C.1. Needs Assessment Update

 

1. A brief description of Wisconsin’s ongoing needs assessment activities and the extent to which families, individuals, and other stakeholders were engaged in the process: The Wisconsin Title V Program hosted two maternal and child health interns during the summer of 2020. These interns conducted key informant interviews with sites that piloted the Community Engagement Assessment Tool in 2019 to identify the tool’s strengths and opportunities for improvement. These interviews informed revisions to the Community Engagement Assessment Tool, with the goal that it could be implemented across a larger number of sites in 2021.

 

Maternal and child health advisory committee meetings continued through 2020, though one of the three annual meetings was cancelled due to COVID-19 response needs. The necessity for virtual meetings at this time has resulted in the Title V Program considering whether the committee could be restructured, to make input and participation more equitable and meaningful to community members as well as the Title V Program. Some potential changes currently under consideration including increasing the proportion of community, family, and youth members to 50% and changing the timing of the meetings to accommodate community members’ schedules.

 

2. Noted changes in the health status and needs of Wisconsin’s maternal and child health population, as compared to identified priority needs for the block grant: The 2020 MCH Needs Assessment was completed prior to the development of both the COVID-19 pandemic and the resurfacing of racism as a topic of public health urgency, and as a result, may not accurately reflect current health concerns of Wisconsin residents. Despite this, the Title V Program’s review and categorization of over 500 unique needs assessment themes did identify and intentionally address equity, racial justice, as well as access to quality health services – themes that permeate these emerging health concerns in Wisconsin. The State Systems Development Initiatives Program plans to implement ongoing needs assessment activities in the coming year to capture shifts in public health concerns in Wisconsin’s current landscape, to reconcile any major changes to the 2020 MCH Needs Assessment findings.

 

Some areas that we are specifically monitoring include child injury, mental health and isolation, breastfeeding initiation, developmental screening and early intervention, and physical activity.

 

3. Noted changes in Wisconsin’s Title V Program Capacity or its maternal and child health systems of care, particularly for children and youth with special health care needs, and the impact of these changes on maternal and child health services delivery: Although COVID-19 resulted in the cancellation of in-person trainings and community events for children and youth with special health care needs, converting trainings and events to a virtual format has increased reach to families and professionals with fewer trainings. However, the redirection of local and tribal health agency efforts to respond to the COVID-19 pandemic resulted in lower local capacity for the crucial engagement, coordination, and referral functions that they play for Wisconsin’s families. Nonetheless, we are hopeful that with the increase of vaccination and decrease in new COVID-19 cases, local staff will be able to return to maternal and child health-focused work.

 

4. The breadth of Wisconsin’s Title V partnerships and collaborations with other federal, tribal, state, and local entities that serve the maternal and child health population: The Wisconsin Title V Program spent time in late 2020 intentionally reviewing current, past, and potential partnerships or collaborations with maternal and child health-focused organizations throughout the state. The team agreed that becoming more involved, or “showing up” to many of these organizations moving forward, is vital to the progress of Title V work in the state, as well as the program’s commitment to advancing equity and racial justice.  

 

The Title V Program has very strong relationships with all of the local and tribal health agencies in Wisconsin, and fund them to implement strategies at the local level to advance our performance measures. The Title V Program is also proud of recent partnerships with Wisconsin Medicaid to implement innovative policy initiatives that expand access to doula services and improve prenatal home visiting services. Wisconsin’s Title V Program is actively working to strengthen their partnership with the state WIC program and local WIC projects, in addition to community-based organizations such as the African American Breastfeeding Network and Roots 4 Change community health worker collective.

 

Wisconsin Title V Program partnerships include national, statewide, local, and tribal affiliations:

 

National 

• Coffective
• Association of State Public Health Nutritionists
• National Institute for Children's Health Quality
• National Action Partnership to Promote Safe Sleep Improvement Innovation Network
• United States Breastfeeding Committee
• Collaborative Improvement and Innovation Network to Advance Care for Children with Medical Complexity
• AMCHP Family Engagement Community of Practice
• AMCHP Leadership Lab mentor for Family Leaders
• Advancing Systems of Services for CYSHCN Café
• Region V MCH Leaders
• MCH National Workforce Development Center
• Go NAPSACC
• Council of State and Territorial Epidemiologists
• National Network of Child Psychiatric Consultation Programs
• American Public Health Association MCH Section Leadership
• National Resource Center for Patient/Family-Centered Medical Home

 

Statewide

• Home Visiting, Department of Children and Families
• Wisconsin Child Welfare Professional Development System
• Children's Hospital of Wisconsin
• Department of Health Services Children's Long-Term Support Waiver Program
• Wisconsin Alliance for Women's Health
• Prenatal Care Coordination Taskforce
• Fetal Infant Mortality Review Team
• Family Voices of Wisconsin
• Wisconsin Association for Perinatal Care
• WIC Program
• Office of Children’s Mental Health
• Regional Centers for CYSHCN
• Children's Health Alliance of Wisconsin
• Wisconsin Early Childhood Collaborating Partners
• The Periscope Project
• Wisconsin Breastfeeding Coalition
• Birth to 3 Program
• Wisconsin Department of Justice Office of Crime Victim Services
• Wisconsin Association of Lactation Consultants
• ABC for Health Inc.
• Facebook group for black families of CYSHCN
• Healthy Early
• Wisconsin Initiative for Stigma Reduction
• Wisconsin Doulas of Color Collective
• Medicaid Services
• Mental Health America
• Children's Committee of the Governor's Council on Mental Health
• Wisconsin Perinatal Quality Collaborative
• Medical College of Wisconsin
• Wisconsin Coalition Against Sexual Assault
• HealthWatch Wisconsin
• Wisconsin Child Abuse and Neglect Prevention Board
• Wisconsin Parent Leadership Collaborative
• Aligning for Adolescent Health
• WI Care Integration initiative
• Wisconsin Integrated Transition Planning Coalition
• Act Early Wisconsin
• Wisconsin Community on Transition
• Bureau of Children Services Program Access Project
• Children’s Long-Term Support Council
• PATCH Program
• healthTIDE
• YoungStar, Department of Children and Families
• University of Wisconsin-Madison Division of Extension
• Wisconsin Technical College System
• Supporting Families Together
• Lived Experiences Group Input Team
• Division of Medicaid Services Customer First Strategy workgroup

 

Local

• Parent support groups based on child's condition or disability
• Milwaukee Health Department Office of Violence Prevention
• Harambee Village Doulas
• Public Health Madison Dane County
• Wisconsin Child Welfare Professional Development System
• African American Breastfeeding Network
• Foundation for Black Women's Wellness

 

Tribal

• Native Breastfeeding Coalition
• Tribal Health Centers and Community Health Centers

 

5. Efforts undertaken by Wisconsin to operationalize its 5-year needs assessment process and findings: The State Systems Development Initiatives Program has developed a plan for ongoing needs assessment activities throughout the 5-year cycle. A core team of Title V Program epidemiologists will work with the State Systems Development Initiatives Coordinator to implement and analyze ongoing needs assessment findings during interim years. The State Systems Development Initiatives Coordinator is immersed in all action planning activities for the Title V Program, ensuring that needs assessment findings and subsequent priority needs are incorporated throughout all planning and coordination of programmatic activities and objectives. This work will continue throughout the entire five-year block grant cycle.

 

6. Changes in organizational structure and leadership: The Wisconsin Title V Program hired a new Title V Director and Maternal and Child Health Unit Supervisor, Fiona Weeks, in January 2021. Additionally, CYSHCN Medical Director, Sharon Fleischfresser, retired in January 2021. Anne Odusanya, the CYSHCN Unit Supervisor was named CYSHCN Director. A new Family Health Section Manager, Ashley Bergeron, began her role in July 2020. In September 2020, The Family Health Section hired a unit supervisor, Kenmikiiya Terry, to oversee the newly-developed Maternal and Infant Mortality Prevention Unit. Kenmikiiya has taken an active role in leading activities related to SPM 01, and other staff hired within this new unit also support Title V programmatic work in varying capacities. Additional new positions within the Maternal and Infant Mortality Prevention Unit that have recently been filled include a Health Equity Coordinator, two Community Partnership Specialists (one focused on the Black community, and one focused on the Indigenous community in Wisconsin), and a Health Communications Specialist.

 

Excitingly, the Bureau of Community Health Promotion hired a new Chief Medical Officer, Dr. Jasmine Zapata, who will be a key leader and champion for Title V work. Dr. Zapata is a dual-board certified physician in pediatrics and preventive medicine, has a Master of Public Health, and is widely recognized as a community leader and advocate. We are incredibly fortunate to have her leadership and expertise in the service of Wisconsin’s Title V program.

 

C.2. Five-Year Needs Assessment Summary

(Next submission 2025)

 

Wisconsin’s ongoing needs assessment activities and the extent to which families, individuals, and other stakeholders were engaged in the process

 

The Wisconsin Title V Program hired two Community Partnership Specialists in 2021; one specialist dedicated to partnering with Black communities, and one specialist dedicated to partnering with Indigenous communities. These specialists have been working to build trust and rapport among community members for the past year, and the Title V Program will work with them in 2022 to implement various community conversations.

 

Maternal and child health advisory committee meetings were discontinued in 2021. When asked, committee members identified that participation was important to them because they wanted to receive programmatic updates from Title V regularly. Since this need can be fulfilled in other ways and is not advisory in nature, the Title V Program is working to identify other opportunities to incorporate public input into action plan development and block grant submission.

 

Noted changes in the health status and needs of Wisconsin’s maternal and child health population, as compared to identified priority needs for the block grant

 

The 2020 MCH Needs Assessment was completed prior to the development of both the COVID-19 pandemic and the resurfacing of racism as a topic of public health urgency, and as a result, may not accurately reflect current health concerns of Wisconsin residents. Despite this, the Title V Program’s review and categorization of over 500 unique needs assessment themes did identify and intentionally address equity, racial justice, as well as access to quality health services – themes that permeate these emerging health concerns in Wisconsin. The State Systems Development Initiatives Program plans to implement ongoing needs assessment activities in the coming year to capture shifts in public health concerns in Wisconsin’s current landscape, to reconcile any major changes to the 2020 MCH Needs Assessment findings.

 

Some areas being monitored by the Title V Program currently include social connection, mental health and isolation, breastfeeding initiation, developmental screening and early intervention, and physical activity.

 

Noted changes in Wisconsin’s Title V Program Capacity or its maternal and child health systems of care, particularly for children and youth with special health care needs, and the impact of these changes on maternal and child health services delivery

 

Trainings and events continued to be offered in a virtual format throughout 2021. This approach has increased reach to families and professionals with fewer trainings. However, the redirection of local and tribal health agency efforts to respond to the COVID-19 pandemic resulted in lower local capacity for the crucial engagement, coordination, and referral functions that they play for Wisconsin’s families. The Title V Program is beginning to see in early 2022 that with the increase of vaccinations and decrease in new COVID-19 cases, local staff can start returning to maternal and child health-focused work. As of April 2022, many local and tribal health agencies have expressed interest and enthusiasm in being able to return to pre-pandemic projects.

 

The breadth of Wisconsin’s Title V partnerships and collaborations with other federal, tribal, state, and local entities that serve the maternal and child health population

 

The Wisconsin Title V Program spent time in late 2020 intentionally reviewing current, past, and potential partnerships or collaborations with maternal and child health-focused organizations throughout the state. The team agreed that becoming more involved, or “showing up” to many of these organizations moving forward, is vital to the progress of Title V work in the state, as well as the program’s commitment to advancing equity and racial justice.

 

The Title V Program has strong relationships with all local and tribal health agencies in Wisconsin, and funds them to implement projects at the local level to advance Title V performance measures. The Title V Program is also proud of recent partnerships with Wisconsin Medicaid to implement innovative policy initiatives that expand access to doula services and improve prenatal home visiting services. Wisconsin’s Title V Program is actively working to strengthen partnerships with the state WIC program and local WIC projects in addition to community-based organizations such as the African American Breastfeeding Network and Roots 4 Change community health worker collective.

 

Wisconsin Title V Program partnerships include national, statewide, local, and tribal affiliations:

 

National Partnerships

• Coffective
• Association of State Public Health Nutritionists
• National Institute for Children's Health Quality
• National Action Partnership to Promote Safe Sleep Improvement Innovation Network
• United States Breastfeeding Committee
• Collaborative Improvement and Innovation Network to Advance Care for Children with Medical Complexity
• AMCHP Family Engagement Community of Practice
• AMCHP Leadership Lab mentor for Family Leaders
• Advancing Systems of Services for Children and Youth with Special Health Care Needs Café
• Region V Maternal and Child Health Leaders
• Maternal and Child Health National Workforce Development Center
• Go NAPSACC (Nutrition and Physical Activity Self-Assessment for Child Care)
• Council of State and Territorial Epidemiologists
• National Network of Child Psychiatric Consultation Programs
• American Public Health Association MCH Section Leadership
• National Resource Center for Patient/Family-Centered Medical Home

 

Statewide Partnerships

• Home Visiting, Department of Children and Families
• Wisconsin Child Welfare Professional Development System
• Children's Hospital of Wisconsin
• Department of Health Services Children's Long-Term Support Waiver Program
• Wisconsin Alliance for Women's Health
• Prenatal Care Coordination Taskforce
• Fetal Infant Mortality Review Team
• Family Voices of Wisconsin
• Wisconsin Association for Perinatal Care
• WIC Program
• Office of Children’s Mental Health
• Regional Centers for Children and Youth with Special Health Care Needs
• Children's Health Alliance of Wisconsin
• Wisconsin Early Childhood Collaborating Partners
• The Periscope Project
• Wisconsin Breastfeeding Coalition
• Birth to 3 Program
• Wisconsin Department of Justice Office of Crime Victim Services
• Wisconsin Association of Lactation Consultants
• ABC for Health Inc.
• Facebook group for black families of Children and Youth with Special Health Care Needs
• Healthy Early
• Wisconsin Initiative for Stigma Reduction
• Wisconsin Doulas of Color Collective
• Medicaid Services
• Mental Health America
• Children's Committee of the Governor's Council on Mental Health
• Wisconsin Perinatal Quality Collaborative
• Medical College of Wisconsin
• Wisconsin Coalition Against Sexual Assault
• HealthWatch Wisconsin
• Wisconsin Child Abuse and Neglect Prevention Board
• Wisconsin Parent Leadership Collaborative
• Aligning for Adolescent Health
• Wisconsin Care Integration initiative
• Wisconsin Integrated Transition Planning Coalition
• Act Early Wisconsin
• Wisconsin Community on Transition
• Bureau of Children Services Program Access Project
• Children’s Long-Term Support Council
• Providers and Teens Communicating for Health (PATCH) Program
• healthTIDE
• YoungStar, Department of Children and Families
• University of Wisconsin-Madison Division of Extension
• Wisconsin Technical College System
• Supporting Families Together
• Lived Experiences Group Input Team
• Division of Medicaid Services Customer First Strategy workgroup

 

Local Partnerships

• Parent support groups based on child's condition or disability
• Milwaukee Health Department Office of Violence Prevention
• Harambee Village Doulas
• Public Health Madison Dane County
• Wisconsin Child Welfare Professional Development System
• African American Breastfeeding Network
• Foundation for Black Women's Wellness

 

Tribal Partnerships

• Native Breastfeeding Coalition
• Tribal Health Centers and Community Health Centers
• Great Lakes Inter-Tribal Epidemiology Center

 

Efforts undertaken by Wisconsin to operationalize its 5-year needs assessment process and findings

 

The State Systems Development Initiatives Program has developed a plan for ongoing needs assessment activities throughout the 5-year cycle. A core team of Title V Program epidemiologists will work with the State Systems Development Initiatives Coordinator to implement and analyze ongoing needs assessment findings during interim years. The State Systems Development Initiatives Coordinator is immersed in all action planning activities for the Title V Program, ensuring that needs assessment findings and subsequent priority needs are incorporated throughout all planning and coordination of programmatic activities and objectives. This work will continue throughout the entire five-year block grant cycle.

 

Changes in organizational structure and leadership

 

The Title V Program hired a new Title V Director and Maternal and Child Health Unit Supervisor, Fiona Weeks, in January 2021. Fiona has a Bachelor’s degree in Sociology and Community Health from Tufts University and a Master of Science in Public Health from the Johns Hopkins University, with a focus on perinatal health and a graduate certificate in Maternal and Child Health. She was a recipient of the MCH Training grant and completed a post-graduate Population Health Service Fellowship through the University of Wisconsin. She is also a doctoral candidate in Population Health at the University of Wisconsin. Before moving into this role, she served as the Title V Maternal and Child Health Epidemiologist and Project Director for Wisconsin PRAMS from 2017-2021.

 

The Wisconsin Department of Health Services’ Bureau of Community Health Promotion hired a new Chief Medical Officer, Dr. Jasmine Zapata, in May 2021. Dr. Zapata is a dual-board certified physician in pediatrics and preventive medicine, has a Master of Public Health, and is widely recognized as a community leader and advocate. She has worked as a physician, public health researcher, assistant professor at the University of Wisconsin, and is also an author and advocates for youth empowerment through a variety of initiatives. Dr. Zapata works closely with Title V Leadership.

 

The Wisconsin Department of Health Services hired a new State Health Officer and Division of Public Health Administrator, Paula Tran, in September 2021. Paula has been a strong public health leader in Wisconsin for more than 10 years and works closely with Title V Program Leadership. She has led and developed community-engaged research projects, statewide health equity efforts and cross-sector alliances, and provided training and technical assistance to affect the social, economic, and environmental determinants of health to advance health equity. Paula has her Master of Public Health degree and Bachelor of Science in Biology from the University of Wisconsin-Madison.

 

Emerging Issues

 

The long-term impacts of the COVID-19 pandemic on both maternal and child health populations and the public health workforce are still emerging. While telehealth has made health services and some social supports, like WIC, more accessible to some families, others are still limited by broadband access; moreover, some services, like blood lead screening, cannot be effectively delivered virtually. The Wisconsin Title V program is exploring how to better leverage the new normal of offering virtual services where possible to maximize our reach, while monitoring equity in access to virtual services.

 

Additionally, the Title V workforce has moved to a hybrid work model, which has also impacted how we work within our teams and how we reach partners and communities. The option to conduct virtual site visits has increased efficiency and decreased the time and travel burden on staff. However, a lack of in-person interaction among and between teams has created openings for misunderstanding and missed opportunities. The Title V program is exploring processes for better onboarding of new staff and opportunities for team building to foster the success of and collaboration among staff in order to optimize program impact.

 

Five-Year Needs Assessment Summary

(Next submission 2025)

 

Wisconsin’s ongoing needs assessment activities and the extent to which families, individuals, and other stakeholders were engaged in the process

During 2022, The Wisconsin Title V team’s two community partnership specialists – staff members in the Maternal and Infant Mortality Prevention Unit – continued partnering with and building trust and rapport among Black and Indigenous community members. A series of community conversations were implemented with Indigenous community members with a focus on facilitators of and barriers to traditional birthing practices. Some themes that were identified from the conversations include:

• Access to midwifery services and doulas

 

• Diversification of the maternal and child health workforce

 

• Early initiation to breast or chest feeding

 

• Continued lactation support

 

• Specialized care

 

• Resources for birthing people with substance use disorder that avoids criminalization and child removal  

The Maternal and Infant Mortality Prevention Unit hosted the first Maternal and Infant Mortality Prevention Gathering. The event engaged over 250 attendees that included state agencies, local and tribal health departments, nonprofits, professional associations, healthcare organizations, faith-based groups, the private sector, and representatives from elected officials. Breakout rooms were utilized to allow for engaged conversation with attendees which led to diverse perspectives being shared and feedback that focused on action.

In 2022, the State Systems Development Initiative project director implemented ongoing needs assessment activities to capture shifts in public health concerns in Wisconsin’s current landscape, to reconcile any major changes to the 2020 MCH Needs Assessment findings.

Noted changes in the health status and needs of Wisconsin’s maternal and child health population, as compared to identified priority needs for the block grant

The 2020 MCH Needs Assessment was completed prior to the development of both the COVID-19 pandemic and the resurfacing of racism as a topic of public health urgency, and as a result, may not accurately reflect current health concerns of Wisconsin residents. Despite this, the Title V program’s review and categorization of over 500 unique needs assessment themes did identify and intentionally address equity, racial justice, as well as access to quality health services – themes that permeate currently emerging health concerns in Wisconsin.

In 2022, the Wisconsin Title V program sought the input of both community members and agencies serving maternal and child health populations in Wisconsin to inform ongoing needs assessment activities. Many of the themes identified in the initial 2020 MCH Needs Assessment were reflected in the ongoing needs assessment activities, though some were further emphasized likely as a result of the COVID-19 pandemic. The themes that were identified included:

• Social connection and mental health support in communities

 

• Social determinants of health, including affordable housing, public transportation, well-paying jobs, and pedestrian infrastructure

 

• Parental and caregiver supports, including childcare, peer support groups, and educational classes and programming

 

• Accessibility and availability of quality healthcare, with an emphasis on children and youth with special healthcare needs, diverse and representative providers, and a need for a variety of supports for birthing persons

 

• Accessibility and availability of healthy food and physical activity

 

• Substance misuse and the accessibility and availability of supports and services, including harm reduction methods

The Title V program also continues to monitor other themes identified in the 2020 MCH Needs Assessment including social connection, mental health and isolation, breastfeeding initiation, high quality perinatal care, developmental screening and early intervention, and physical activity and nutrition.

Noted changes in Wisconsin’s Title V program capacity or its maternal and child health systems of care, particularly for children and youth with special health care needs, and the impact of these changes on maternal and child health services delivery

With the decrease in new COVID-19 cases, local staff have been able to return to maternal and child health-focused work. As a result, the Wisconsin Title V program did not offer COVID-19 as a project topic option for local and tribal health agencies to use their annual Title V funding on, although the long-term impacts of the COVID-19 pandemic are still informing local approaches to maternal and child health work.  

The Children and Youth with Special Health Care Needs Unit implemented a variety of virtual trainings in 2022 in collaboration with partners to support the transition to adult health care and establishment of a medical home. Although virtual trainings can increase reach and access across the state, the team has experienced the challenge of having high registration numbers but low attendance. With the COVID-19 pandemic causing a dramatic increase in the virtual meeting format, and resultant fatigue, individuals may feel less accountable to attend events that they have registered for. The Title V program is taking this into consideration for planned trainings in 2023.

The Children and Youth with Special Health Care Needs Unit hired a unit supervisor and a program director in the fall of 2022. These two roles will help support staff internally and promote collaboration across the Title V program on strategic direction to improve services for children and youth with special health care needs.

The breadth of Wisconsin’s Title V partnerships and collaborations with other federal, tribal, state, and local entities that serve the maternal and child health population

In 2022, the Wisconsin Title V program spent time intentionally revising their funding process with specific goals to center equity and increase investment in local, community-based organizations and projects. The revised process was informed and supported by feedback from the mid-year Needs Assessment, staff members (including community partner specialists, health equity strategists, and staff with lived experience), and the National Maternal and Child Health Workforce Development Center. As a result of the changes to the funding process, Wisconsin’s Title V program went from funding three community-based organizations throughout the state in 2022 to 12 community-based organizations in 2023. The Wisconsin Title V program is looking forward to continuing to refine the funding process in years to come in order to continue to support the program’s commitment to advancing equity and racial justice.

The Title V program has strong relationships with all local and tribal health agencies in Wisconsin, and funds them to implement projects at the local level to advance Title V performance measures. Wisconsin’s Title V program is actively working to strengthen partnerships with the state WIC program and local WIC projects in addition to community-based organizations such as the African American Breastfeeding Network and Roots 4 Change community health worker cooperative.

Wisconsin Title V Program partnerships include national, statewide, local, and tribal affiliations:

National Partnerships

• Advancing Systems of Services for Children and Youth with Special Health Care Needs Café
• AMCHP Family Leadership, Education, and Development Committee
• AMCHP Leadership Lab 
• American Public Health Association MCH Section Leadership
• Association of State Public Health Nutritionists
• Catalyst Center
• Coffective 
• Collaborative Improvement and Innovation Network to Advance Care for Children with Medical Complexity
• Council of State and Territorial Epidemiologists
• Go NAPSACC (Nutrition and Physical Activity Self-Assessment for Child Care)
• Got Transition
• Healthy Birth Day
• Michigan Breastfeeding Network
• Midwest Genetic Network
• National Academy for State Health Policy
• National Institute for Children's Health Quality
• National Maternal Child Health Workforce Development Center
• National Network of Child Psychiatric Consultation Programs
• National Network of State Adolescent Health Coordinators
• National Resource Center for Patient/Family-Centered Medical Home
• Region V Maternal and Child Health Leaders
• Smith Research and Consulting 
• Star Legacy
• State Adolescent Health Resource Center
• U.S. Department of Labor – Wage and Hour Division
• United States Breastfeeding Committee
• University of Minnesota Extension, Department of Family, Health, and Wellbeing
• University of Minnesota School of Public Health

Statewide Partnerships

• ABC for Health 
• Act Early Wisconsin 
• American College of Obstetricians and Gynecologists
• American Diabetes Association, Wisconsin Chapter
• American Family Children Hospital 
• Birth to 3 Program 
• Black Mamas Matter Alliance 
• Bureau of Children Services  
• Children Come First Advisory Committee 
• Children’s Long-Term Support Council 
• Children’s Wisconsin 
• Children's Committee of the Governor's Council on Mental Health 
• Children's Health Alliance of Wisconsin 
• Children's Long-Term Support Waiver Program, Department of Health Services
• Chronic Disease Prevention Unit, Department of Health Services
• Cooperative Educational Service Agency 1 
• Family Voices of Wisconsin 
• Federally Qualified Health Centers 
• Fetal Infant Mortality Review Team 
• Froedtert Hospital 
• Genetics Systems Integration Hub
• Gunderson Lutheran Medical Center
• healthTIDE 
• HealthWatch Wisconsin 
• Healthy Early 
• Help Me Grow 
• Home Visiting, Department of Children and Families 
• March of Dimes 
• Marshfield Clinic
• Medicaid Services 
• Medical College of Wisconsin 
• Mental Health America 
• Moms Mental Health Initiative 
• Mothers Milk Bank of the Western Great Lakes 
• Neola 
• No Wrong Door Supporting Kids Together Project, Bureau of Children Services Program
• Office of Children’s Mental Health 
• Prenatal Care Coordination Task Force 
• Providers and Teens Communicating for Health Program 
• Regional Centers for Children and Youth with Special Health Care Needs  
• St. Vincent Hospital 
• Student Services, Prevention and Wellness Team, Department of Public Instruction 
• Supporting Families Together Association 
• The Periscope Project 
• University of Wisconsin Hospitals and Clinics 
• University of Wisconsin School of Medicine and Public Health 
• University of Wisconsin-Madison Division of Extension  
• University of Wisconsin-Madison Environmental Design Lab, Rooted
• University of Wisconsin-Madison School of Human Ecology 
• Waisman Center 
• Well Badger 
• Wisconsin Academy of Nutrition and Dietetics
• Wisconsin Adolescent Health Initiatives 
• Wisconsin Alliance for Women's Health 
• Wisconsin Association for Perinatal Care 
• Wisconsin Breastfeeding Coalition 
• Wisconsin Boys and Girls Club
• Wisconsin Chapter American Academy of Pediatrics  
• Wisconsin Child Welfare Professional Development System 
• Wisconsin Coalition Against Sexual Assault (WCASA) 
• Wisconsin Collaborative for Healthcare Quality 
• Wisconsin Community on Transition 
• Wisconsin Doulas Association 
• Wisconsin Doulas of Color Collective 
• Wisconsin Early Childhood Collaborating Partners 
• Wisconsin Guild of Midwives 
• Wisconsin Immunization Program, Department of Health Services
• Wisconsin Integrated Transition Planning Project 
• Wisconsin Lead Program, Department of Health Services
• Wisconsin Leadership Education in Neurodevelopmental and Related Disabilities (LEND) Program 
• Wisconsin Parent Leadership Collaborative 
• Wisconsin Perinatal Quality Collaborative 
• Wisconsin State Laboratory of Hygiene 
• Wisconsin Technical College System 
• Wisconsin YMCA Alliance
• Wisconsin Women’s Health Foundation 
• Women, Infants, and Children (WIC) Program 
• YoungStar, Department of Children and Families

Local Partnerships

• African American Breastfeeding Network
• Allied Wellness Center
• Amery Regional Center Foundation
• Ashland Birth Center
• Aurora Sinai Medical Center
• Chippewa County Health Department
• Cia Siab
• City of Milwaukee Health Department
• City of Racine Healthy Babies Program
• County Communities on Transition
• Dignity with Departure
• Doulaing the Doula
• Eau Claire City-County Health Department
• Family Resource Center of St. Croix Valley
• Fathers Making Progress
• Gerald L. Ignace Health Center, Milwaukee
• Healing Our Hearts
• Latino Children and Family Council of Dane County
• Latino Health Council of Milwaukee
• Marathon County Health Department
• Public Health Madison Dane County
• Rock County Public Health
• Roots4Change Cooperative
• Unidos, Dane County
• United Way St. Croix Valley
• Us 2 Behavioral Health Care
• Winnebago County Health Department

Tribal Partnerships

• Indigenous Birth Services
• Great Lakes Inter-Tribal Epidemiology Center
• Native Breastfeeding Coalition of Wisconsin
• Tribal Health Centers and Community Health Centers
• Waking Women Healing Institute
• Wise Women Gathering Place

Efforts undertaken by Wisconsin to operationalize its 5-year needs assessment process and findings

The State Systems Development Initiatives project director developed a plan for ongoing needs assessment activities throughout the 5-year cycle. A core team of Title V program epidemiologists and the Title V Evaluator and Epidemiologist will work to implement and analyze ongoing needs assessment findings during interim years. The Title V Evaluator and Epidemiologist is immersed in all action planning activities for the Title V program, ensuring that needs assessment findings and subsequent priority needs are incorporated throughout all planning and coordination of programmatic activities and objectives. This work will continue throughout the entire five-year block grant cycle.

Changes in organizational structure and leadership

The Wisconsin Title V program created a new hybrid role, Title V Epidemiologist and Evaluator and hired Mary Kusch in July 2022. Mary has a bachelor’s degree in Psychology and a Master of Public Health in Epidemiology from the University of Wisconsin – Milwaukee. She completed a postgraduate Population Health Service Fellowship through the University of Wisconsin. Before moving into this role, she worked with a variety of community-based organizations on evaluation and data-centered activities. The Title V Epidemiologist and Evaluator is a key collaborator on the implementation, monitoring, and evaluation of work conducted by local and tribal health agencies and other contracted organizations and will help develop and implement new data collection and measures as well as evaluate the effectiveness of the strategies. She will work closely with the State Systems Development Initiative Coordinator to lead the Needs Assessment, including planning and implementing activities, engaging stakeholders, and synthesizing data to drive decision-making.

The Wisconsin Department of Health Services’ Bureau of Community Health Promotion, Family Health Section hired a new Children and Youth with Special Health Care Needs Unit Supervisor, Dr. Julie Thiel, in September 2022. Dr. Thiel is a pharmacist with 25 years of healthcare experience with a strong interest in mental health. Dr. Thiel obtained her Bachelor of Science in Pharmacy from the University of Wisconsin-Madison and her Doctor of Pharmacy degree from the University of Florida-Gainesville, receiving the Outstanding Professional Leadership Award for her class. She transferred within the Department of Health Services to the Division of Public Health from the Division of Care and Treatment Services where she served as the Pharmacy Director and Lab Supervisor for Winnebago Mental Health Institute and Wisconsin Resource Center.  She volunteered as an Advanced Pharmacy Practice Experience preceptor through University of Wisconsin- Madison School of Pharmacy and Concordia University School of Pharmacy and volunteer faculty through the Medical College of Wisconsin assisting with the establishment of the Northeastern Wisconsin Psychiatry Residency Program. Julie was the recipient of the University of Wisconsin-Madison School of Pharmacy’s Clinical Instructor Excellence Award in 2016 and Pharmacy Society of Wisconsin’s Pharmacist of the Year Award in 2022. In her new role at the Division of Public Health, she is part of the Title V leadership team. Unit responsibilities include overseeing three program areas: children and youth with special health care needs, newborn screening, and birth defects prevention and surveillance.

The Wisconsin Department of Health Services’ Bureau of Community Health Promotion, Family Health Section hired a new Children and Youth with Special Health Care Needs Program Director in October of 2022. Michelle Lund is a Licensed Professional Counselor with over ten years of experience working as a treatment provider for youth and young adults with behavioral health needs and in private practice as a psychotherapist and manager of multiple clinics. Michelle transferred from the Bureau of Prevention, Treatment and Recovery where she served as the bureau’s lead substance use services treatment coordinator for the state and oversaw various multimillion dollar federal grant programs that worked to address the opioid epidemic and focused on implementing evidence-based practices for children, youth, and families throughout Wisconsin. In her new role, Michelle serves as the Title V Co-Director, leader of the Children and Youth with Special Health Care Needs programs in Wisconsin, and coordinates across divisions, bureaus, sections, and units to provide strategic direction and improve services for children and youth with special health care needs. Michelle holds a master's degree in clinical Mental Health Counseling and a Bachelor of Arts degree in Psychology and German Language.

In February of 2023, Fiona Weeks left her role as the Title V Director and Maternal and Child Health Unit Supervisor. Fiona served as the Title V Director and Maternal and Child Health Unit Supervisor for two years. During her time in this role, she brought many impactful contributions to the Title V program and maternal and child health in Wisconsin that centered a dedication to advocate for change to advance health equity. In May of 2023, the supervisor/director position was split, and Katrina Heche was hired as Wisconsin’s Title V MCH Director. She had served for four years as the Wisconsin State Systems Development Initiative Project Director prior to being hired into this position and her knowledge of Wisconsin’s Title V program equips her well for this role. The recruitment of a new Unit Supervisor is ongoing at the time of this application submission.

Emerging Issues

The Title V workforce has continued with a hybrid work model that began during the COVID-19 pandemic. This has impacted how staff work within teams and how the program reaches partners and communities. The option to conduct virtual site visits has increased efficiency and decreased the time and travel burden on staff. However, a lack of in-person interaction among and between teams has created openings for misunderstanding and missed opportunities. The Title V program is exploring processes for better onboarding of new staff and opportunities for team building to foster the success of and collaboration among staff in order to optimize program impact.

While the long-term impacts of the COVID-19 pandemic on both maternal and child health populations and the public health workforce are still emerging, the critical need for social connection and mental health support is clear. This issue has been identified across a variety of stakeholders, including by community members and organizations across Wisconsin, the Office of Children's Mental Health, as well as the U.S. Surgeon General in his declaration of a national youth mental health crisis. Wisconsin received close to $50 million in additional funding from the federal government as a part of the American Rescue Plan Act to support this urgent situation to address mental health and substance use needs. Additionally, the Title V program has identified social connection as a State Performance Measure and offered it as a project option for local and tribal health agencies so they could utilize their annual Title V funding to support social connections within their own communities.

Five-Year Needs Assessment Summary

Next submission 2025

 

The 2020 MCH Needs Assessment was completed prior to the development of both the COVID-19 pandemic and the increase in governmental systems recognizing racism as a major public health concern and topic of public health urgency, and as a result, may not accurately reflect current health concerns of Wisconsin residents. Despite this, the Title V program’s review and categorization of over 500 unique needs assessment themes did identify and intentionally address equity, racial justice, as well as access to quality health services – themes that permeate these emerging health concerns in Wisconsin.

 

In 2022, the Wisconsin Title V program sought the input of both community members and agencies serving maternal and child health populations in Wisconsin to inform ongoing needs assessment activities. Many of the themes identified in the initial 2020 MCH Needs Assessment were reflected in the ongoing needs assessment activities, though some were further emphasized likely as a result of the COVID-19 pandemic. Themes identified included social connection and mental health support in communities, social determinants of health (including affordable housing, public transportation, well-paying jobs, and pedestrian infrastructure), parental and caregiver supports (including childcare, peer support groups, and educational classes and programming), accessibility and availability of quality healthcare (with an emphasis on children and youth with special healthcare needs, diverse and representative providers, and a need for a variety of supports for birthing persons, accessibility and availability of healthy food and physical activity, and substance misuse and the accessibility and availability of supports and services, including harm reduction methods. 

 

The upcoming results of the 2025 MCH Needs Assessment will likely bring a variety of updates to each of the five population health domains.

 

Process Description for Needs Assessment Update

 

 

Goals, Framework, Methodology 

 

Planning for the 2025 MCH Needs Assessment kicked off in August 2023 when the Title V director assembled a group of three core leaders to form the Title V Needs Assessment Project Manager team – the Title V Evaluator and Epidemiologist (Mary Kusch), Health Equity Coordinator (Julia Norton), and MCH Unit Supervisor (Nikki Ripp). With guidance from the Title V director, this team began planning for the upcoming assessment that will inform Wisconsin’s priorities and performance measures for the 2026-2030 block grant cycle.

 

To ensure the design and implementation of the 2025 MCH Needs Assessment is rooted in principles of health equity, staff that can speak to the needs of diverse communities throughout the entire planning process including staff with personal and professional ties to Black/African American, Alaska Native/American Indian, Latine, LBGTQIA2S+, and parents of children and youth with special health care needs communities were intentionally chosen to join the steering committee. Steering committee members are primarily programmatic staff who have never worked on a needs assessment of any scale prior to this cycle. While onboarding new staff to this work was a challenge, the team is excited about having a group of diverse voices that haven’t been heard in previous needs assessment planning years.

 

The health equity coordinator and the Title V evaluator and epidemiologist kicked off needs assessment planning meetings in September of 2023 by evaluating who had provided feedback during the 2020 MCH Needs Assessment and identifying populations to prioritize input from in the 2025 MCH Needs Assessment. While many Wisconsin residents were reached in the 2020 MCH Needs Assessment, 92% of those participants were middle-aged, affluent White women. To make a more concentrated effort to hear from underserved and underrepresented communities across the state, the following communities identified and prioritized when planning surveys, outreach, and communications related to the 2025 MCH Needs Assessment: Amish/Mennonite/Plain; migrant (moving from one place to another for work); refugee (fleeing persecution or conflict from my home country);immigrant; farmworker; active military member; military veteran; grandparents raising grandchildren; new parents; teen parents; foster parents; parents with a disability or special healthcare needs; parents with substance use management needs; youth with substance use management needs; breastfeeding or chestfeeding people; LBGTQIA2S+; those with interpersonal, domestic, or sexual violence experiences; those with housing instability unhoused experiences.

 

After generating a robust list of communities to engage with, the planning team carried out an asset mapping project by identifying local organizations in each of the five public health regions of Wisconsin that work with the aforementioned populations. The Title V needs assessment steering committee obtained organizations’ contact information to be able to share opportunities to engage in the upcoming needs assessment activities. Of the 260 local organizations the team identified, many had already partnered with the Title V program on other projects, including with the Maternal and Infant Mortality Prevention team, the Children and Youth with Special Health Care Needs unit, and the Adolescent Well-Being project team.

 

In March of 2024, the Title V Needs Assessment Steering Committee hosted a public forum and invited all 260 organizations that could speak on behalf of the populations being targeted this cycle. This planning forum was designed for public stakeholders to offer their feedback on a drafted needs assessment community survey. A total of 85 attendees represented 56 organizations during the daytime and evening public forums. Communities were asked to share their thoughts on word choice and language of survey questions, response options, and structure of the survey, with their suggested changes being implemented afterward.

 

Another public forum will be hosted in June of 2024 for organizations with continued interest in needs assessment involvement and partnership. This forum will be an opportunity to share the timeline, discuss the plan for data collection efforts through the summer, and communicate ways to sign up to receive mailed surveys and focus group materials. Tips and tricks for hosting focus groups will also be shared, and a guest speaker will share recommendations on how to facilitate effective dialogue using health equity principles. The 2025 Needs Assessment launches publicly on July 10, 2024.

 

 

Data Sources Utilized to Inform the Needs Assessment Process

 

During the fall of 2023, the Title V evaluator and epidemiologist began to compile a variety of existing data sources that could be utilized to assess the health and well-being of families in communities across Wisconsin. During the initial review process, specific attention was paid to include measures that captured various social determinants of health that impact health outcomes for families across the state. This included measures of economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. Various other types of measures were reviewed as well, including demographics, health status and outcomes, and systems of power, privilege, and oppression. After the initial review process, the following data sources were identified:

 

• American Community Survey (U.S. Census Data)
• Behavioral Risk Factor Surveillance System
• CDC mPINC
• CDC WISQARS
• CDC WONDER
• March of Dimes
• National Immunization Survey
• National Survey of Children’s Health (NSCH)
• Wisconsin Perinatal Period of Risk Reports
• Pregnancy Risk Assessment Monitoring System
• SAMHSA National Survey on Drug Use and Health
• U.S. Department of Agriculture, Household Food Security Report
• U.S. Department of Education
• U.S. Environmental Protection Agency
• WIC (Special Supplemental Nutrition Program for Women, Infants, and Children)
• Wisconsin Hospital Discharge Data
• Wisconsin STD Program
• Wisconsin Vital Statistics
• Youth Risk Behavior Survey

Once the initial set of data sources and applicable measures were identified, the Title V epidemiologist and evaluator presented the information to the larger Needs Assessment Steering Committee and facilitated a conversation around the choice of measures, including if any should be added or removed as well as which measures the team would like to see broken down by various demographics (such as race and ethnicity, socioeconomic status, and public health region in the state). It was essential to the approach to include the larger team in this conversation as they bring diverse perspectives with their personal and professional ties to a variety of communities that are most impacted by the efforts of the Title V program. This existing data compilation will be used as supportive information to enhance understanding of what is gathered from communities in real-time surveys and focus groups.

 

Quantitative and Qualitative Methods

 

The Needs Assessment Steering Committee identified a variety of primary and secondary data sources to support the needs assessment process with the following: 1) assessing the strengths and needs of the MCH population in each of the five identified population health domains; 2) MCH program capacity; and 3) supportive partnerships and collaborations. For primary data collection the team will be utilizing a community-focused survey, an organizational-focused survey, and offering community leaders the opportunity to host focus groups in the summer of 2024. The community-focused survey will be translated into Spanish and Hmong in order to meet the needs of non-English speaking communities and increase the potential in receiving responses from a wider variety of community members.

 

The Needs Assessment Steering Committee team held a series of conversations around the best use of secondary data sources in the needs assessment process and future selection of priorities. The team discussed the benefits and limitations of secondary data sources, including methods, who was and was not represented in the data, the current political and social climate, and how these contexts can influence this data. As a result, the Needs Assessment Steering Committee decided it was essential to center the voice and experiences of Wisconsin community members from real-time, primary data collection, and secondary data sources will offer support to the priorities that are identified in the primary data collection methods.

 

 

Interface between the collection of needs assessment data, the finalization of the state’s Title V priority needs, and the development of the state’s Action Plan.

 

Once all aspects of the needs assessment data collection process are complete, the Needs Assessment Steering Committee will work towards identifying priority needs and developing Wisconsin’s Action Plan for 2026-2030. Because the needs assessment process is intentionally rooted in principles of health equity, the team will be prioritizing the responses, needs, and experiences of community members with an emphasis on those that are most impacted by the health inequities addressed by the Title V program. There may be opportunities to weigh the data according to demographics with the greatest need for their responses to come through. The team will be looking for areas of alignment between community needs and organizational priorities in order to maximize the potential for positive impact in the next cycle. Once priority needs are identified, the team is planning to reach back out to communities and organizations that participated in the needs assessment process to ensure that the priorities selected resonate with them. Once priorities are finalized, the Wisconsin Title V team will choose national and state performance measures, develop the strategic plan, and create actionable and measurable strategies beyond what is collected by the national and state performance measures.

 

Community Conversations

 

In addition to the secondary data sources that were compiled, the team is also working with HealthTIDE, Title V’s technical assistance provider for physical activity and nutrition, to include data from their community conversations in 2022-2023 in collaboration with partners across the state. These conversations were carried out as a part of National Performance Measure 8.1 to increase physical activity in children ages six to eleven as well as Representative Participation State Performance Measure 04 to engage voices of communities to advance equitable work. The purpose of the community conversations was to elevate the voices of Black, Indigenous, and Latino Wisconsin parents and caregivers to better understand how to support health, wellness, and well-being of underserved families. Many themes pertaining to raising healthy children emerged beyond physical activity and nutrition.

 

Findings from African American Breastfeeding Network’s conversations demonstrated that mental health is a priority for Black parents and caregivers, community connection is vital to the health and wellbeing of Black families, Black parents and caregivers are overworked and under-resourced, and ongoing systemic racism contributes to stress and other health-related issues. A few of the findings from the Wisconsin Tribal and Indigenous conversations held by the Greater Lakes Inter-Tribal Council found that both within and beyond nutrition and physical activities needs, cultural is a vital part of wellness, having resources to provide for children is essential, access to self-care opportunities is a major need, and eating indigenous foods is highly valued but access to these foods is low. Themes from the conversations held with Latino families demonstrated that there is a need for more culturally responsive programming for physical activity and nutrition options and mental health support needs, and systemic racism and stigma regarding immigration status is pervasive and a barrier to children and parents achieving optimal health.

 

III.C.1.b. Findings

 

The 2020 MCH Needs Assessment for the Wisconsin Title V program utilized multiple data sources including CDC Wonder, Vital Records, Wisconsin’s Interactive Statistics on Health, Hospital Discharge data, Pregnancy Risk Assessment Monitoring System (PRAMS), American Community Survey, Wisconsin Sexually Transmitted Diseases program, Behavioral Risk Factor Surveillance System survey, Youth Risk Behavior Surveillance System survey, National Survey for Children’s Health and National Immunization Survey for Children to identify the following priority needs:

• Advance equity and racial justice

 

• Assure access to quality health services

 

• Cultivate supportive social connections and community environments

 

• Enhance identification, access, and support for individuals with special health care needs and their families

 

• Improve perinatal outcomes

 

• Foster positive mental health and associated factors

 

• Promote optimal nutrition and physical activity

 

III.C.1.b.i. MCH Population Health and Wellbeing

 

The United Health Foundation State Health Rankings (2023) place Wisconsin 22nd overall and 34th for health outcomes. The two measures Wisconsin’s faring the worst (both ranked 49th relative to other states) are low per capita public health funding and low birthweight racial gap. Other challenges highlighted in Wisconsin’s rankings include residential segregation (ranked 48th), high prevalence of excessive drinking (47th), and a high prevalence of obesity (40th).  Positive trends indicate a low prevalence of non-medical drug use, a high prevalence of high school completion, and a high voter participation rate.

 

The Annie E. Casey Foundation Kids Count Data Center (2023 Data Book) ranks Wisconsin 10th out of all states for overall child well-being, a composite rank based-on ranks for economic well-being (10th), education (7th), health (16th), family and community factors (18th). The data is from 2021.

According to the Kids Count Data Book economic well-being 13% of children in Wisconsin are growing up in poverty and 23% whose parents lack secure employment   The two lower ranking categories for Wisconsin are the health category and family and community factors.  Data included in the health category are as follows: low birth weight babies 7.7%, children without health insurance 4%, 27 child and teen deaths per 100,000, child and teens (ages 10-17) that are overweight or obese 31%. Looking at the data within the family and community category includes children in single parent families 32%, children in families where the household head lacks a high school diploma 8%, children living in high poverty areas 6%, and and 10 teen births per 1,000.

Wisconsin vital records data shows there were 60,032 births in the state in 2022 and 64% of births were by persons ages 25 to 34 years old. Among births in Wisconsin during the 2020–2022 period, 7.8% of infants were considered to have low birth weight <2,500g (5 pounds 8 ounces), 10% were born preterm (infant born prior to 37 weeks of gestation), and 9.6% required specialized medical care and were admitted to neonatal intensive care units (NICUs). Wisconsin’s low birth rate of 7.8% is similar to the overall U.S. rates of 8.6% however there are stark differences by race.  During the 2020–2022 period, babies born to Black birthing persons had a 16.8% low birth weight.

The 2022 National Survey of Children’s Health estimated that about 90.7% of Wisconsin children reported excellent or very good health, however only 81.0% of Black children in Wisconsin enjoyed excellent or very good health. Sixty-six percent of Wisconsin children ages zero to17 years have adequate insurance for their health needs, leaving 34% with inadequate insurance coverage. Consistent coverage over the past 12 months was reported by 91.4% of survey respondents. Health insurance coverage for children estimated coverage by private insurance 61.6%, public health insurance 23%, and combination public and private insurance 8.2%, and 7.1% uninsured at the time of the survey.

Approximately 263.558 or 20.7% of Wisconsin children under age 18 had a special health care need. Further broken down by race/ethnicity of the child, estimated based on the CSHCN screener, that 21.6% of Hispanic kids, 19.7% of White kids, and 10% of other non-Hispanic kids had a special health care need. The survey gathered information on health conditions (from a list of 25 conditions), 21.7% had two or more current or lifelong conditions and 7.9% of respondents shared that their child had one current or lifelong condition.

The child and family demographic section estimated that 91.9% of families have at least one caregiver employed full-time, 3.5% have at least one caregiver employed part-time, and 4.6% of families have a caregiver unemployed or working without pay. The family structure that a child lives in estimated 72% have two parents currently married, 19.7% have a single parent, and 6.3% of family structures have two parents not currently married. An estimated 14.8% of children have at least one parent who was born outside the U.S. An estimated 5.2% of children born in the U.S. live with caregiver(s) other than parents.

According to  Wisconsin’s vital records data there were 60,157 deaths of Wisconsin residents in 2022, occurring at a rate of 1,031.6 deaths per 100,000 people. According to vital records, the leading causes of death for all ages were heart disease (21.8%), cancer (19.3%), unintentional injuries (8.2%), and COVID-19 (4.8%). Among children and youth between the ages of one and 17 years, there were 69 deaths for children ages one to four, and 226 deaths for children/youth ages five to 17 with unintentional injuries as the leading cause of death followed by intentional self-harm (suicide) and assault (homicide).

According to the CDC’s National Center for Health Statistics, in Wisconsin:

• Life Expectancy (at Birth): 77.7 years (2020)
• Drug Overdose Death Rate: 31.6 (per 100,000)
• Firearm Injury Death Rate: 13.5 (per 100,000)
• Homicide Rate: 6.4 (per 100,000)
• COVID-19 Death Rate: (Q4, 2022) 22.4 (per 100,000)

Infant mortality is a high priority issue in Wisconsin. According to the 2022 provisional data from the CDC, Wisconsin's infant mortality rate is 5.36 infant deaths per 1,000 live births. The state's three-year average infant mortality rate from 2020 to 2022 was 5.6 deaths per 1,000 live births. However, there are large racial inequities in the state with data from 2020 showing the non-Hispanic white infant mortality rate was 4.35 deaths per 1,000 live births compared to a non-Hispanic Black infant mortality rate of 14.0 deaths per 1,000 live births.

Emerging Issues

The Title V workforce has continued with a hybrid work model that began during the COVID-19 pandemic. This has impacted how staff work within teams and how the program reaches partners and communities. The option to conduct virtual site visits has increased efficiency and decreased the travel time burden on staff. However, a lack of in-person interaction among and between teams has created openings for misunderstanding and missed opportunities. The Title V program is exploring processes to improve onboarding of new staff and opportunities for team building to foster the success of and collaboration among staff in order to optimize program impact.

While the long-term impacts of the COVID-19 pandemic on both maternal and child health populations and the public health workforce are still emerging, the critical need for social connection and mental health support is clear. This issue has been identified across a variety of stakeholders, including by community members and organizations across Wisconsin, the Office of Children's Mental Health, as well as the U.S. Surgeon General in his declaration of a national youth mental health crisis. Wisconsin received close to $50 million in additional funding from the federal government as a part of the American Rescue Plan Act to support this urgent situation to address mental health and substance use needs. Additionally, the Title V program has identified social connections as a State Performance Measure and offered it as a project option for local and Tribal health agencies so they could utilize their annual Title V funding to support social connections within their own communities.

Noted changes in Wisconsin’s Title V program capacity or its maternal and child health systems of care, particularly for children and youth with special health care needs, and the impact of these changes on maternal and child health services delivery

 

The Children and Youth with Special Health Care Needs (CYSHCN) unit supervisor and program director, who were hired in the fall of 2022, have now been working in the program for over a year to promote quality care for children and youth with special health care needs in Wisconsin. Previously these two positions had been one role but were separated to allow for more balanced workloads and to increase support and focus on CYSHCN work. The CYSHCN state team replaced their contracted staff statewide program coordinator position with a full-time DHS CYSHCN program coordinator position that was filled in the Summer of 2023. An additional staffing change was that a full-time position that bridged the CYSHCN unit and MCH unit retired, and the position was not filled. The Title V team continues to look for ways to collaborate across units to maintain a cohesive workforce.

 

The CYSHCN state team is currently comprised of the unit supervisor, program director, one full-time and one part-time program coordinator, and a CYSHCN epidemiologist. While a relatively newer team, this group has spent 2023 working to assure that children and youth with special health care needs are identified early, receive high quality coordinated care, and receive, with their families, the supports they need. They will continue to collaborate to provide statewide leadership on children and youth with special health care needs through the promotion, coordination, and implementation of the CYSHCN program and through serving as program liaisons with internal and external partners and stakeholders.

 

In Spring of 2023, the MCH unit supervisor/Title V director position was separated into two full time positions to allow additional support to staff and fiscal oversight. The maternal and child health block grant coordinator/states systems development initiatives (SSDI) coordinator transitioned into the Title V director role. The SSDI position was absorbed by the Title V epidemiology/evaluator.

 

III.C.1.b.ii Title V Program Capacity

 

III.C.1.b.ii.a. Impact of Organizational Structure

This section is considered optional according to current Block Grant Guidance. Wisconsin is not reporting on this in the 2023 Report/2025 Application. See previous submission for details.

 

III.C.1.b.ii.b. Impact of Agency Capacity

This section is considered optional according to current Block Grant Guidance. Wisconsin is not reporting on this in the 2023 Report/2025 Application. See previous submission for details.

 

III.C.1.b.ii.c. Title V Workforce Capacity and Workforce Development

For information regarding Wisconsin's Title V Workforce Capacity and Workforce Development, please see section titled MCH Workforce Development and section titled MCH Epidemiology Workforce.

 

III.C.1.b.ii.d. State Systems Development Initiative

For information regarding Wisconsin's State Systems Development Initiative grant program, please see section titled State Systems Development Initiative.

 

III.C.1.b.ii.e. Other MCH Data Capacity

For information regarding Wisconsin's other MCH Data Capacity efforts, please see section titled Other MCH Data Capacity.

 

III.C.1.b.iii. Title V Program Partnerships, Collaboration, and Coordination

For information regarding Wisconsin's Title V Program Partnerships, Collaboration, and Coordination, please see the section titled Public and Private Partnerships.

 

III.C.1.b.iv. Family and Community Partnerships

For information regarding Wisconsin's Family and Community Partnerships, please see section titled Family Partnership.

 

III.C.1.c. Identifying Priority Needs and Linking to Performance Measures

This section is considered optional according to current Block Grant Guidance. Wisconsin is not reporting on this in the 2023 Report/2025 Application. See previous submission for details.