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