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2022 2023 2024 2025 2026

Ongoing Needs Assessment Activities

WY MCH leadership and MCH Epidemiology Program (MCH Epi) staff will work closely to identify and implement interim activities to occur between 5 year needs assessments (NA).

Current and planned ongoing NA activities include:

The CYSCHN Director is receiving MCHB-funded technical assistance (TA) to support completion of the National Standards for Systems of Care for CYSHCN assessment. Assessments will be completed from the perspective of WY MCH and other agencies/organizations involved in WY’s CYSHCN systems of care. Assessment findings will help the CYSHCN Program to select standards for action and revise the state action plan for the CSHCN domain.
WY MCH is partnering with the OMNI Institute to hold focus groups on well woman visit, safe sleep, child well visit, and systems of care for CYSHCN. Results will inform state action plan strategies and activities, ensuring that voices of community members are included.
In 2020 MCH Epi created dashboards to monitor key WY MCH indicators from birth certificate data, PRAMS, and all Title V National Outcome Measures (NOM) and Performance Measures (NPM). The dashboards allow for identification of trends and examination of disparities and MCH data are more accessible to partners.
MCH Epi is creating data briefs on the selected MCH priorities, focusing on the chosen NPMs. These are snapshots of where WY stands in the priority and highlight the data that helped drive the process for priority selection.
WY MCH will convene the MCH/Title V Steering Committee annually to gather feedback on state action plan progress and address challenges/barriers. The meetings offer an opportunity to connect with other statewide assessments (e.g. State Health Assessment, MIECHV) that could inform ongoing needs assessment efforts for MCH.

In spring 2021, WY MCH released an online public input survey to gather input on recent and planned activities and identify emerging needs. The survey asked, “What are the unmet needs in your community?” for each of the five primary domains. WY MCH is using the results to inform action planning.

Health Status and Needs Update

Women’s/Maternal Health

Maternal Mortality and Morbidity

Due to WY’s small population and small numbers of maternal deaths, maternal death rates fluctuate. Aggregated data suggests that the WY maternal mortality rate is similar to the national rate. 2020 was the first year of MMRC review of cases, we completed case reviews for 3 2018 3 maternal deaths, 2 were found to be pregnancy related.

From 2016-2020, WY’s severe maternal morbidity rate was 91.5 per 10,000 delivery hospitalizations. The most common severe maternal morbidity in WY is transfusion, followed by eclampsia.

Maternal Mental Health

As suicide and drug overdoses are among the leading causes of maternal mortality in WY, maternal mental health is an area of focus.

In WY, 18% of new moms reported depression prior to pregnancy, 17% reported depression during pregnancy, and 14% reported postpartum depression (PPD). PPD was highest among women ages 15-24 years and was also significantly higher for women in the lowest Federal Poverty Levels. A majority (86%) of women reported their providers discussed depression with them at a postpartum visit (PRAMS, 2016-2019).

Preconception Health

According to the 2018 Behavioral Risk Factor Surveillance System (BRFSS), 65% of WY women reported having a preventive medical visit in the past year, significantly less than the U.S. prevalence of 73%. While the prevalence in WY has increased over the past few years, it has been significantly less than the U.S. prevalence since 2009. In 2019, the prevalence of women reporting having a well women visit in the past year was highest for those with a college degree or more (78%), and those with a household income of $75,000 or more (75%). In addition, a higher prevalence of women with health insurance (73%) compared to uninsured women (35%) reporting having a preventive medical visit in the past year.

Maternal Smoking

Significant reductions in the prevalence of women smoking during pregnancy have been seen in both the U.S. and in WY. While decreases in smoking have been seen, the 2019 WY prevalence (13.6%) is significantly higher than the U.S. prevalence of 6.0% (NVSS). The prevalence of smoking during pregnancy was significantly higher among WY women with less than a high school education (32.0%) compared to those with at least a high school education (25.7), those some college education (11.1%) and those who graduated from college (1.0%) and significantly higher among women on Medicaid (29%) compared to those who are uninsured (16%) and those with private insurance (6.2%) (NVSS). To reach the HP2030 goal of 95.7% of women giving birth not reporting smoking during pregnancy, WY needs to increase the percentage of women giving birth who did not smoke during pregnancy by 10.7%.

Family Planning

In 2019, 22% of women reported having an unintended pregnancy, which is a significant decrease from 33% in 2012. The rate of unintended pregnancies did not differ by race, but differences were seen by income level. Women living with incomes ≤100% FPL reported having an unintended pregnancy significantly more (38%) compared to women living with incomes 201-300% FPL (17%) and 301%+ FPL (13%).

In 2019, 69% of WY women at risk of pregnancy/not actively trying to become pregnant reported use of the most/moderately effective form of contraception. The prevalence has not changed significantly since 75% in 2012. No differences were seen by race/ethnicity, income or Medicaid status. Although no longer a Title V priority, MCH Epi will continue to monitor and conduct analysis around contraceptive use (PRAMS).

Perinatal/Infant Health

Infant Mortality

WY’s 2015-2019 infant mortality rate (IMR) was 5.6 deaths/1,000 live births; with a majority of deaths occurring 63% among neonatal infants (VSS). The WY IMR was lower than the 2018 national rate of 5.7 deaths/1,000 live births and both met the HP2020 objective (6.0 deaths/1,000 live births) but not the HP2030 objective of 5.0 deaths per 1,000 live births. From 2009-20019, the WY IMR among white women was 6.3/1,000 and was 7.9/1,000 among American Indian women (VSS 2009-2019).

Both the neonatal and postneonatal mortality rates in WY have been similar to U.S. rates over the past 10 years. From 2015-2019, the leading causes of death among WY neonates were congenital malformation, deformations, and chromosomal abnormalities followed by disorders related to short gestation and low birth weight. The leading causes of postneonatal infant death were sudden unexpected infant death (SUID), congenital malformation, deformations, and chromosomal abnormalities (WY VSS).

Preterm and Low Birth Weight (LBW) Births

In 2019, 10% of WY infants were born preterm, which was not significantly different from the 2019 U.S. prevalence (10%). Since 2009, WY’s preterm rate has fluctuated; the highest prevalence was 11% in 2014 and the lowest at 9% in 2017. The 2019 rate was the same as the 2009. The prevalence of LBW births in WY has increased since 2009; the 2019 prevalence of 10% was significantly higher than the 2009 prevalence (8%). The 2019 WY prevalence was significantly higher than the 2019 U.S. prevalence 8%. In 2019, WY had not met the HP2020 preterm goal of 9.4%, or the HP2020 LBW goal of 7.8%. MCH Epi will continue to monitor changes in preterm and LBW deliveries and will examine the LBW increase in more detail.

Infant Sleep Environment

The leading cause of postneonatal infant death in WY from 2015 to 2019 was SUID, which includes sudden infant death syndrome (SIDS). Over 84% of WY women reported their infants are put to sleep on their backs only (PRAMS, 2016-2019), exceeding the HP2020 goal of 75.8%. However, less than one third of women reported their infants always or often were placed to sleep on a separate approved sleep surface and 31% reported their infants were usually placed to sleep with no soft bedding. Disparities in sleep environments were seen by race and ethnicity, as well as by income. Planned program activities include conducting focus groups to better be able to understand the observed disparities in sleep environments.

Breastfeeding

The WY breastfeeding initiation rate (90.9%) exceeds the HP2020 Goal (81.9%) (PRAMS, 2016-2019). In 2017, 31.4% of infants in WY were breastfeed exclusively through six months, exceeding the HP2020 Goal of 25.5%, and significantly higher than the 20.0% in 2007(National Immunization Survey, 2016). WY continues to monitor breastfeeding rates, however, as WY has met the HP2020 and HP 2030 goals and has maintained high breastfeeding rates, breastfeeding is not a Title V priority

Child Health

Child Mortality

In 2019, the mortality rate for WY children ages 1-9 (CMR) was 16.8/100,000, similar to the 2019 US rate of 16.7/100,000. The WY CMR has not changed significantly since 2009. Similar to the US, the 2017-2019 CMR is higher for children ages 1-4 (25.3/100,000) than for children ages 5-9 (20.3/100,000), but unlike the US the difference in the rates between the two age groups was significant.

Unintentional Injury

Between 2009 and 2019, unintentional injury (UI) accounted for 40% of the deaths among WY children ages 1-9 and UI is the second-leading cause of death in this age group. Among UI related deaths, drowning (21.3%) and motor vehicle traffic injuries (19.1%) were the most common mechanisms of fatal injuries (VSS).

According to the Healthcare Cost and Utilization Project - State Inpatient Database (HCUP-SID), there were no significant changes in the WY child injury hospitalization rates from 2016-2018. Since 2016, the WY child injury hospitalization rate has been lower than the U.S. rate and the 2018 WY rate (82.7/100,000 children 0-9 years) was significantly lower than the U.S. (122.1/100,000). Childhood mortality and injury hospitalization are no longer a WY Title V priority, but MCH Epi will continue to monitor this topic.

Overall Health and Preventive Care

According to the 2018-2019 NSCH, 94% of WY children ages 0-11 were reported to be in excellent or very good health, 48% received care in a medical home, 58% had adequate and continuous insurance, and 19% received care in a well-functioning system. Data indicated that a significantly higher prevalence of children who received care in a medical home were reported to be in excellent or very good health, compared to children who did not receive care in a medical home.

In 2019, 64.6% of eligible, Medicaid-enrolled children ages 1-9 who should receive at least one initial or periodic Early and Periodic Screening, Diagnosis and Treatment (EPSDT) screening received at least one such screening. WY continues to see an increase in the percent of eligible children receiving at least one EPSDT screening, and this has increased by 17.9% since 2013 (WY Centers for Medicare and Medicaid Services 416 Report).

Obesity and Physical Activity

In 2018-2019, 14.3% of WY children ages 10-13 were reported as being obese, compared to 16.4% in the U.S. (NSCH). In 2018-2019 36% of WY children ages 6-11 were active for 60 minutes every day. This prevalence was significantly higher than the US prevalence of 28%, for the first time since 2016-2017 (NSCH). Small numbers continue to make any noted disparities in physical activity between different groups of children difficult to evaluate. The Child Health program is currently focusing efforts addressing policies around obesity and physical activity with licensed childcare facilities in WY.

Adolescent Health

Adolescent Mortality

The WY adolescent (ages 10-19) mortality rate (AMR) decreased significantly from the 2009 rate of 66.8/100,000 adolescents to 31.8 per 100,000 adolescents in 2018. In 2019 the AMR increased 52.7/100,000, but was not significantly different from the 2009 rate. The 2019 WY AMR was significantly higher than the 2019 US AMR of 32.1/100,000. From 2009-2019, he leading cause of death among 10-19 year olds in WY was unintentional injury (42% of deaths) and suicide (32% of deaths) (WY VSS). WY MCH Epi will continue to monitor this rate, and adolescent health program priorities include prevention of adolescent suicide and motor vehicle injury.

The 2017-2019 AMR was significantly higher among ages 15-19 (72.5/100,000) compared to ages 10-14 (11.1/100,000), males (54.6/100,000) compared to females (25.7/100,000) and Non-Hispanic American Indians/Alaska Natives (166.1/100,000) compared to Non-Hispanic Whites (39.2/100,000). The AMR among WY youth ages 15-19 is higher than the US AMR among the same age group (49.8/100,000) (NVSS).

Motor Vehicle Mortality

The 2017-2019 adolescent (ages 15-19) motor vehicle mortality rate (AMVMR) in WY has decreased from the 2007-2009 rate of 37.8/100,000 to 22.0/100,000 (NVSS, 2017-2019). However, the WY rate has been significantly higher than the US rate since 2007.

The YAYAHP plans to implement Teens in the Driver’s Seat as a strategy to tackle motor vehicle mortality by focusing on seat belt use among adolescents. In partnership with MCH Epi, the YAYAHP is proposing a new question around seatbelt use to be added to the WY Prevention Needs Assessment (PNA), as the YRBSS is no longer administered in WY.

Suicide, Self-Harm, and Risk and Protective Factors

Over the last decade, the WY adolescent suicide rate has increased by more than two-thirds the rate it was from 2007-2009, while the US rate has increased by half of what it was from 2007-2009 to 2017-2019. The 2017-2019 WY rate (32.1/100,000) was almost triple the U.S. rate of 11.2/100,000. Suicides made up 32% of all deaths among adolescents ages 10-19 in WY from 2009 to 2019 (VSS). From 2015 to 2019, adolescent males in WY died by suicide at a significantly higher rate (48.5/100,000) than females (11.5/100,000). This difference is also seen in national data (NVSS).

The YAYAP is working to increase adolescent well-visit rates and promote mental health screenings during adolescent well-visits. In 2019, 69% of adolescents, 12-17 years, had a preventative medical visit in the past year, significantly less than the 80% in the US, and down from 78% in 2016/2017 (NSCH). According to 2019 WY Medicaid data, 34% of adolescents (ages 10-20 years) eligible to receive at least one screening received a screening, an increase from 24% in 2015 when, the lowest rate observed in the past 10 years (WY Centers for Medicare and Medicaid Services 416 report).

Children with Special Health Care Needs (CSHCN)

Approximately 18% of WY children ages 0-17 years (24,351) have special health care needs. In 2018-2019, 57% of WY CHSCN had insurance that was considered adequate for a child’s health needs, and 8.6% of WY CSHCN reported receiving care in a well-functioning system compared to 14% of CSHCN in the US. While the 2018-2019 prevalence in WY is not significantly less than the 2016-2017 prevalence of 17% this is a decrease of almost 50% in the percent of children who received care in a well-functioning system (NSCH, 2018-2019).

In 2018-2019, 38% WY CSHCN reported having a medical home, compared to the 49.7% of non-CSHCN children in WY, and 42% of CSHCN in the US. WY’s CSHCN Program has chosen to work on increasing the prevalence of CSHCN in WY receiving care in a medical home over the next five years, with a specific focus on the need to improve the care-coordination component of a medical home for the WY CSHCN population. The prevalence of WY CSHCN receiving care-coordination when needed (55%) is the lowest among all the components of a medical home (NSCH, 2018-2019).

Emerging Needs Update

Childhood Lead Poisoning Prevention

The WDH-PHD does not currently fund a dedicated lead program and has lacked capacity for ones since 2014. Blood lead test results are a reportable disease/condition in WY. In 2018, only 5% (1,958) of WY children under the age of six had been tested for lead, significantly less than the national average of 19%. Of the children who were tested in 2018, 3% (49) had elevated blood lead levels, which was higher than the national average of 2%. In early 2020, WY MCH partnered with the State Epidemiologist/State Health Officer to submit an application for the CDC Childhood Lead Poisoning Prevention grant. If funded, the grant will fund one FTE to implement activities to improve lead screening, reporting, surveillance, follow-up, and linkages to services for children with elevated blood lead levels.

COVID-19 and MCH Emergency Preparedness and Response

During the past year, all MCH Epi staff and some WY MCH staff assisted with the State’s COVID-19 response, temporarily shifting capacity away from MCH efforts. Support included staffing COVID-19 call lines, case investigation, contact tracing, and COVID-19 data. MCH staff contributed subject matter expertise related to the impact of COVID-19 on pregnant women and children.

WY PRAMS added two COVID-19 supplements. The general COVID-19 supplement began Oct 2020 with the July 2020 births. The COVID-19 Vaccine Supplement, asking about vaccine administration and hesitancy, began data collection in April 2021 with the January 2021 births.

MCH Epi is conducting a linkage of COVID-19 cases in women of reproductive age to birth/fetal death records 2020 to describe the pregnant population who also had COVID-19 and monitor the outcomes to both the infant and mother. MCH Epi is monitoring for potential maternal mortality cases who also were diagnosed with COVID-19. To date, there have been no maternal mortality cases linked to COVID-19 cases.

In 2020, WY MCH submitted a CDC PHAP application to expand capacity to address the unique needs of MCH populations and MCH systems of care in times of emergency, not limited to COVID-19. In addition, a team of stakeholders currently participate in an AMCHP Emergency Preparedness and Response Action Learning Collaborative.

Oral Health

The WDH-PHD Oral Health Program was eliminated in 2016 due to budget reductions, therefore the role of WY MCH in oral health activities is limited. WY MCH participates in a statewide WY Oral Health Coalition co-led by the WY Primary Care Association. WDH-PHD also serves on the Rocky Mountain Network of Oral Health Steering Committee, a HRSA-funded oral health integration project focused on children 0-40 months and pregnant women.

MCH Epi continues to monitor oral health data. In 2018-2019, 14% of WY children ages 1-17 had decayed teeth/cavities in the past year, which was slightly higher than the prevalence of 10% in 2016-2017, and higher than the U.S. prevalence of 12% in 2018-2019. WY children had a slightly higher prevalence of children ages 1-17 (81%) who had dental visits in the past year compared to the US (80%) (NSCH).

In 2020 the WY Oral Health Coalition received funding from the WY Office of Rural Health to update a statewide oral health needs assessment. WY MCH will use results to monitor oral health among MCH populations and will continue to address oral health through active participation in WY Oral Health Coalition activities and through the Title V Priority - Promote Healthy and Safe Children.

Child and Adolescent Health Insurance

In 2018-2019, the prevalence of children ages 0-17 who were adequately insured in the past year in WY (57%) was significantly less than the U.S. prevalence (67%). According to the 2019 American Community Survey (ACS), 10% of WY children (ages 0-17) were not currently insured, which is significantly more than the US prevalence (5%). When examined by race, the highest prevalence of uninsured children was among non-Hispanic American Indian/Alaska Native (31%) (ACS, 2019). In 2018-2019, uninsured children (ages 1-17) had the lowest prevalence (67%) of having a preventive dental visit in the past year, as well as the lowest prevalence (23%) of receiving care within a medical home (NSCH). These numbers coupled with the uninsured statistics from the CYSHCN population show it is clear there is much work left to do in these areas.

While child health insurance (NOM 21) was identified as an emerging need during the 2020 NA, it was not selected as a priority due to capacity challenges and concerns over the impact WY MCH is actually positioned to make. WY MCH will continue to monitor child health insurance measures and will work to promote access to health insurance among clients served through WY MCH programs.

Capacity Update

Between 2012 and 2020, the WY MCH Unit Manager assumed the dual role of Title V and CSHCN Director due to limited leadership capacity in the CYSHCN program. To strengthen leadership capacity for CYSHCN services after this initial transition, the former Child Health Program and CYSHCN Program were consolidated to form an expanded CYSHCN Program overseeing the Child Health and CSHCN population domains, and is now led by one program manager who also assumes the role of Title V CSHCN Director. The WY Newborn Screening and Genetics Program will transfer to the CYSHCN program in 2021 to consolidate all CYSHCN services and workforce capacity.

WY MCH continues to allocate State funding to each of WY’s 23 local PHN offices to support local MCH programming. Due to the economic downturn, future State funding may be reduced; however, no significant cuts are expected for the current State biennium (2021-2022). WY MCH will integrate Title V 2021-2025 priorities and strategies into contracts with local PHN offices as early as summer 2022, when current contracts are up for renewal.

Title V Partnerships and Collaborations Update

WY MCH partners with MCH Epi for epidemiology and evaluation support for MCH programming. WY MCH also partners with other State agencies and programs to improve MCH population health, including: Health Care Financing; Department of Workforce Services; Department of Family Services; Department of Education; WDH Behavioral Health Division; WDH PHD ; the University of WY; WY Health Council (Title X grantee); the federal Maternal, Infant, Early Childhood Home Visiting (MIECHV) grant, administered by an out-of-state, non-profit partner; and other statewide organizations and associations (WY Medical Society, Uplift, WY Primary Care Association, WY American Academy of Pediatrics Chapter, WY American College of Obstetricians and Gynecologists Chapter, WY Kids First, WY Afterschool Alliance, WY 211, WY Community Foundation).

WY MCH representatives sit on the following statewide councils:

WY Governor’s Council on Developmental Disabilities
WY Governor’s Early Childhood State Advisory Council
WY Early Intervention Council
WY Preschool Development Grant Executive Leadership Committee
WY Citizen Review Panel

In July 2020, WY MCH executed new two-year contracts with all 23 county PHN offices with TANF and State General Funds provided for reimbursement of MCH services. These funds support an estimated 47 full-time employees across WY in support of MCH services. Although no formal funding agreements exist yet, WY MCH also works with the Northern Arapaho and Eastern Shoshone Tribes to promote and provide gap-filling financial assistance and care coordination services as part of the CYSHCN Program. CYSHCN staff provide training and support to tribal nurses to improve and sustain programming.

Efforts to Operationalize Five-Year Needs Assessment Findings

The WY MCH NA framework was not designed to be static or time-defined; many elements will persist throughout the five-year grant cycle.

Steering Committee and MCH Priority Action Team Involvement

The WY MCH/Title V Steering Committee formed in 2019 to drive NA activities, approve priorities, and hold WY MCH accountable to its developed State Action Plan (SAP)and met in January 2020 to approve draft Title V priorities. Due to COVID-19 the committee did not meet again to approve the final WY MCH SAP until June 2021. The committee will meet annually to receive updates on implementation of WY MCH’s SAP and to offer expert feedback and recommendations, in order to improve WY MCH accountability, increase leadership buy-in, and provide opportunities for ongoing feedback and quality improvement.

In spring 2020, WY MCH convened MCH Priority Action Teams (PATs) to gather input on the selected priorities and strategies for the 2021-2025 NA, and to establish consistent engagement of stakeholders in the Title V SAP planning, development, implementation, and evaluation. Due to COVID-19, the PATs have not met as planned to formally launch the 2021-2025 five-year cycle. Program managers plan to convene a PAT per priority topic twice a year to monitor progress on the SAP and offer support in implementation of MCH activities, with the support of Uplift, the WY Family Voices affiliate.

Strategic Plan Implementation

In January 2021, WY MCH released a Request for Proposal for strategic planning, strategic implementation, workforce development, and leadership consultation services. Seven proposals were received and Lolina, Inc. was selected for an initial two-year contract with options for renewals throughout the 2021-2025 Title V cycle, as needed.

In late 2020, WY MCH began holding weekly 30-30 meetings to check in on SAP, successes, and challenges experienced over the past 30 days and planned commitments for the upcoming 30 days. Designed to improve individual and team accountability for implementation of strategies, the 30-30 schedule rotates by domain to ensure each MCH population domain is highlighted and how the core values are operationalized in the work.

WY MCH continues efforts in two key areas of its original NA framework - program and policy development and resource allocation - throughout FFY21. This provides staff an opportunity to revisit original plans and make adjustments based on new information, changing community needs and/or capacity. WY MCH plans to revisit and revise its SAP and ESMs/SPMs ahead of the start of FFY22 and will receive technical assistance from the MCH Evidence Center and from Lolina, Inc. throughout summer 2021.

WY MCH will then focus on resource allocation and will revise its budget to align with updates to the SAP and consider revising county MCH funding allocations and contract deliverables to assure each county is working towards at least one MCH priority area and/or strategy in their next contract renewal.

Organizational Structure and Leadership Updates

WY MCH administers the Title V MCH Services Block Grant (BG) and provides leadership for state and local efforts that improve the health of MCH populations. The table below outlines MCH and MCH Epi staff.

Staff Member	Title/Role	Unit/ Program	FTE	Title V Domain	Tenure with WY MCH/ MCH Epi (Tenure with State of WY)
MCH Unit Staff
Danielle Marks, MSW, MPH*	MCH Unit Manager, Title V Director	MCH	1	All	7 (7)
Jamin Johnson, MS, CHES	CYSHCN Program Manager, Title V CSHCN Director	MCH	1	Child; CYSHCN; Cross-Cutting	3 (5)
Megan Selheim, BS, MFA	Youth and Young Adult Health Program Manager	MCH	1	Adolescent; Cross-Cutting	<1 (<1)
Vacant as of May 28, 2021	Women and Infant Health Program Manager	MCH	1	Women/Maternal; Perinatal/Infant; Cross-Cutting	N/A
Sapphire Heien, BA	MCH Grants and Contracts Specialist, Title V BG Coordinator	MCH	1	All	2 (6)
Carleigh Soule, MS	Newborn Screening and Genetics Coordinator	MCH	1	Perinatal/Infant; CSHCN; Cross-Cutting	15 (15)
Natalie Hudanick	Women and Infant Health Program Coordinator	MCH	1	Women/Maternal; Perinatal/Infant; Child; Cross-Cutting	<1 (<1)
Denise Robinson	Children’s Special Health Benefits and Eligibility Specialist	MCH	1	CSHCN; Cross-Cutting	1 (14)
Sheli Gonzales	Children’s Special Health Benefits and Eligibility Specialist	MCH	1	CSHCN; Cross-Cutting	15 (19)
Eleana Dubreus	CDC Public Health Associate and MCH Emergency Preparedness and Response Liaison	MCH	1	All	<1 (<1)
MCH Epidemiology Program Staff
Ashley Busacker, PhD	Senior Epidemiology Advisor	MCH Epi	1	All	11 (11)
Joseph Grandpre, PhD	Chronic Disease/Maternal and Child Health Epidemiology Unit Manager	MCH Epi		All	8 (19)
Moira Lewis, MPH	MCH Epidemiology Program Manager	MCH Epi	1	All	2 (2)
Neva Ruso	PRAMS Coordinator/MCH Epidemiologist	MCH Epi	1	All	<1 (<1)
* Between July and September 2021, the Title V Director will be out on maternity leave with interim duties to be transferred to the Title V CSHCN Director and Community Health Section Chief.

Key organizational/staffing changes since last report’s submission include:

Hiring of YAYAHPM to fill position left vacant in August 2020
Hiring of MCH Epidemiologist/WY PRAMS Coordinator to fill a position left vacant in February 2020
Reclassification of a former CYSHCN Benefits and Eligibility Specialist position (vacant due to retirement) to Women and Infant Health Program Coordinator position (hired June 2021)
Consolidation of the Child Health Program and CYSHCN Program to include programmatic activities and leadership oversight;
Assignment of Title V CSHCN Director duties to the new CYSHCN Program Manager who now oversees both Child Health and CYSHCN domains;
Movement of the Newborn Screening and Genetics Program from the Women and Infant Health Program to CYSHCN Program
Welcoming of a CDC Public Health Associate, who serves as the MCH Emergency Preparedness and Response Liaison

See below for an updated WY MCH organizational chart as of summer 2021.

WY MCH partners closely with PHN Unit leadership and two full-time PHN staff (MCH Consultant and MCH Data Coordinator) to implement a statewide home visiting program and support local MCH services implementation, including CYSHCN care coordination services. The MCH Consultant and MCH Data Coordinator were recently filled due a retirement and promotion.

WY MCH benefits from a strong MCH Epidemiology Program housed within the Public Health Sciences Section of the WDH-PHD. Program staff include a Program Manager, MCH Epidemiologist/PRAMS Coordinator, CDC-Assigned Senior MCH Epidemiologist, and Chronic Disease/MCH Epidemiology Unit Manager (0.25 FTE support for MCH Epidemiology). A fifth MCH epidemiology position, a MCH/Injury Epidemiologist, is vacant and may be eliminated in budget cuts.

Ongoing Needs Assessment Activities

WY MCH leadership and MCH Epi staff will work closely to identify and implement interim activities to occur between 5-year needs assessments (NA).

Current and planned ongoing NA activities include:

Under the new CYSCHN Director’s leadership, the Maternal and Child Health Bureau (MCHB)-funded TA-supported National Standards for Systems of Care for CYSHCN assessment will be revisited. WY MCH will further define the current state of CYSHCN, gaps in data, information needed, and the desired state, working with PHN, Medicaid, and other partners to strategically direct the program
WY MCH partnered with the OMNI Institute to hold focus groups on well woman visits, safe sleep, child well visits, and CYSHCN systems of care. Results will inform state action plan strategies and activities, ensuring community member voices influence implementation
MCH Epi maintains dashboards to monitor key indicators from birth certificate data, PRAMS, and Title V NOMs and NPMs for ongoing assessment, to identify trends and disparities, and makes data more accessible to partners
MCH Epi creates data briefs focused on the selected MCH priorities and selected NPMs
WY MCH will annually convene MCH/Title V Steering Committee (SC) to gather feedback on state action plan progress and address challenges/barriers

In spring 2022, WY MCH released an online public input survey to gather input on recent and planned activities and identify emerging needs. For each domain, the survey asked, “What are the unmet needs in your community?” WY MCH will use the results to inform ongoing action planning and implementation.

Health Status and Needs Update

Women’s/Maternal Health

Maternal Mortality and Morbidity

The Wyoming MMRC has completed reviews of 2018-2020 pregnancy-associated deaths. From 2018-2020, 13 women died during pregnancy or within one year after the end of their pregnancy. Most of these deaths occurred after the end of their pregnancy. 12 of these deaths were reviewed and six were determined by the committee to be pregnancy-related. Mental health conditions were the most common cause of pregnancy-related deaths. Substance use was involved in all six pregnancy-related deaths. All of the pregnancy-related deaths were deemed to be preventable.

From 2016-2020, WY’s severe maternal morbidity rate was 91.5 per 10,000 delivery hospitalizations. The most common severe maternal morbidity in WY is transfusion, followed by eclampsia.

Maternal Mental Health

In WY, 19% of new moms reported pre-pregnancy depression, 19% reported depression during pregnancy, and 13.9% reported postpartum depression (PPD). PPD was highest among women ages 15-24 years, and also significantly higher for women in the lowest FPL, as well as among American Indian/Alaska Native (AI/AN) women compared to White women, and women with less than a high school education or equivalent compared to those with more than a high school education. A majority (87%) of women reported their providers discussed depression with them at a postpartum visit (PRAMS, 2016-2020).

Preconception Health

According to the 2020 Behavioral Risk Factor Surveillance System (BRFSS), 65% of WY women reported having a preventive medical visit in the past year, significantly less than the U.S. prevalence of 71%. While the prevalence in WY has increased over the past few years, it has been significantly less than the U.S. prevalence since 2009. In 2020, the prevalence of women reporting having a well women visit in the past year was highest for those with a college degree or more (74%), and those with a household income of $75,000 or more (73%). A higher prevalence of women with health insurance (70%) compared to uninsured women (45%) report having a preventive medical visit in the past year.

Maternal Smoking

Significant reductions in the prevalence of women smoking during pregnancy continue to be seen in the U.S. and WY. While decreases in smoking have been seen, the 2020 WY prevalence (13%) is significantly higher than the U.S. prevalence of 6% (National Vital Statistics System [NVSS]). The prevalence of smoking during pregnancy was significantly higher among WY women with less than a high school education (29%) compared to those with at least a high school education (23%), those with some college education (20%), and those who graduated from college (1%), and significantly higher among women on Medicaid (27%) compared to those who are uninsured (17%) and those with private insurance (5%) (NVSS). To reach the HP2030 goal of 96% of women giving birth not reporting smoking during pregnancy, WY needs to increase the percentage of women giving birth who did not smoke during pregnancy by 9%.

Family Planning

In 2020, 25% of women reported having an unintended pregnancy, compared to 33% in 2012. The rate of unintended pregnancies did not differ by race, but differences were seen by income level. Women living with incomes ≤100% FPL reported having an unintended pregnancy significantly more (38%) compared to women living with incomes 201-300% FPL (17%) and 301%+ FPL (12.7%).

In 2020, 67% of WY women at risk of pregnancy/not actively trying to become pregnant reported use of the most/moderately effective form of contraception. The prevalence has not changed significantly since 2012. No differences were seen by race/ethnicity, income, or Medicaid status. Although no longer a Title V priority, MCH Epi will continue to monitor contraceptive use (PRAMS).

Perinatal/Infant Health

Births

From 2016-2020, there were a total of 33,355 births of WY residents, an average of 6,671/year. Of those births, 90% occurred within WY, and 10% occurred out-of-state. Among in-state births, 74% occurred in seven facilities. Two of those seven facilities accounted for 36% of in-state births.

Infant Mortality

WY’s 2016-2020 infant mortality rate (IMR) was 5.4 deaths/1,000 live births; with a majority of deaths (63%) occurring among neonatal infants (WY VSS). The WY IMR was lower than the 2019 national rate of 5.6 deaths/1,000 live births. Both met the HP2020 objective (6.0 deaths/1,000 live births); but not the HP2030 objective of 5.0. From 2010-2020, the WY IMR among white women was 5.7/1,000 and was 7.4/1,000 among AI/AN women (VSS 2010-2020).

Both neonatal and postneonatal mortality rates in WY have been similar to U.S. rates over the past 10 years. From 2016-2020, the leading causes of death among WY neonates were congenital malformation, deformations, and chromosomal abnormalities, followed by disorders related to short gestation and low birth weight. The leading causes of postneonatal infant death were SUID, congenital malformation, deformations, and chromosomal abnormalities (VSS).

Preterm and Low Birth Weight (LBW) Births

In 2020, 10% of WY infants were born preterm, the same as the 2020 U.S. prevalence. Since 2009, WY’s preterm rate has fluctuated from a high of 11% in 2014 and a low of 9% in 2017. The 2020 rate was the same as 2009. The prevalence of LBW births in WY has increased since 2009; the 2020 prevalence of 10% was not significantly higher than the 2009 prevalence (8%) but it was significantly higher than the 2020 U.S. prevalence of 8%. WY has not met the HP2020 preterm goal of 9%, or the HP2020 LBW goal of 8%. MCH Epi will continue to monitor changes in preterm and LBW deliveries and will examine the LBW increase in more detail.

Infant Sleep Environment

The leading cause of postneonatal infant death in WY from 2016 to 2020 was SUID. Over 90% of WY women reported their infants are put to sleep on their backs only (PRAMS, 2016-2020), exceeding the HP2020 goal of 76%. However, less than one third of women reported their infants always or often were placed to sleep on a separate approved sleep surface; 34% reported their infants were usually placed to sleep with no soft bedding. Disparities in sleep environments were seen by race, ethnicity, and income. Planned program activities include conducting focus groups to better understand the observed disparities in sleep environments.

Breastfeeding

The WY breastfeeding initiation rate (91%) exceeds the HP2020 Goal (82%) (PRAMS, 2016-2020). According to the National Immunization Survey (NIS), in 2018 30% of infants in WY were breastfed exclusively through six months compared to 26% in the U.S. To reach the HP2030 goal of 42% of infants breastfed exclusively through six months, WY needs to increase its percentage in 2018 by 41% (NIS). As WY has continued to show good breastfeeding rates, breastfeeding is not a Title V priority, although monitoring will continue.

Child Health

Child Mortality

In 2019, the WY child mortality rate (CMR) among children ages 1-9 years was 16.8/100,000 (the 2020 rate was not reportable), similar to the 2019 U.S. rate of 16.7/100,000. The WY CMR has not changed significantly since 2009. The 2017-2019 CMR is significantly higher for children ages 1-4 (25.3/100,000) than for children ages 5-9 (20.3/100,000).

Unintentional Injury

Between 2011 and 2021, unintentional injury (UI) was the leading cause of death among WY children ages 1-9 and accounted for 44% of deaths in this age group. Drowning (23%) and motor vehicle traffic injuries (21%) were the most common mechanisms of UI fatal injuries (VSS). Childhood mortality and injury hospitalization are no longer a WY Title V priority, but MCH Epi will continue to monitor this topic.

Overall Health and Preventive Care

According to the 2019-2020 NSCH, 91% of WY children ages 0-11 were reported to be in excellent or very good health, 48.0% received care in a medical home, 55% had adequate and continuous insurance, and 16% received care in a well-functioning system. A significantly higher prevalence of children who received care in a medical home were reported to be in excellent or very good health, compared to children who did not receive care in a medical home.

In 2019, 65% of eligible, Medicaid-enrolled children ages 1-9 who should receive at least one initial or periodic EPSDT screening received at least one screening. WY continues to see an increase in the percent of eligible children receiving at least one EPSDT screening, with an 18% increase since 2013. 2020 data is not yet available (WY Centers for Medicare & Medicaid Services [CMS] 416 Report).

Obesity and Physical Activity

In 2019-2020, 11% of WY children ages 10-13 were obese, significantly less than 16% in the U.S. (NSCH). In 2019-2020, 39% of WY children ages 6-11 were active for 60 minutes every day, which was significantly higher than the U.S. prevalence of 26% (NSCH). Small numbers continue to make any noted disparities in physical activity between different groups of children difficult to evaluate.

Adolescent Health

Adolescent Mortality

The WY adolescent (ages 10-19) mortality rate (AMR) decreased significantly from the 2009 rate of 66.8/100,000 adolescents to 31.8/100,000 adolescents in 2018, then increased in 2019 to 52.7/100,000. There was another decrease in 2020 to 43.1/100,00, the 2020 rate was not significantly different from the 2009 rate. The 2020 WY AMR was not significantly different than the 2020 US AMR of 37,6/100,000. From 2011-2021, the leading cause of death among 10-19 year olds in WY was UI (41% of deaths) and suicide (34% of deaths) (VSS).

The 2018-2020 AMR was significantly higher among ages 15-19 (65.6/100,000) compared to ages 10-14 (21.2/100,000), males (59.4/100,000) compared to females (25.4/100,000) and Non-Hispanic AI/ANs (150.8/100,000) compared to Non-Hispanic Whites (40.7/100,000).

Motor Vehicle Mortality

The 2018-2020 adolescent (ages 15-19) motor vehicle mortality rate in WY has decreased from the 2007-2009 rate of 37.8/100,000 to 21.9/100,000 (NVSS, 2018-2020). However, the WY rate has been significantly higher than the US rate since 2007. While the U.S. male rate for 2016-2020 of 15.1/100,000 was significantly higher than the U.S. female rate of 8.0/100,000, there was no observed difference between WY male rate (23.1/100,000) and the female rate (19.4/100,000) for 2016-2020.

The YAYAHP is focusing on injury hospitalization among 10-19 year olds as an NPM for decreasing motor vehicle mortality. The WY injury hospitalization rate for 10-19 years old in 2019 (248.9/100,000 10-19 year olds) was significantly higher than the 2019 U.S. rate (204.2/100,000). The YAYAHP is implementing Teens in the Driver’s Seat as a strategy to tackle motor vehicle mortality and injury hospitalizations by focusing on seat belt use among adolescents. In partnership with MCH Epi, the YAYAHP added a new question around seatbelt use to the WY Prevention Needs Assessment (PNA), as the Youth Risk Behavior Surveillance System is no longer administered in WY.

Suicide, Self-Harm, and Risk and Protective Factors

By 2017-2019, the WY adolescent suicide rate (32.1/100,000) increased by more than two-thirds the rate it was from 2007-2009 (18.0/100,000), while the U.S. rate has increased by half of what it was from 2007-2009 (7.2/100,000) to 2017-2019 (10.8/100,000). The WY rate decreased between 2017-2019 to 2018-2020 from 32.1/100,000 to 23.7/100,000, but the WY rate has remained significantly higher than the U.S. rate since 2007-2009. Suicides made up 32% of all deaths among adolescents ages 10-19 in WY from 2009 to 2019 (VSS). From 2015 to 2019, adolescent males in WY died by suicide at a significantly higher rate (48.5/100,000) than adolescent females (11.5/100,000). Data on the WY female rate from 2016-2020 is not reportable, however this difference is also seen in national data (NVSS).

The YAYAHP is working to increase adolescent well visit rates and promote mental health screenings during adolescent well visits. In 2019/2020, 71% of adolescents, 12-17 years, had a preventive medical visit in the past year, compared to 76% in the U.S., and down from 78% in 2016/2017 (NSCH). According to 2019 WY Medicaid data, 34% of adolescents (ages 10-20 years) eligible to receive at least one screening received a screening, an increase from 24% in 2015 when the lowest rate in the past 10 years was observed (WY CMS 416 report).

Children with Special Health Care Needs

Approximately 18% of WY children ages 0-17 years (24,064) have a special health care need. In 2019/2020, 52% of WY CYHSCN had insurance that was considered adequate for a child’s health needs, significantly less than the U.S. percentage of 63% of CYHSCN. In WY, 12.7% of CYSHCN reported receiving care in a well-functioning system compared to 14% of CYSHCN in the U.S. (NSCH).

In 2019/2020, 42% of WY CYSHCN reported having a medical home, compared to the 49% of non-CSHCN children in WY, and 42% of CYSHCN in the U.S. WY’s CYSHCN Program has chosen to work on increasing the prevalence of WY CYSHCN receiving care in a medical home over the next five years, with a specific focus on the need to improve the care-coordination component of a medical home for this population. The prevalence of WY CSHCN receiving care-coordination when needed (57%) is the lowest among all the components of a medical home (NSCH).

Emerging Needs Update

Childhood Lead Poisoning Prevention

The WDH PHD historically lacked capacity and funding for a lead surveillance and prevention program. Blood lead test results are a reportable condition in WY. In 2021, only 3% of WY children under the age of six were tested for lead, and 2% of those tested had elevated blood lead levels. In comparison, in the U.S. in 2018 (the most recent year available for comparison), 18% of children under the age of six were tested for lead, and 3% of those tested had elevated blood lead level. An epidemiologist has been hired to support implementation of the CDC Childhood Lead grant, awarded to WDH PHD in August 2021. MCH is an implementation partner on this grant.

COVID-19 and MCH Emergency Preparedness and Response

In FY21, all MCH Epi staff and some WY MCH staff continued support for the State’s COVID-19 response, including staffing COVID-19 call lines, case investigation, contact tracing, and COVID-19 data collection, analysis, and reporting. MCH staff contributed subject matter expertise related to the impact of COVID-19 on pregnant women and children.

MCH Epi is conducting a linkage of COVID-19 cases in women of reproductive age to birth/fetal death records in 2020 and 2021 to describe the pregnant population who also had COVID-19 and monitor the outcomes of both the infant and mother. MCH Epi is monitoring for potential maternal mortality cases who also were diagnosed with COVID-19. To date, there have been no maternal mortality cases linked to COVID-19 cases.

Since late 2020, a CDC Public Health Associate Program (PHAP) fellow has worked to expand WY MCH capacity to address the MCH population needs and systems of care in emergency preparedness and response. The associate coordinated with the NBS Program and the Public Health Preparedness and Response (PHPR) Unit to develop the state’s first NBS Emergency Procedures Plan (EPP), designed to assure continuity of operations during an emergency situation. The associate also developed the state’s first-ever Wyoming Access and Functional Needs (AFN) Core Advisory Committee Charter to guide collective AFN preparedness efforts. WY MCH will continue collaboration with PHPR.

Oral Health

The WDH PHD Oral Health Program was eliminated in 2016 due to budget cuts. The role of WY MCH in oral health activities is limited. The unit participates in a statewide WY Oral Health Coalition co-led by the WYPCA. In 2020, the WY Oral Health Coalition received funding from the State Office of Rural Health (SORH) to update a statewide oral health NA. These efforts were suspended due to turnover experienced by the grantee agency, and the assessment has not been completed. When efforts resume, WY MCH will use results to monitor oral health among MCH populations, determine our capacity to address needs, and add to our work plans as it relates to the Title V Priority, Promote Healthy and Safe Children.

Child and Adolescent Health Insurance

In 2019/2020, the prevalence of children ages 0-17 who were adequately insured in the past year in WY (55%) was significantly less than the U.S. prevalence (67%), and significantly less than the WY prevalence in 2016-2017 (63%). According to the 2019 American Community Survey, 10.1% of WY children (ages 0-17) were not currently insured, significantly higher than the U.S. prevalence (5%). When examined by race, the highest prevalence of uninsured children was among non-Hispanic AI/AN (31%) (ACS). Due to the pandemic, 2020 data is not available. In 2019/2020, uninsured children (ages 1-17) had the lowest prevalence (58%) of having a preventive dental visit in the past year, as well as the lowest prevalence (24%) of receiving care within a medical home (NSCH). These numbers, coupled with the uninsured statistics from the CYSHCN population, clearly show there is much work left to do in these areas.

Capacity Update

In 2021, the former CHP and CYSHCN Program were consolidated to form an expanded CYSHCN Program overseeing the Child Health and CSHCN population domains. This program is now led by one program manager who also assumes the role of the Title V CYSHCN Director. The WY NBS and Genetics Program was transferred to the CYSHCN program in 2021 to consolidate all CYSHCN services and workforce.

The WY MCH team has undergone a near-full leadership change. The WY MCH Unit Manager/Title V Director assumed the role in February 2022, followed by a new CYSHCN Program Manager/CYSHCN Director in April 2022. The current WIHP Manager assumed the role in November 2021. The YAYHP Manager is the most tenured program manager in the unit, having served in the role for nearly two years. Capacity has been impacted given the personnel changes in WY MCH, however, the unit’s capacity will improve going forward.

WY MCH continues to allocate state funding to local PHN offices or local health departments to support local MCH programming. Due to the economic downturn, state funding reductions will impact county funding in biennium fiscal year 2023-2024. WY MCH has since integrated Title V 2021-2025 priorities and strategies into contracts with local PHN under the contract renewal process.

Title V Partnerships and Collaborations Update

WY MCH partners with MCH Epi for epidemiology and evaluation support. MCH Epi manages the SSDI grant for Wyoming. WY MCH also collaborates with other MCHB investments, such as the F2FHIC (housed in the UW WIND). In the next year, WY MCH will also participate in the Region VII Tribal Relations Community of Practice.

WY MCH partners with other state agencies and programs to improve MCH population health, including: Health Care Financing (HCF); DWS; DFS; WDE; WDH BHD; WDH PHD programs (e.g., WIC, WIVPP, PHPR, SORH, Communicable Disease Unit); UW; WY Health Council (Title X grantee); the federal MIECHV grant, administered by DFS; and other statewide organizations and associations (e.g., WY Medical Society, WY Hospital Association, Uplift, WY Primary Care Association [WYPCA], WY American Academy of Pediatrics (AAP) Chapter, WY American College of Obstetricians and Gynecologists Chapter, WY Kids First, WY Afterschool Alliance, WY 211, WY Community Foundation).

WY MCH representatives sit on the following statewide councils:

WY Governor’s Council on Developmental Disabilities
WY Governor’s Early Childhood State Advisory Council
WY Early Intervention Council
WY Preschool Development Grant Executive Leadership Committee
WY Citizen Review Panel

In 2022, WY MCH executed new two-year contracts with all 23 counties using TANF and state funds provided for reimbursement of MCH services. These funds support an estimated 47 full-time employees across WY in support of MCH services. Although no formal funding agreements exist, WY MCH also works with the Northern Arapaho and Eastern Shoshone Tribes to promote and provide gap-filling financial assistance and care coordination services as part of the CYSHCN Program. CYSHCN staff provide training and support to tribal nurses to improve and sustain programming.

In the coming year, WY MCH will continue to establish and build partnerships with state and local organizations that serve the state’s MCH population or otherwise have a vested interest in health, social, and economic outcomes facing families in our state.

Efforts to Operationalize Five-Year Needs Assessment Findings

The WY MCH NA framework was not designed to be static or time-defined. Many elements will persist throughout the five-year grant cycle.

Steering Committee and Partner Involvement

The WY MCH/Title V SC formed in 2019 to drive NA activities, approve priorities, and hold WY MCH accountable to its developed state action plan (SAP). This SC met in January 2020 to approve draft Title V priorities. Due to COVID, the SC did not meet again until June 2021, at which time the SC approved the final WY MCH SAP. The SC met again in June 2022 to hear implementation updates, offer guidance and feedback, and assure accountability to the plan. The committee is expected to meet annually hereafter to receive implementation updates and offer feedback and recommendations to support WY MCH accountability, increase leadership buy-in, and provide opportunities for ongoing feedback and QI.

Strategic Plan Implementation

In January 2021, WY MCH released a Request for Proposal (RFP) for strategic planning, strategic implementation, workforce development, and leadership consultation services. Seven proposals were received and Lolina, Inc. was selected for an initial two-year contract, with options for renewals throughout the 2021-2025 Title V cycle.

In partnership with Lolina, WY MCH uses a 60/60 implementation structure, where we visit progress across domains every eight weeks and discuss the successes, challenges, and how MCH values are being operationalized over the past 60 days, and what is planned for implementation in the next 60 days. This performance and implementation management process is designed to support individual and team accountability for implementation of strategies, rotating by domain to ensure each MCH population domain is highlighted.

WY MCH will revisit and revise its SAP and ESMs/State Performance Measures (SPMs) before FFY23, and will receive TA from the MCH Evidence Center and Lolina, Inc. throughout summer 2022. WY MCH will then focus on resource allocation and structure its budget to align with updates to the SAP.

Organizational Structure and Leadership Updates

WY MCH administers the Title V MCH Services Block Grant and provides leadership for state and local efforts that improve the health of MCH populations. The table below outlines MCH and MCH Epi staff and their full-time employee (FTE) status.

Staff Member	Title/Role	Unit/ Program	FTE	Title V Domain	Tenure with WY MCH/ MCH Epi (Tenure with State of WY)
Feliciana Turner	MCH Unit Manager, Title V Director	MCH	1	All	<1 (16)
Carleigh Soule, MS	CYSHCN Program Manager, Title V CSHCN Director	MCH	1	Child; CYSHCN; Cross- Cutting	16 (16)
Megan Selheim, BS, MFA	Youth and Young Adult Health Program Manager	MCH	1	Adolescent; Cross- Cutting	2 (2)
Kelly Belz, MPH	Women and Infant Health Program Manager	MCH	1	Women/ Maternal; Perinatal/ Infant; Cross- Cutting	<1 (<1)
Amanda Creathbaum, AS	Grants and Contracts Specialist, Title V Block Grant Coordinator	MCH	1	All	<1 (4)
Vacant as of 4/4/2022	Newborn Screening and Genetics Coordinator	MCH	1	Perinatal/ Infant; CYSHCN; Cross- Cutting	N/A
Natalie Hudanick, MPH	Women and Infant Health Program Coordinator	MCH	1	Women/ Maternal; Perinatal/ Infant; Child; Cross- Cutting	1 (1)
Denise Robinson	Benefits and Eligibility Specialist	MCH	1	CYSHCN; Cross- Cutting	2 (15)
Sheli Gonzales	Benefits and Eligibility Specialist	MCH	1	CSHCN; Cross- Cutting	16 (20)
Eleana Dubreus	CDC PHAP Associate	MCH	1	All	2 (2)
Vacant (new position)	Pediatric Mental Healthcare Access Grant Coordinator	MCH	1	CYSHCN; Adolescent	N/A
Ashley Busacker, PhD	Senior Epidemiology Advisor	MCH Epi	1	All	12 (12)
Joseph Grandpre, PhD	Chronic Disease/MCH Epi Unit Manager	MCH Epi	0.25	All	9 (20)
Moira Lewis, MPH	MCH Epidemiology Program Manager	MCH Epi	1	All	3 (3)
Neva Ruso, MPH	PRAMS Coordinator/MCH Epidemiologist	MCH Epi	1	All	2 (2)

Key organizational/staffing changes since last report’s submission include:

MCH Unit Manager/Title V Director position vacated in January 2022 and rehired in February 2022
CYSHCN Program Manager/CYSHCN Director position vacated in December 2021 and rehired in April 2022
Posting/recruitment for a PMHCA grant coordinator position
Posting/recruitment of the NBSGPC vacated in April 2022 due to promoting the previous NBSGPC into the CYSHCN position
CDC PHAP graduated in June 2022

See below for an updated WY MCH organizational chart as of April 2022.

WY MCH partners closely with PHN Unit leadership and two full-time PHN staff to implement a statewide home visiting program and support implementation of local MCH services, including CYSHCN care coordination services.

WY MCH benefits from a strong MCH Epi housed within the Public Health Sciences Section of the WDH PHD. Program staff include a Program Manager, MCH Epi/PRAMS Coordinator, CDC-Assigned Senior MCH Epidemiologist, and Chronic Disease/MCH Epi Unit Manager (0.25 FTE support for MCH Epi). A fifth MCH epidemiology position, a MCH/Injury Epidemiologist, was eliminated due to budget reductions. See below for an updated WY MCH Epi organizational chart as of April 2022.

The CDC MCH Senior Epidemiology Advisor is located to the left of the Chronic Disease/MCH Epidemiology Unit Manager, Joe Grandpre. Joe Grandpre supports an MCH Epidemiology Program Manager, Moira Lewis, who is supported by an Epidemiologist and PRAMS Coordinator, Neva Ruso.

WY MCH Epi Organizational Chart as of April 2022

Ongoing Needs Assessment Activities

WY MCH leadership and MCH Epi staff will work closely to identify and implement interim activities to occur between 5-year needs assessments (NA).

Current and planned ongoing NA activities include:

Cross-Domain Efforts:
- MCH Epi maintains dashboards to monitor key indicators from birth certificate data, PRAMS, and Title V NOMs and NPMs for ongoing assessment, to identify trends and disparities, and makes data more accessible to partners.
- MCH Epi creates data briefs focused on the selected MCH priorities and selected NPMs.
- WY MCH will begin planning for the next five-year needs assessment. This will involve developing a framework that will incorporate social determinants of health and plan for community and family engagement throughout the entire process.
- In spring 2023, WY MCH released an online public input survey to gather input on recent and planned activities and identify emerging needs. For each domain, the survey asked, “What are the unmet needs in your community?” WY MCH will use the results to inform ongoing action planning and implementation.
- WY MCH will annually convene MCH/Title V Steering Committee (SC) to gather feedback on state action plan progress and address challenges/barriers.
Children/CYSHCN:
- The CYSHCN Director is undertaking assessment and planning activities to inform future strategic direction for the program. This will involve reviewing program data, analyzing key indicators from the NSCH, reviewing CYSHCN expenditure data, collecting staff and public health nurses’ perspectives, and reviewing previous CYSHCN national standards assessment and other frameworks and guides (e.g., Blueprint). As this work progresses, these efforts will engage communities/families.
- WY MCH has invested in NSCH oversampling for two years. The first full completion of oversampling occurred for NSCH 2022, with 1,250 responses (double the baseline number of responses for Wyoming). This is anticipated to provide Wyoming a larger data set to further assess CYSHCN population needs and identify disparities by demographic characteristics.
Women and Infant Health:
- The WIHP continues to engage in maternal mortality review to identify contributing factors and inform prevention recommendations.
Youth and Young Adult Health:
- WY MCH will leverage Title V and SSDI funds and partner with the CPU to survey young adults. The first iteration occurred in 2022. The survey focuses on 18-29 year olds and asks about attitudes and behaviors related to substance use, mental health, motor vehicle safety, healthcare access, sexual health, and interpersonal violence. The data will further inform current and future strategies. In addition to the standard report at the state and county level, WY MCH has applied for an intern through the Graduate Student Epidemiology Program (GSEP) for more detailed analysis across demographic stratifiers.
- WY MCH leveraged other federal funds to support a comprehensive sexual violence needs assessment and economic impact report, released in March 2023, that will inform shared risk and protective factors with other MCH priorities.

Health Status and Needs Update

Women’s/Maternal Health

Maternal Mortality and Morbidity

The Wyoming MMRC has completed reviews of 2018-2021 pregnancy-associated deaths. From 2018-2021, 16 women died during pregnancy or within one year after the end of their pregnancy. Most of these deaths occurred after the end of their pregnancy. Fifteen of these deaths were reviewed and seven were determined by the committee to be pregnancy-related. Mental health conditions were the most common cause of pregnancy-related deaths. Substance use was involved in six of the seven pregnancy-related deaths. All but one of the pregnancy-related deaths were deemed to be preventable.

From 2017-2021, WY’s severe maternal morbidity rate was 86.3 per 10,000 delivery hospitalizations. The most common severe maternal morbidity in WY is transfusion, followed by eclampsia.

Maternal Mental Health

In WY, 20.3% of new moms reported pre-pregnancy depression, 19.4% reported depression during pregnancy, and 14.5% reported postpartum depression (PPD). PPD was highest among women ages 15-24 years, and also significantly higher for women in the lowest FPL, as well as among American Indian/Alaska Native (AI/AN) women compared to White women, and women with less than a high school education or equivalent compared to those with more than a high school education. A majority (87.4%) of women reported their providers discussed depression with them at a postpartum visit (PRAMS, 2016-2021).

Preconception Health

According to the 2021 Behavioral Risk Factor Surveillance System (BRFSS), 68% of WY women reported having a preventive medical visit in the past year, the first time in over a decade this prevalence was not significantly less than the U.S. prevalence. In 2021, the prevalence of women reporting having a well women visit in the past year continued to be highest for those with a college degree or more (77%), and those with a household income of $75,000 or more (79%). A higher prevalence of women with health insurance (76%) compared to uninsured women (35%) report having a preventive medical visit in the past year.

Maternal Smoking

Significant reductions in the prevalence of women smoking during pregnancy continue to be seen in the U.S. and WY. While the WY 2021 prevalence (10%) was significantly less than the WY 2020 prevalence (13%), it is still significantly higher than the U.S. 2021 prevalence of 5% (National Vital Statistics System [NVSS]). The prevalence of smoking during pregnancy was significantly higher among WY women with less than a high school education (26%) compared to those with at least a high school education (18%), those with some college education (8%), and those who graduated from college (1%), and significantly higher among women on Medicaid (23%) compared to those who are uninsured (12%) and those with private insurance (4%) (NVSS). WY still needs to increase the percentage of women giving birth who did not smoke during pregnancy by 5% to reach the HP2030 goal of 96% of women giving birth not reporting smoking during pregnancy.

Family Planning

In 2021, 21.5% of women reported having an unintended pregnancy, compared to 33% in 2012. The rate of unintended pregnancies did not differ by race, but differences were seen by income level. Women living with incomes ≤100% FPL reported having an unintended pregnancy significantly more (38.9%) compared to women living with incomes 201-300% FPL (16.3%) and 301%+ FPL (12.9%).

In 2021, 54% of WY women at risk of pregnancy/not actively trying to become pregnant reported use of the most/moderately effective form of contraception. The prevalence has not changed significantly since 2015. No differences were seen by race/ethnicity, income, or Medicaid status. While not currently a Title V priority, MCH Epi will continue to monitor contraceptive use (PRAMS).

Perinatal/Infant Health

Births

From 2018-2022, there were a total of 31,348 births of WY residents, an average of 6,297/year. Of those births, 89% occurred within WY, and 11% occurred out-of-state. Among in-state births, 73% occurred in seven facilities. Two of those seven facilities accounted for 35% of in-state births.

Infant Mortality

WY’s 2018-2022 infant mortality rate (IMR) was 5.7 deaths/1,000 live births; with a majority of deaths (74%) occurring among neonatal infants (WY VSS), compared to the national rate of 5.4 deaths/1,000 live births in 2020. Both met the HP2020 objective (6.0 deaths/1,000 live births); but not the HP2030 objective of 5.0. From 2018-2022, the WY IMR among white women from urban counties was 7.0 deaths/1,000 live births, compared to 5.9/1,000 for women from rural counties, and 4.5/1,000 for women from frontier counties (VSS 2018-2022).

Both neonatal and postneonatal mortality rates in WY have been similar to U.S. rates over the past 10 years. From 2018-2022, the leading causes of death among WY neonates were congenital malformation, deformations, and chromosomal abnormalities, followed by disorders related to short gestation and low birth weight. The leading causes of postneonatal infant death were SUID, congenital malformation, deformations, and chromosomal abnormalities (VSS).

Preterm and Low Birth Weight (LBW) Births

In 2021, 11% of WY infants were born preterm, the same as the 2021 U.S. prevalence. Since 2009, WY’s preterm prevalence has fluctuated from a high of 11% in 2014 and a low of 9% in 2017. The 2021 prevalence was comparable to the 2009 prevalence. The 2021 prevalence of LBW births in WY was 9%. The WY prevalence has been significantly higher than the U.S. since 2018. WY has not met the HP2020 preterm goal of 9%, or the HP2020 LBW goal of 8%. MCH Epi will continue to monitor changes in preterm and LBW deliveries and will examine the LBW increase in more detail.

Infant Sleep Environment

The leading cause of postneonatal infant death in WY from 2018 to 2022 was SUID. Over 84% of WY women reported their infants are put to sleep on their backs only (PRAMS, 2016-2021), exceeding the HP2020 goal of 76%. However, less than one third of women reported their infants always or often were placed to sleep on a separate approved sleep surface; 36.6% reported their infants were usually placed to sleep with no soft bedding. Disparities in sleep environments were seen by race, age, and income.

Breastfeeding

The WY breastfeeding initiation rate (91.2%) exceeds the HP2020 Goal (82%) (PRAMS, 2016-2021). According to the National Immunization Survey (NIS), in 2018 30% of infants in WY were breastfed exclusively through six months compared to 26% in the U.S. To reach the HP2030 goal of 42% of infants breastfed exclusively through six months, WY needs to increase its percentage in 2018 by 41% (NIS). Breastfeeding is currently not a Title V priority, and while WY continues to show good breastfeeding rates, monitoring will continue.

Child Health

Child Mortality

In 2021, the WY child mortality rate (CMR) among children ages 1-9 years was 30.4/100,000, significantly higher than the U.S. rate of 17.5/100,000. The WY CMR has not changed significantly since 2009. The 2017-2019 CMR is significantly higher for children ages 1-4 (25.3/100,000) than for children ages 5-9 (20.3/100,000). Rates for 2020 are not available.

Unintentional Injury

Between 2012 and 2022, unintentional injury (UI) remained the leading cause of death among WY children ages 1-9 and accounted for 44% of deaths in this age group. Motor vehicle traffic injuries (23%) and drowning (21%) were the most common mechanisms of UI fatal injuries (VSS). Childhood mortality and injury hospitalization are not currently a WY Title V priority, but MCH Epi continues to monitor this topic.

Overall Health and Preventive Care

According to the 2020-2021 NSCH, 91% of WY children ages 0-11 were reported to be in excellent or very good health, 49.0% received care in a medical home, 56% had adequate and continuous insurance, and 17% received care in a well-functioning system. A significantly higher prevalence of children who received care in a medical home were reported to be in excellent or very good health, compared to children who did not receive care in a medical home.

In 2020, 45% of eligible, Medicaid-enrolled children ages 1-9 who should receive at least one initial or periodic EPSDT screening received at least one screening, a drop from 65% the previous year. This was the first decrease in the percent of eligible children receiving at least one EPSDT screening since 2015. In both WY and the U.S., decreases were seen for almost all ages in 2020 (WY Centers for Medicare & Medicaid Services [CMS] 416 Report).

Obesity and Physical Activity

In 2020-2021, 12% of WY children ages 10-13 were obese, significantly less than 17% in the U.S. (NSCH). In 2020-2021, 40% of WY children ages 6-11 were active for 60 minutes every day, significantly higher than the U.S. prevalence of 26% (NSCH). Small numbers continue to make any noted disparities in physical activity between different groups of children difficult to evaluate.

Adolescent Health

Adolescent Mortality

The WY adolescent (ages 10-19) mortality rate (AMR) increased from 43.1/100,000 in 2020 to 62.6/100,000 in 2021, significantly higher than the U.S. rate of 39.5/100,000. From 2012-2022, the leading cause of death among 10-19 year olds in WY was UI (42% of deaths) and suicide (34% of deaths) (VSS).

The 2019-2021 AMR was significantly higher among ages 15-19 (82.3/100,000) compared to ages 10-14 (25.2/100,000), males (74.7/100,000) compared to females (29.5/100,000). Due to small numbers in 2019-2021, disparities by race/ethnicity are not able to be observed.

Motor Vehicle Mortality

The 2019-2021 adolescent (ages 15-19) motor vehicle mortality rate in WY was 22.4/100,000, similar to the rate reported for 2018-2020 (21.9/100,000), and still significantly higher than the U.S. 2019-2021 rate of 12.0/100,00 (NVSS, 2019-2021). While the U.S. male rate for 2017-2021 of 15.4/100,000 was again significantly higher than the U.S. female rate of 8.1/100,000, there was still no significant difference between WY male rate (25.0/100,000) and the female rate (17.0/100,000) for 2017-2021.

The YAYAHP continues to focus on injury hospitalization among 10-19 year olds as an NPM for decreasing motor vehicle mortality. The WY injury hospitalization rate for 10-19 years old in 2020 (235.0/100,000 10-19 year olds) was no longer significantly higher than the 2020 U.S. rate (210.0/100,000), which was the case in 2019. The YAYAHP is working on expanding Teens in the Driver’s Seat to more schools to tackle motor vehicle mortality and injury hospitalizations by focusing on seat belt use among adolescents. In 2022, initial data was collected on seatbelt use from a new question in WY Prevention Needs Assessment (PNA), added via a partnership with MCH Epi and the YAYAHP. Initial data show that just over half (52%) of middle and high schoolers in Wyoming reported to “always” wear their seatbelt when riding in a car.

Suicide, Self-Harm, and Risk and Protective Factors

The 2019-2021 WY adolescent suicide rate was 30.4/100,000, continuing to be significantly higher than the U.S. rate of 10.6 in 2019-2021. Suicides made up 34% of all deaths among adolescents ages 10-19 in WY from 2012 to 2022 (VSS). The 2017-2021 suicide rate for adolescent males was 45.8/100,000, continuing to be significantly higher than the adolescent female rate of 13.6/100,000 (NVSS).

Children with Special Health Care Needs

Approximately 20% of WY children ages 0-17 years (26,199) have a special health care need. In 2020/2021, 52% of WY CYSHCN had insurance that was considered adequate for a child’s health needs, again, significantly less than the U.S. percentage of 64% of CYSHCN. In WY, 18% of CYSHCN reported receiving care in a well-functioning system compared to 14% of CYSHCN in the U.S. (NSCH).

In 2020/2021, 48% of WY CYSHCN reported having a medical home, similar to the 49% of non-Children with Special Health Care Needs (CSHCN) children in WY, and 42% of CYSHCN in the U.S. WY’s CYSHCN Program is currently taking a closer look at data from the NSCH to assist in planning the next steps for the program. As part of this effort, WY is currently participating in a three- year oversample for the NSCH to ensure enough data is available to be able to help drive decisions for future programmatic efforts.

Emerging Needs Update

Childhood Lead Poisoning Prevention

Blood lead test results are a reportable condition in WY. In 2022, only 5% of WY children under the age of six were tested for lead, and 2% of those tested had elevated blood lead levels. In comparison, in the U.S. in 2018 (the most recent year available for comparison), 18% of children under the age of six were tested for lead, and 3% of those tested had elevated blood lead level. The WDH PHD historically lacked capacity and funding for a lead surveillance and prevention program; however, WDH PHD was awarded the CDC Childhood Lead grant in August 2021. MCH is an implementation partner on this grant.

COVID-19

In 2023, MCH Epi is planning to conclude the initial linkage of COVID-19 cases in women of reproductive age to birth/fetal death records from 2020-2022 to describe the pregnant population who also had COVID-19 and monitor the outcomes of both the infant and mother. MCH Epi continues to monitor for potential maternal mortality cases who also were diagnosed with COVID-19. To date, there have been no maternal mortality cases linked to COVID-19 cases.

WY PRAMS added two COVID-19 supplements. The general COVID-19 supplement began in October 2020 with the July 2020 births. The COVID-19 Vaccine Supplement, asking about vaccine administration and hesitancy, began data collection in April 2021 with the January 2021 births. Both supplements are no longer being collected starting with 2023 births, and MCH Epi should have the final datasets for these in late 2023 to conduct analyses.

Oral Health

The WDH PHD Oral Health Program was eliminated in 2016 due to budget cuts. The unit participates in a statewide WY Oral Health Coalition led by the Wyoming Primary Care Association (WYPCA). WY MCH will consider how to incorporate oral health as part of the next five-year needs assessment health, determine our capacity to address needs, and assess if including it as a priority is feasible.

An important policy decision related to oral health was made during the 2023 legislative session. The approved supplemental budget included a Medicaid dental reimbursements rate increase. This increase is expected to improve access to dental care for Medicaid patients. Over half of Medicaid patients are children.

Child and Adolescent Health Insurance

In 2020/2021, the prevalence of children ages 0-17 who were adequately insured in the past year in WY (56%) continued to be significantly less than the U.S. prevalence (68%). According to the 2021 American Community Survey, about 1 in 10 (10%) of WY children (ages 0-17) were not currently insured, significantly higher than the U.S. prevalence (5%). When examined by race, the highest prevalence of uninsured children was among non-Hispanic AI/AN (26%), followed by Hispanic children (23%) (ACS). In 2020/2021, only 55% of uninsured children (ages 1-17) in WY were reported as having a preventive dental visit in the past year compared to 84% of insured children, and only 21% of uninsured children received care within a medical home compared to 50% of insured children (NSCH). These numbers, coupled with the uninsured statistics from the CYSHCN population, clearly show there is much work left to do in these areas.

Capacity Update

In early 2022, the WY MCH team underwent leadership changes. The WY MCH Unit Manager/Title V Director assumed the role in February 2022, followed by a new CYSHCN Program Manager/CYSHCN Director in April 2022. However, the remainder of the year, the WY MCH team experienced relatively few changes in capacity or staff turnover. In March 2023, the Title V Coordinator resigned, leaving a vacancy. The position was refilled by the end of April 2023.

WY MCH continues to allocate state funding to local PHN offices or local health departments to support local MCH programming. Due to the economic downturn, state funding reductions will impact county funding in biennium fiscal year 2023-2024. PHN offices also experience staffing challenges, especially in the most rural/frontier counties. WY MCH has since integrated Title V 2021-2025 priorities and strategies into contracts with local PHN under the contract renewal process.

Title V Partnerships and Collaborations Update

WY MCH partners with MCH Epi for epidemiology and evaluation support. MCH Epi manages the SSDI grant for Wyoming. WY MCH also collaborates with other Maternal and Child Health Bureau (MCHB) investments, such as the Family to Family Health Information Center (F2FHIC) (housed in the UW WIND). In 2022, WY MCH also participated in the Region VII Tribal Relations Community of Practice.

WY MCH partners with other state agencies and programs to improve MCH population health, including: Health Care Financing (HCF); DWS; DFS; WDE; WDH BHD; WDH PHD programs (e.g., WIC, WIVPP, Public Health Preparedness and Response (PHPR), State office of Rural Health (SORH), Communicable Disease Unit); UW; WY Health Council (Title X grantee); the federal MIECHV grant, administered by DFS; and other statewide organizations and associations (e.g., WY Medical Society, WY Hospital Association, Uplift, WYPCA, WY American Academy of Pediatrics (AAP) Chapter, WY American College of Obstetricians and Gynecologists Chapter, WY Kids First, WY Afterschool Alliance, WY 211, WY Community Foundation).

WY MCH representatives sit on the following statewide councils:

WY Governor’s Council on Developmental Disabilities
WY Governor’s Early Childhood State Advisory Council
WY Early Intervention Council
WY Preschool Development Grant Executive Leadership Committee

Efforts to Operationalize Five-Year Needs Assessment Findings

The WY MCH NA framework was not designed to be static or time-defined. Many elements will persist throughout the five-year grant cycle.

Steering Committee and Partner Involvement

The WY MCH/Title V SC formed in 2019 to drive NA activities, approve priorities, and hold WY MCH accountable to its developed state action plan (SAP). This SC met in January 2020 to approve draft Title V priorities. Due to COVID, the SC did not meet again until June 2021, at which time the SC approved the final WY MCH SAP. The SC met again in June 2022 and 2023 to hear implementation updates, offer guidance and feedback, and assure accountability to the plan. The committee is expected to meet annually to receive implementation updates and offer feedback and recommendations to support WY MCH accountability, increase leadership buy-in, and provide opportunities for ongoing feedback and Quality Improvement (QI).

Strategic Plan Implementation

In partnership with Lolina, WY MCH has engaged in performance management activities. Formerly, we conducted 60/60s to discuss implementation by domain every 60 days; however in 2022, WY MCH moved toward quarterly QI workshops to begin in spring 2023. This process is designed to support individual and team accountability for implementation of strategies and improve capabilities to operationalize our values.

WY MCH will revisit and revise its SAP and ESMs/State Performance Measures (SPMs) before FFY24, and will receive TA from the MCH Evidence Center and Lolina, Inc. throughout summer 2023. WY MCH will then focus on resource allocation and structure its budget to align with updates to the SAP.

Organizational Structure and Leadership Updates

Staff Member	Title/Role	Title V Domain	Tenure with WY MCH/ MCH Epi (Tenure with State of WY)
Feliciana Turner, BS	MCH Unit Manager, Title V Director	All	1 (17)
Carleigh Soule, MS	CYSHCN Program Manager, Title V CSHCN Director	Child; CYSHCN; Cross- Cutting	17 (17)
Megan Selheim, BS, MFA	Youth and Young Adult Health Program Manager	Adolescent; Cross- Cutting	3 (10)
Kelly Belz, MPH	Women and Infant Health Program Manager	Women/ Maternal; Perinatal/ Infant; Cross- Cutting	1.5 (1.5)
Jaycie Gutierrez, AS	Grants and Contracts Specialist, Title V Block Grant Coordinator	All	<1 (<1)
Meg Callahan, BS	Newborn Screening and Genetics Coordinator	Perinatal/ Infant; CYSHCN; Cross- Cutting	<1 (<1)
Natalie Hudanick, MPH	Women and Infant Health Program Coordinator	Women/ Maternal; Perinatal/ Infant; Child; Cross- Cutting	2 (2)
Denise Robinson	Benefits and Eligibility Specialist	CYSHCN; Cross- Cutting	3 (16)
Sheli Gonzales	Benefits and Eligibility Specialist	CYSHCN; Cross- Cutting	17 (21)
William Nolan, BS	WIC/MCH Data Management Specialist	All	<1 (<1)
Quinn Brophy, BA	CDC PHAP Associate	Adolescent	<1 (<1)
Joseph Grandpre, PhD	Chronic Disease/MCH Epi Unit Manager	All	10 (21)
Moira Lewis, MPH	MCH Epidemiology Program Manager	All	4 (4)
Neva Ruso, MPH	PRAMS Coordinator/MCH Epidemiologist	All	3 (3)
Michelle Azar, MPH	CSTE Applied Epidemiology Fellow	Women/ Maternal; Perinatal/ Infant;	1 (1)

Key organizational/staffing changes since last report’s submission include:

Unable to successfully recruit a Pediatric Mental Health Care Access (PMHCA) grant coordinator; seeking coordination services through a request for applications
Matched with a Council of State and Territorial Epidemiologists (CSTE) fellow in May 2022
Filled the newborn screening and genetics program coordinator in July 2022
Hired an at-will employee contract (AWEC) data specialist, in partnership with WIC, in July 2022
The CDC-assigned senior MCH epidemiologist vacated the position in August 2022
Onboarded a CDC PHAP in October 2022
The Title V coordinator/grants and contract specialist vacated the position in March 2023, and was refilled by the end of April 2023

See below for an updated WY MCH organizational chart as of April 2023.

WY MCH Organizational Chart as of April 2023

WY MCH benefits from a strong MCH Epi team, housed within the Public Health Sciences Section of the WDH PHD. Program staff include a Program Manager, MCH Epi/PRAMS Coordinator, CSTE Fellow, and Chronic Disease/MCH Epi Unit Manager (0.25 FTE support for MCH Epi). WY MCH and MCH Epi plan to apply for another CDC-assigned epi advisor. See below for an updated WY MCH Epi organizational chart as of April 2023.

WY MCH Epi Organizational Chart as of April 2023

Finally, WY MCH continues to partner closely with PHN Unit leadership and two full-time PHN staff to implement a statewide home visiting program and support implementation of local MCH services, including CYSHCN care coordination services.

Ongoing Needs Assessment Activities

WY MCH leadership and MCH Epi staff will work closely to identify and implement interim activities to occur between 5-year needs assessments (NA).

Current and planned ongoing NA activities include:

Cross-Domain Efforts:
- MCH Epi maintains dashboards to monitor key indicators from birth certificate data, PRAMS, and Title V NOMs and NPMs for ongoing assessment, to identify trends and disparities, and to make data more accessible to partners.
- MCH Epi creates data briefs focused on the selected MCH priorities and selected NPMs.
- WY MCH is conducting the next five-year needs assessment. This involves a framework that incorporates social determinants of health and plans for community and family engagement throughout the entire process.
- WY MCH annually convenes the MCH/Title V Steering Committee (SC) to gather feedback on state action plan progress and address challenges/barriers. During the needs assessment process, the SC will be engaged more frequently to keep them apprised of progress, challenges, and needs.
Children/CYSHCN:
- The CYSHCN Director is undertaking assessment and planning activities to inform future strategic direction for the program. This involves reviewing program data, analyzing key indicators from the NSCH, reviewing CYSHCN expenditure data, collecting staff and public health nurses’ perspectives, and reviewing previous CYSHCN national standards assessment and other frameworks and guides (e.g., Blueprint). As this work progresses, these efforts will engage communities/families.
- WY MCH has invested in NSCH oversampling for three years. The first full completion of oversampling occurred for NSCH 2022, with 1,250 responses. In 2023, Wyoming had 1,300 responses. Both years of completed oversampling have doubled the responses over the 2019 baseline of 600 responses. This is anticipated to provide Wyoming with a larger data set to further assess CYSHCN population needs and identify disparities by demographic characteristics.
Women and Infant Health:
- The WIHP continues to engage in maternal mortality review to identify contributing factors and inform prevention recommendations.
Youth and Young Adult Health:
- WY MCH leveraged Title V and SSDI funds and partnered with the CPU to survey young adults. The first iteration occurred in 2022. The survey focuses on 18-29-year-olds and asks about attitudes and behaviors related to substance use, mental health, motor vehicle safety, healthcare access, sexual health, and interpersonal violence. The data will further inform current and future strategies. In addition to the standard report at the state and county level, WY MCH worked with an intern through the GSEP for more detailed analysis across demographic stratifiers. This survey will be administered again in the fall of 2024.

Health Status and Needs Update

Women’s/Maternal Health

Maternal Mortality and Morbidity

The Wyoming MMRC has completed reviews of 2018-2021, and all but one 2022 pregnancy-associated deaths. From 2018-2022, 12 women died during pregnancy or within one year after the end of their pregnancy. Most of these deaths occurred after the end of their pregnancy. Twenty of these deaths were reviewed and ten were determined by the committee to be pregnancy-related. Mental health conditions were the most common cause of pregnancy-related deaths. Substance use was involved in six of the seven pregnancy-related deaths. All but one of the pregnancy-related deaths were deemed to be preventable.

From 2017-2021, WY’s severe maternal morbidity rate was 86.3 per 10,000 delivery hospitalizations. The most common severe maternal morbidity in WY is transfusion, followed by eclampsia.

Maternal Mental Health

In WY, 21.1% of women reported pre-pregnancy depression, 19.7% reported depression during pregnancy, and 14.4% reported postpartum depression (PPD). PPD was highest among women ages 15-24 years, and also significantly higher for women in the lowest FPL, as well as among American Indian/Alaska Native (AI/AN) women compared to White women, and women with less than a high school education or equivalent compared to those with more than a high school education. A majority (87.4%) of women reported their providers discussed depression with them at a postpartum visit (PRAMS, 2016-2022).

Preconception Health

According to the 2022 Behavioral Risk Factor Surveillance System (BRFSS), 64% of WY women reported having a preventive medical visit in the past year, significantly less than the U.S. prevalence (73%). In 2021, the prevalence of women reporting having a well-women visit in the past year continued to be highest for those with a degree or more (72%), and those aged 35-44 (71%). A higher prevalence of women with health insurance (70%) compared to uninsured women (37%) report having a preventive medical visit in the past year.

Maternal Smoking

Reductions in the prevalence of women smoking during pregnancy continue to be seen in the U.S. and WY, however, the WY 2022 prevalence (9%) remains significantly higher than the U.S. 2022 prevalence of 4% (National Vital Statistics System [NVSS]). The prevalence of smoking during pregnancy was significantly higher among WY women with less than a high school education (22%) and those with at least a high school education (17%), compared to those with some college education (8%), and those who graduated from college (1%), and significantly higher among women on Medicaid (21%) compared to those who are uninsured (8%) and those with private insurance (4%) (NVSS). WY did not see a significant difference in the 2022 prevalence compared to the 2021 prevalence (10%). Wyoming needs to increase the percentage of women giving birth who did not smoke during pregnancy by 5% to reach the HP2030 goal of 96% of women giving birth not reporting smoking during pregnancy.

Family Planning

In 2022, 24.2% of women reported having an unintended pregnancy, compared to 33% in 2012. The rate of unintended pregnancies did not differ by race, but differences were seen by income level. Women living with incomes ≤100% FPL reported having an unintended pregnancy significantly more (50.2%) compared to women living with incomes 201-300% FPL (17.5%) and 301%+ FPL (11.1%).

In 2022, 54% of WY women at risk of pregnancy/not actively trying to become pregnant reported use of the most/moderately effective form of contraception. The prevalence has not changed significantly since 2015. No significant differences were seen by race/ethnicity, income, or Medicaid status. While not currently a Title V priority, MCH Epi will continue to monitor contraceptive use (PRAMS).

Perinatal/Infant Health

Births

From 2019-2023, there were a total of 30,777 births of WY residents, an average of 6,155/year. Of those births, 89% occurred within WY, and 11% occurred out of state. Among in-state births, 73% occurred in seven facilities. Two of those seven facilities accounted for 35% of in-state births.

Infant Mortality

WY’s 2019-2023 infant mortality rate (IMR) was 5.6 deaths/1,000 live births; with a majority of deaths (70%) occurring among neonatal infants (WY VSS). This IMR matched the national rate of 5.6 deaths/1,000 live births in 2022. Both met the HP2020 objective (6.0 deaths/1,000 live births); but not the HP2030 objective of 5.0. From 2019-2023, the WY IMR among women from urban counties was 6.3 deaths/1,000 live births, compared to = 4.5/1,000 for women from rural counties, and 4.2/1,000 for women from frontier counties (VSS 2019-2023).

Both neonatal and postneonatal mortality rates in WY have been similar to U.S. rates over the past 10 years. From 2019-2023, the leading causes of death among WY neonates were congenital malformation, deformations, and chromosomal abnormalities, followed by disorders related to short gestation and low birth weight. The leading causes of postneonatal infant death were SUID, congenital malformation, deformations, and chromosomal abnormalities (VSS).

Preterm and Low Birth Weight (LBW) Births

In 2023, 10% of WY infants were born preterm, the same as the 2023 U.S. prevalence. Since 2009, WY’s preterm prevalence has fluctuated from a high of 11% in 2014 and a low of 9% in 2017. The 2023 prevalence was comparable to the 2009 prevalence. The 2023 prevalence of LBW births in WY remained around 9%. The WY prevalence has been significantly higher than the U.S. since 2018. WY has not met the HP2020 preterm goal of 9% or the HP2020 LBW goal of 8%. MCH Epi will continue to monitor changes in preterm and LBW deliveries and will examine the LBW increase in more detail.

Infant Sleep Environment

The leading cause of postneonatal infant death in WY from 2019 to 2023 was SUID. Over 81.9% of WY women reported their infants are put to sleep on their backs only (PRAMS, 2016-2022), exceeding the HP2020 goal of 76%. However, less than one third of women reported their infants always or often were placed to sleep on a separate approved sleep surface; 38.6% reported their infants were usually placed to sleep with no soft bedding. Disparities in sleep environments were seen by race, age, and income.

Breastfeeding

The WY breastfeeding initiation rate (91.5%) exceeds the HP2020 Goal (82%) (PRAMS, 2016-2022). According to the National Immunization Survey (NIS), in 2020 27% of infants in WY were breastfed exclusively through six months compared to 26% in the U.S. While similar to the national percentage, Wyoming is below the HP2030 goal of 42% of infants breastfed exclusively through six months. Breastfeeding is currently not a Title V priority, and while WY continues to show good breastfeeding rates, monitoring will continue.

Child Health

Child Mortality

In 2022, the WY child mortality rate (CMR) among children ages 1-9 years was 22.9/100,000, similar to the U.S. rate of 19.3/100,000. The 2020-2022 CMR was significantly higher for children ages 1-4 (236.8/100,000) than for children ages 5-9 (11.0/100,000).

Unintentional Injury

Between 2013 and 2023, unintentional injury (UI) remained the leading cause of death among WY children ages 1-9 and accounted for 44% of deaths in this age group. Motor vehicle traffic injuries (23%) and drowning (23%) were the most common mechanisms of UI fatal injuries (VSS). Childhood mortality and injury hospitalization are not currently a WY Title V priority, but MCH Epi continues to monitor this topic.

Overall Health and Preventive Care

According to the 2021-2022 NSCH, 94% of WY children ages 0-11 were reported to be in excellent or very good health, 53% received care in a medical home, 61% had adequate and continuous insurance, and 25% received care in a well-functioning system. In 2021, 47% of eligible, Medicaid-enrolled children ages 1-9 who should receive at least one initial or periodic EPSDT screening received at least one screening (WY Centers for Medicare & Medicaid Services [CMS] 416 Report).

Obesity and Physical Activity

In 2021-2022, 14% of WY children ages 6-11 were obese, significantly less than 20% in the U.S. (NSCH). In 2020-2021, 45% of WY children ages 6-11 were active for 60 minutes every day, significantly higher than the U.S. prevalence of 26% (NSCH). Small numbers continue to make any noted disparities in physical activity between different groups of children difficult to evaluate.

Adolescent Health

Adolescent Mortality

The WY 2022 adolescent (ages 10-19) mortality rate (AMR) of 56.5/100,000 remains significantly higher than the U.S. rate of 38.6/100,000. From 2013-2023, the leading cause of death among 10-19-year-olds in WY was UI (41% of deaths) and suicide (34% of deaths) (VSS).

The 2020-2022 AMR remained significantly higher among ages 15-19 (81.3/100,000) compared to ages 10-14 (27.9/100,000), as well as males (74.1/100,000) compared to females (32.9/100,000). Due to small numbers in 2020-2022, disparities by race/ethnicity are not able to be observed.

Motor Vehicle Mortality

The 2020-2022 adolescent (ages 15-19) motor vehicle mortality rate in WY was 27.1/100,000, and still significantly higher than the U.S. 2020-2022 rate of 12.5/100,00 (NVSS, 2020-2022). While the U.S. male rate for 2018-2022 of 15.6/100,000 was again significantly higher than the U.S. female rate of 7.9/100,000, there was still no significant difference between WY male rate (31.8/100,000) and the female rate (18.9/100,000) for 2018-2022.

The YAYAHP continues to focus on injury hospitalization among 10-19-year-olds as an NPM for decreasing motor vehicle mortality. The WY injury hospitalization rate for 10-19-year-olds in 2021 (208.4/100,000 10-19-year-olds) was again not significantly different than the 2021 U.S. rate (214.1.0/100,000). The YAYAHP is working on developing and promoting a parent-teen driver agreement to parents of new teen drivers to tackle motor vehicle mortality and injury hospitalizations. In 2022, initial data was collected on seatbelt use from a new question in WY Prevention Needs Assessment (PNA), added via a partnership with CPU, MCH Epi, and the YAYAHP. Initial data show that just over half (52%) of middle and high schoolers in Wyoming reported to “always” wear their seatbelt when riding in a car.

Suicide, Self-Harm, and Risk and Protective Factors

The 2020-2022 WY adolescent suicide rate among 10-19-year-olds was 15.9/100,000, significantly higher than the U.S. rate of 6.6 in 2020-2022. Suicides made up 34% of all deaths among adolescents ages 10-19 in WY from 2013 to 2023 (VSS). From 2018-2022, males had a significantly higher suicide rate (26.7/100,000) compared to females 5.4/100,000, (NVSS).

Children with Special Health Care Needs

Approximately 20% of WY children ages 0-17 years (25,922) have a special health care need. In 2021/2022, 60% of WY CYSHCN had insurance that was considered adequate for a child’s health needs, again, which was not significantly less than the U.S. percentage of 63% of CYSHCN. In WY, 16% of CYSHCN reported receiving care in a well-functioning system compared to 13% of CYSHCN in the U.S. (NSCH).

In 2021/2022, 47% of WY CYSHCN reported having a medical home, similar to the 51% of non-Children with Special Health Care Needs (CSHCN) children in WY, and 41% of CYSHCN in the U.S. WY’s CYSHCN Program is continuing to examine data from the NSCH to assist in planning the next steps for the program. As part of this effort, WY is currently participating in a three-year oversample (2022-2024) for the NSCH to ensure enough data is available to be able to help drive decisions for future programmatic efforts.

Emerging Needs Update

Childhood Lead Poisoning Prevention

Blood lead test results are a reportable condition in WY. In 2023, 8.2% of WY children under the age of six were tested for lead, up from 5% the previous year. The percent of those tested who had elevated blood lead levels was 0.7% in 2023. In comparison, in the U.S. in 2018 (the most recent year available for comparison), 18% of children under the age of six were tested for lead, and 3% of those tested had elevated blood lead levels. The WDH PHD historically lacked the capacity and funding for a lead surveillance and prevention program; however, WDH PHD was awarded the CDC Childhood Lead grant in August 2021. MCH is an implementation partner on this grant.

COVID-19

MCH Epi is concluding the linkage of COVID-19 cases in women of reproductive age to birth/fetal death records from 2020 to February 2024 to describe the pregnant population who also had COVID-19 and monitor the outcomes of both the infant and mother. MCH Epi continues to monitor for potential maternal mortality cases who also were diagnosed with COVID-19. To date, there have been no maternal mortality cases linked to COVID-19 cases.

WY PRAMS added two COVID-19 supplements. The general COVID-19 supplement began in October 2020 with the July 2020 births. The COVID-19 Vaccine Supplement, asking about vaccine administration and hesitancy, began data collection in April 2021 with the January 2021 births. Both supplements are no longer being collected starting with 2023 births, and MCH Epi just received the final datasets for these in May 2024.

Oral Health

While the WDH PHD Oral Health Program was eliminated eight years ago, WY MCH stays apprised of the Wyoming Oral Health Coalition activities. The coalition is currently facilitated by Cheyenne Regional Medical Center and the Laramie County Community Partnership. This coalition released a 2023 oral health environmental scan, developed by the Rocky Mountain Network of Oral Health, with pertinent data related to fluoride varnish application and billing; dental hygienist, therapist, and assistant scope of practice, teledentistry, and community water fluoridation in WY. It details strengths and opportunities.

WY MCH is also including oral health in the current needs assessment to determine if it should be prioritized in the next cycle.

In FFY23, WY MCH also began exploring opportunities to address oral health in partnership with Medicaid. Title V funds are expected to be leveraged in FFY24 to support messaging to parents about the importance of dental visits in the first year, how to avoid tooth decay by not putting a baby to sleep with a bottle, and the importance of using fluoridated products for children.

Child and Adolescent Health Insurance

In 2021/2022, the prevalence of children ages 0-17 who were adequately insured in the past year in WY (59%) continued to be significantly less than the U.S. prevalence (68%). According to the 2021 American Community Survey, about 8% of WY children (ages 0-17) were not currently insured, which was again, significantly higher than the U.S. prevalence (5%). When examined by race, the highest prevalence of uninsured children was among non-Hispanic AI/AN (19%), followed by Hispanic children (9%) (ACS), though because of small numbers it continues to be difficult to make conclusions on these differences. In 2021/2022, only 59% of uninsured children (ages 1-17) in WY were reported as having a preventive dental visit in the past year compared to 85% of insured children, and only 28% of uninsured children received care within a medical home compared to 53% of insured children (NSCH). These numbers, coupled with the uninsured statistics from the CYSHCN population, continue to show there is much work left to do in these areas.

Capacity Update

In FFY23, the WY MCH team experienced relatively few changes in capacity or staff turnover. In April 2023, the new Title V Coordinator started in the position following a vacancy. We have also since added a PQC Coordinator to the MCH team.

WY MCH continues to allocate state funding to local PHN offices or local health departments to support local MCH programming. Due to the economic downturn, state funding reductions impacted county funding in the biennium fiscal year 2023-2024. PHN offices also experience staffing challenges, especially in the most rural/frontier counties. WY MCH has since integrated Title V 2021-2025 priorities and strategies into contracts with local PHN under the MOU renewal process. We will continue to integrate Title V priorities in future MOUs with the counties/PHN offices to ensure alignment as priorities may shift after the completion of the needs assessment.

Title V Partnerships and Collaborations Update

WY MCH partners with MCH Epi for epidemiology and evaluation support. MCH Epi manages the SSDI grant for Wyoming. WY MCH also collaborates with other Maternal and Child Health Bureau (MCHB) investments, such as the Family-to-Family Health Information Center (F2FHIC) (housed in the UW Wyoming Institute for Disabilities [WIND]) and the Maternal Health Innovation grantee (UW College of Health Sciences).

WY MCH partners with other state agencies and programs to improve MCH population health, including Health Care Financing (HCF); DWS; DFS; WDE; WDH BHD; WDH PHD programs (e.g., WIC, WIVPP, Public Health Preparedness and Response (PHPR), State Office of Rural Health (SORH), Communicable Disease Unit (CDU); UW; WY Health Council (Title X grantee); the federal MIECHV grant, administered by DFS; and other statewide organizations and associations, such as WY Medical Society, WY Hospital Association, Uplift, WY Primary Care Association (WYPCA), WY American Academy of Pediatrics (AAP) Chapter, WY American College of Obstetricians and Gynecologists Chapter, WY Kids First, WY Afterschool Alliance, WY 211, WY Community Foundation, and WY Family Resource Centers Collective.

WY MCH representatives sit on the following statewide councils:

WY Governor’s Council on Developmental Disabilities
WY Governor’s Early Childhood State Advisory Council
WY Early Intervention Council
WY Maternal Health Taskforce
WY Governor’s Ob Subcommittee

WY MCH is in the process of executing new two-year MOUs with all 23 counties using TANF and state funds provided for reimbursement of MCH services. These funds support an estimated 47 full-time employees across WY in support of MCH services.

Although no formal funding agreements exist, WY MCH also works with the Northern Arapaho and Eastern Shoshone Tribes to promote and provide gap-filling financial assistance and care coordination services as part of the CYSHCN Program. CYSHCN staff provide training and support to tribal nurses to improve and sustain programming. WY MCH has also strengthened its partnership with both Tribes around maternal mortality review. Each Tribe has a designated member participating in the MMRC. WY MCH continues to look for additional opportunities to collaborate with and support Tribal health programs, and continue building trust and relationships.

WY MCH has and will continue to establish and build partnerships with state and local organizations that serve the state’s MCH population or otherwise have a vested interest in health, social, and economic outcomes facing families in our state. Through the needs assessment process, we have been working to connect with a range of existing and potential partners.

Efforts to Operationalize Five-Year Needs Assessment (NA) Findings

The WY MCH NA framework was not designed to be static or time-defined. Many elements have persisted throughout the five-year grant cycle.

Steering Committee (SC) and Partner Involvement

The WY MCH/Title V SC was formed in 2019 to drive NA activities, inform priorities, and hold WY MCH accountable to its developed state action plan (SAP). This SC met in January 2020 to approve draft Title V priorities. Due to COVID, the SC did not meet again until June 2021, at which time the SC approved the final WY MCH SAP. The SC met again in June 2022 and 2023 to hear implementation updates, offer guidance and feedback, and assure accountability to the plan. The committee generally meets annually to receive implementation updates and offer feedback and recommendations to support WY MCH accountability, increase leadership buy-in, and provide opportunities for ongoing feedback and Quality Improvement (QI). As we’re working on the 2025 needs assessment, the SC will be convened more frequently in 2024 to ensure they are apprised of our progress and can offer guidance and support as needed.

After convening MCH PATs in spring 2020 to gather input on the selected priorities and strategies for the 2021-2025 NA, the PATs were unable to meet as planned to formally launch the 2021-2025 five-year cycle due to COVID. Program managers worked to move toward virtual PAT meetings, and have found other ways to plug into existing groups that are working toward similar priorities. Because PATs were not entirely functional or effective, WY MCH will consider different methods or options to engage communities, families, and partners in the next cycle’s priority selection and implementation process.

Strategic Plan Implementation

In partnership with Lolina, WY MCH has engaged in performance management activities. Previously, we conducted 60/60s to discuss implementation by domain every 60 days; however, WY MCH moved toward quarterly QI workshops to begin in spring 2023. This process is designed to support individual and team accountability for implementing strategies and improving capabilities to operationalize our values.

WY MCH will revisit and revise its SAP and ESMs/State Performance Measures (SPMs) before FFY25 and will receive TA from the MCH Evidence Center and Lolina, Inc. throughout the summer of 2024 as needed. WY MCH will then focus on resource allocation and structure its budget to align with SAP updates

We will also begin looking forward to how we need to prepare for strategic planning and implemention as the next cycle begins, to include strategic efforts geared toward the two required universal NPMs.

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