State Title V Program Purpose and Design

The Wisconsin Title V Program strives to assure that all families have access to a coordinated, integrated and sustainable system of services and supports. The Title V Program works with local and tribal health agencies, community-based organizations, and other partners to provide and/or assure quality health services are delivered to mothers, children, and families. Approximately 60% of Title V funds to Wisconsin are subcontracted to local, regional and statewide partners to support system-building efforts focused on maternal and child health priorities and performance measures.

Advancement of Title V priorities and performance measures is further enhanced through collaboration with other federal grants. The Title V Program works closely with Title X-funded agencies to advance well-woman visits. Adolescent health is further supported with the Personal Responsibility Education Program, Sexual Risk Avoidance Education and Rape Prevention Education. A home visiting nurse consultant position serves as a liaison between the Title V and Maternal Infant and Early Childhood Home Visiting grants. Alignment between Home Visiting benchmarks and Title V performance measures support individual and systems building activities. Title V is also intentionally aligning with a newly created unit focused on maternal and infant mortality prevention. Staff from this unit serve on Title V performance measure workgroups, and consult on strategies and community engagement efforts.

Wisconsin’s Title V Program design is framed by Life Course Theory, focusing on systems building strategies and collaboration with community partners, because the broader community environment strongly affects the capacity to be healthy. Differential exposures to risk and protective factors among population groups lead to health disparities. With this frame, the Title V Program identified SPMs related to African American infant mortality prevention, social connections, high-quality perinatal care, and representative participation.

Wisconsin’s Title V Program takes a multi-faceted approach to effecting change, and addressing national and state performance measures through:

• Leveraging local and tribal health infrastructure to reach community institutions like schools, clinics, and child care centers

• Working with statewide professional organizations and quality improvement collaboratives to foster best practice and quality improvement in health care settings

• Supporting community-based organizations who are innovating and meeting urgent community needs

• Providing incentives and technical assistance to partners and grantees to advance equity

• Supporting data infrastructure, such as the Pregnancy Risk Assessment Monitoring System and National Survey of Child Health, to monitor population health and track progress

• Connecting community members directly to Title V and partner agency programs through the Well Badger Resource Center

Partnerships with local and tribal agencies

To receive Title V funding, all local and tribal health agencies in Wisconsin are required to complete a Supplement to Grants and Contracts, and select what objectives they will address in the upcoming calendar year (Figure 1). In 2020, all local and tribal health agencies in the state received Title V funds to implement at least 1 of 5 objectives aligning with select performance measures and strategies. Local agencies collaborated with community partners to:

1. Improve breastfeeding initiation and duration rates with strategies directed to workplaces, childcare sites and/or community groups.

2. Support safe infant sleep practices with strategies focused on community groups, childcare providers and hospital/health systems.

3. Improve rates of developmental screening with strategies directed to community groups, medical providers and childcare providers.

4. Decrease rates of adolescent suicides through suicide awareness activities and strategies with community groups, health care providers/health care systems, and local school districts.

5. Complete the Foundational Practices for Health Equity assessment of organizational capacity (or Community Engagement Assessment Tool) and implement practice changes to advance health equity.

6. Implement practice changes to improve perinatal depression screening and follow-up services.

In 2022, an additional objective will be available for local and tribal health departments to select related to promoting child nutrition and physical activity. Traditionally, quarterly virtual Learning Communities are facilitated for each objective to bring participating sites together for collaborative learning, however, this approach was put on hold for many sites in 2020 as they became inundated with COVID-19 response activities. Nonetheless, state Title V staff and contracted partners continued to provide technical assistance through one-on-one consultations and webinars. The Title V Program funds partner agencies to provide technical assistance for local efforts. Children’s Health Alliance of Wisconsin supports safe sleep, developmental screening, and medical home objectives. Mental Health America of Wisconsin supports agencies implementing suicide prevention activities, and the MATCH (Mobilizing Action toward Community Health) Group supports local efforts to advance health equity. Agencies implementing the breastfeeding objective are supported by Title V Program staff and colleagues in Chronic Disease and WIC. The perinatal depression objective was primarily supported by Title V Program staff.

Partnership with State Agencies

The Wisconsin Title V program has close working relationships with several state agencies, which facilitates systems and policy change. For example, Title V staff have partnered with Wisconsin Medicaid to enhance the quality of the Prenatal Care Coordination home visiting benefit and to pilot reimbursement of doula services. Title V also funds a partnership with the WI Department of Public Instruction to conduct the Youth Risk Behavior Survey and disseminate the results to inform local public health strategies. A very unique partnership includes the home visiting nurse consultant position that sits with the Title V program, but is part of the Family Foundations Home Visiting core team in the Department of Children and Families. This nurse consultant fosters alignment between Title V priorities and home visiting implementation, and provides insight to the Title V team into the needs of families being served by home visiting.

Partnerships with External Agencies

Wisconsin’s Title V Program leverages the unique strengths of public health partners in Wisconsin and nationally to effect systems change. A new Title V collaboration with Coffective, Wisconsin Perinatal Quality Collaborative, and the Wisconsin Collaborative for Healthcare Quality is working to reach medical providers and promote evidence-based practices for outcomes such as breastfeeding, preventing maternal mortality, and increasing preventive visits for adolescents and women of reproductive age. The Title V Program also partners with the Children’s Health Alliance of Wisconsin and the Wisconsin Women’s Health Foundation – which both have regular contact with Wisconsin families – to disseminate consistent and evidence-based public health messaging. Mental Health America is another Title V Program partner, providing training and technical assistance on suicide prevention to local health departments and schools. Rather than trying to maintain state staff that has all of the relevant expertise and relationships with stakeholders, the Title V Program relies on these key partners to reach target audiences and deliver high-quality and evidence-based information and programming.

Innovation and Promising Practices

Several innovative and evidence-informed programs are also supported to advance Title V performance measures. The Periscope Project is a free resource for health care providers caring for pregnant and postpartum women struggling with mental health or substance abuse disorders. First Breath is a program of the Wisconsin Women’s Health Foundation that helps perinatal women and family members quit smoking. Providers and Teens Communicating for Health (PATCH) is a youth-driven program that works to ensure adolescent well visits are high-quality and youth-friendly. Wisconsin is looking to fund additional innovative and promising practices in the coming years while supporting robust evaluation to measure the effectiveness of these practices.

Support systems for Children and Youth with Special Health Care Needs

Title V funds five regional centers for children and youth with special health care needs to provide information, referral, and follow-up services for families and providers along with outreach, education, and training. The Well Badger Resource Center provides a phone line and website for parents and providers. In 2010, the Title V Program’s children and youth with special health care needs team established “hubs of expertise.” Family Voices of Wisconsin supports family leadership, advocacy, public policy, family education, and training. Parent-to-Parent of Wisconsin provides individual parent matching support. The Wisconsin Medical Home Initiative promotes medical home implementation for providers and families. ABC for Health, Inc. provides health benefits assistance in partnership with the regional centers, and supports health benefits advocacy for children and youth with special health care needs. The Youth Health Transition Initiative provides outreach, education, web-based training, a Learning Community, and grants to support youth health transition quality improvement at the practice/health system level. The Genetics Systems Integration Hub integrates genetics with public health systems in order to support individuals with genetic conditions. These groups form the Children and Youth with Special Health Care Needs Network that works together to advance systems of care for children and youth with special health care needs, as well as NPM 11 and NPM 12 by implementing strategies at the individual, family, community, health practice, system, and state level.

The implementation structure (Figure 2) is driven by the Spectrum of Prevention. The following diagrams depict the framework with the levels of prevention and an example for medical home.

Figure 2: Children and Youth with Special Health Care Needs - Implementation Structure

Implementing equity in programming

In addition to targeted interventions and improving the conditions that shape health, sharing power and leadership with communities is key to achieving equity. The Wisconsin Title V program supports the integration of representative participation by family, youth and community members into planning and decision-making across all of its programs and grantees. For example, the Title V Program currently strives to have family, youth and community representatives make up 25% of the maternal and child health Advisory Committee, working toward 50% representation. The Community Engagement Assessment Tool was created and piloted by the Wisconsin Title V program and is currently being utilized to guide practice changes to enhance family, youth and community engagement (Table 1).

So far, all of the members of the CYSCHN Network of providers have completed this assessment and implemented at least one practice or policy change to foster family, youth, and community engagement in their programs. This tool will be pushed out to all grantees in phases, and the Title V program will provide technical assistance for creating and implementing an action plan to advance the agencies’ level of engagement with the communities they serve.

Table 1: The Overall Categories of Engagement section of the Community Engagement Assessment Tool asks partners to select which category best describes the majority of the work their program is doing related to family, youth and community engagement.

Quality Improvement efforts

Quality improvement has been embedded into the purpose and design of Wisconsin’s Title V Program. In addition to quality improvement strategies that enhance engagement, multiple projects are being implemented and supported by the Title V Program. Wisconsin’s Perinatal Quality Collaborative is led by the Wisconsin Association for Perinatal Care. Initiatives address human milk feeding, maternal hypertension, and care for women and infants affected by opioids. The Wisconsin Collaborative for Healthcare Quality convenes an adolescent and child health steering team, a group of Wisconsin health care systems focused on increasing the number of adolescents receiving annual well visits and the number of young children receiving developmental screening. The Title V Program provides quality improvement grants to clinical practice sites and tribal health agencies to enhance shared care planning for children and youth with special health care needs. In addition, Wisconsin participates in Collaborative Improvement and Innovation Network initiatives with national partners related to infant mortality prevention and social determinants of health; children’s heathy weight; children with medical complexity; and adolescent and young adult behavioral health.