Association of State and Public Health Nutritionists. The purpose of this program is to build state capacity around maternal and child-focused nutrition by increasing nutrition competency of the state Title V workforce, and optimizing maternal and child health nutrition-related data sources to contribute to data-driven programs and activities related to assessment, policy development, and assurance. The specific objective of the Children’s Healthy Weight State Capacity Building Program is to develop three state models in the Title V Program’s nutrition integration, which can then be implemented and replicated in states nationwide. The state models will increase access to high-quality, evidence-based nutrition services for maternal and child populations, including all women of childbearing age and their children, using innovative strategies to integrate nutrition statewide into Title V programs. This program will support states to strengthen, align, and coordinate current nutrition programs, services, and resources to build and expand capacity around maternal and child-centered nutrition. The Children’s Healthy Weight State Capacity Building Program will build on lessons learned from, and formative work currently underway in, the Children’s Healthy Weight CoIIN to support states in developing and/or increasing capacity to improve the nutritional status of maternal and child populations across the lifespan. The program will increase partnerships and collaboration across maternal and child health-focused agencies to support nutrition integration into Title V programs and increase awareness of the importance of coordinated statewide nutrition services. In 2022, the Title V program will continue convening the Title V Physical Activity and Nutrition Workgroup for NPM 8.1 which includes partners from Wisconsin Department of Instruction and Wisconsin Department of Children’s and Families, healthTIDE, and the Chronic Disease Prevention Unit. Of note, many of the members of this workgroup are also members of the collaboration strategy between the Wisconsin Title V and Chronic Disease and Prevention programs, outlined in NPM 8.1 Strategy 1, fostering alignment of goals, projects and strategies needed to support the broader goal of a Comprehensive Statewide Nutrition and Physical Activity coordination. The Title V physical activity and nutrition survey conducted in 2021 asked recipients about interest in participation in ongoing efforts in statewide physical activity and nutrition work. There were 125 participants who expressed interest. Title V in partnership with healthTIDE will formalize a structure that engages these participants in a collective manner. Structure models, meeting formats, and frequency will be presented to the participants for feedback and decision. The Wisconsin Title V physical activity and nutrition Workgroup will research and identify training opportunities and healthTIDE will host learning collaboratives for local and tribal health departments to enhance Title V workforce capacity around nutrition and physical activity. In partnership with the Association of State and Public Health Nutritionists, Title V will continue its collaboration with the Association of State and Public Health Nutritionists and representatives from the National Survey of Children’s Health to add questions related to nutrition. The additional questions will bring actionable data to all Title V programs focused on nutrition.