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 reproductive health. 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, consult on strategies and community engagement efforts, and assist with competitive funding process development for Title V funds.

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 State Performance Measures related to African American infant mortality prevention, social connection, 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 childcare 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

Figure 1: All local and tribal health agencies must fill out the MCH Supplement to GAC and select which initiatives they want to pursue in the upcoming year, in order to receive funds from the Title V Program.

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 form and select what objectives they will address in the upcoming calendar year (Figure 1). In 2021, all local and tribal health agencies in the state received Title V funds to implement at least one of six objectives aligning with selected performance measures and strategies. Local agencies collaborated with community partners to:

1. Provide infrastructural and leadership support to improve the health of mothers, children, and families during the COVID-19 pandemic.

2. Implement and evaluate strategies to improve breastfeeding initiation and duration rates in workplaces, childcare sites, and community.

3. Implement and evaluate strategies targeting community groups, medical providers, and childcare providers to improve local rates of developmental screening.

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. Implement one practice change to enhance family, youth and community engagement and one additional practice change to advance health equity for the maternal and child health population.

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

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 and 2021 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 developmental screening and medical home GAC Objectives. Mental Health America of Wisconsin supports agencies implementing suicide prevention activities. The MATCH (Mobilizing Action toward Community Health) Group supports local efforts to advance health equity. Agencies implementing the breastfeeding GAC Objective are supported by Title V Program staff and colleagues in the Chronic Disease Unit and WIC Section of the Wisconsin Department of Health Services. The perinatal depression GAC Objective is primarily supported by Title V Program staff.

Partnerships 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 the Wisconsin Division of Medicaid Services to enhance the quality of the Prenatal Care Coordination home visiting benefit and to pilot reimbursement of doula services. The Title V Program also funds a partnership with the Wisconsin Department of Public Instruction to conduct the Youth Risk Behavior Surveillance Survey and disseminate its results to inform local public health strategies. Additionally, the Title V Program employs a home visiting nurse consultant who is also part of the Family Foundations Home Visiting core team in the Department of Children and Families. This nurse consultant fosters alignment between Title V Priority Needs and home visiting implementation and provides insight to the Title V team regarding needs of families being served by home visitors.

Partnerships with external agencies

Wisconsin’s Title V Program leverages the unique strengths of public health partners in Wisconsin and nationally to effect system 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 partnered with the Children’s Health Alliance of Wisconsin and the Wisconsin Women’s Health Foundation in 2021 –both of which have regular contact with Wisconsin families – to disseminate consistent, evidence-based public health messaging. Mental Health America is another Title V partner, providing training and technical assistance on suicide prevention to local and tribal health agencies and schools.  The Title V Program relies on external 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. Title V is currently supporting a collaboration with Wisconsin Medicaid and community-based doula providers to pilot a Medicaid reimbursement model for doula services within the Prenatal Care Coordination benefit. 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

The Title V Program currently funds five regional centers to provide information, referral, and follow-up services for families and providers of children with special health care needs, including with outreach, education, and training. In addition to these regional centers, the Well Badger Resource Center provides a phone line and website for parents and providers. 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 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 to support individuals with genetic conditions. These groups form the Children and Youth with Special Health Care Needs Network and work together to advance systems of care for children with special health care needs – including NPM 11 and NPM 12 – by implementing strategies at the individual, family, community, health practice, system, and state levels. The implementation structure for the Children and Youth with Special Health Care Needs Network is driven by the Spectrum of Prevention.

Implementing equity in programming

In addition to targeted interventions and improving 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 of family, youth and community members into planning and decision-making across all programs and grantees. 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).

In 2021, most of the members of the Children and Youth with Special Health Care Needs Network completed this assessment and implemented at least one practice or policy change to foster family, youth, and community engagement in their programs. Local and Tribal Health Departments who opted to work on the Health Equity objective also utilized this tool in 2021. This tool will be introduced 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.