Coordinating Health Services: WIC and Other Public Health Programs
Dave Thomason, Representative, National WIC Association (NWICA); Kansas State WIC Director Ann Barone, LDN, Chief, WIC Program, Rhode Island Department of Health Mary Pittaway, Nutrition Services Supervisor, Missoula City-County Health Department in Montana Joan Bowsher, Montana State WIC Director
Agenda
Welcome and WIC Collaboration Project Speaker Introductions WIC Reauthorization, New Food Package, and National WIC Association Historical Perspective Ellen Schleicher, ASTHO Erin Cox, NACCHO Dave Thomason, Representative, National WIC Association (NWA); Kansas State WIC Director
Rhode Island WIC Ann Barone, Chief, WIC Program, Rhode Island Collaboration Activities Department of Health Missoula City, MT, WIC Mary Pittaway, Nutrition Services Supervisor, Collaboration Activities Missoula City-County Health Department in Montana Joan Bowsher, Montana State WIC Director Q&A Exit survey open for participants on Web
Objectives
At the conclusion of this Web cast participants will be able to : Discuss national WIC efforts, including reauthorization and implementation of the new WIC food package Describe lessons learned from multi-sector collaboration – including opportunities and challenges Identify models of WIC-public health collaboration using strategies focused on policy, administrative and clinical coordination, and community-based initiatives Find and access the resource, “Coordination Strategies Handbook: A Guide for WIC and Primary Care Professionals.”
ASTHO-NACCHO WIC Collaborations Project
Goal: To promote integrated delivery of WIC and other health services at the state and local levels. Adapt and update portions of USDA/FNS and HRSA’s BPHC handbook
http://www.fns.usda.gov/WIC/resources/ strategies.htm Adapted portions will be available on the ASTHO and NACCHO Web sites in the fall
Membership and partner survey to identify innovative WIC food package implementation policies
Speaker Introductions
WIC Reauthorization, New Food Package, and National WIC Association Historical Perspective Dave Thomason, Representative, National WIC Association (NWA); Kansas State WIC Director
Rhode Island WIC Ann Barone, LDN, Chief, WIC Program, Rhode Island Collaboration Activities Department of Health Missoula City, MT, WIC Mary Pittaway, Nutrition Services Supervisor, Collaboration Activities Missoula City-County Health Department in Montana Joan Bowsher, Montana State WIC Director
The Joy of a Healthy Smiling baby!
The National WIC Association
•Represents 90 WIC Agencies in all 50 geographic states, 36 Indian Tribal Organizations, Puerto Rico, Guam, the Virgin islands and American Samoa. •2,000 Local WIC Agencies and 10,000 WIC Clinics. •Thousands of WIC Staff members including Registered Dietitians, Nurses, Clerks, and Administrators.
WIC Basics
Federally funded through the USDA Domestic, Discretionary Program Funded Annually through Congressional appropriations process Current FFY2009 Funding Levels:
$5.074 billion Food $1.8 billion Nutrition Services & Administration
WIC Basics
WIC serves 9 million clients 930,000 pregnant women 600,000 breastfeeding women 670,000 postpartum women 2.3 million infants 4.5 million children up to age 5
WIC Basics
WIC is an adjunct to Health Care. WIC’s mission is Public Health Nutrition GOALS: Increase full term births Increase birth weight of newborns Increase initiation and duration of Breastfeeding Influence lifetime nutrition and health behaviors in targeted, high-risk population
National WIC Association WIC 2009 Reauthorization
Review of WIC Food Packages by the Institute of Medicine every 10 years or when changes occur in national nutrition standards. Maintain the Scientific Integrity of the Food Packages Promoting and Supporting Breastfeeding in WIC. Maintain Eligibility Criteria
National WIC Association WIC 2009 Reauthorization
Giving States the option to certify children for one year. Improving WIC Infrastructure and Enhancing service delivery through Information Technology. Assessing the Effects of Nutrition Services.
NEW WIC Food Package
Interim Rule Published in December 7, 2007 Implementation by October 1, 2009
NEW WIC Food Package Overview
Adds whole grain breads, tortillas, other whole grains and cereals. Offers canned beans.
NEW WIC Food Package Overview
Eliminates fruit juice for infants. Adds baby food fruits and vegetables. Adds baby food meats for exclusively breastfed infants. Formula issuance will be linked to infant’s age.
NEW WIC Food Package Overview
Reduces the amount of cheese given. Offers reduced fat milk for women and children two and older. Soy milk and tofu are options. Exclusively BF Moms receive 30oz of canned fish.
NEW WIC Food Package Overview
Offers Fruits and Vegetables.
Fresh, frozen or canned without added sugars, fats, oils, or salt.
Comments on the New Food Packages
Comments due by February 1, 2010 Send Comments by US mail to: Director, Supplemental Food Programs Division Food and Nutrition Service, USDA 3101 Park Center Drive, Room 528, Alexandria, Virginia 22302
Send electronic comments via the Federal eRulemaking portal
Go to: http://www.regulations.gov Select: “Food and Nutrition Service,” from the agency drop down menu, then click “Submit” In the Docket ID column, select FNS-2006-0037
For more information on the Food Package Interim Rule and WIC
Go To: http://www.fns.usda.gov/wic WIC Works Resource System
http://www.nal.usda.gov/wicworks
http://www.nwica.org
Successful Collaboration
NWA Committees and Task Forces
Immunizations Oral Health Value Enhanced Nutrition Assessment Disaster Planning Risk Identification NWA/FNS/CDC Data Consolidation group
Successful Collaboration
Understanding WIC
Models of Operation – State, County, Nonprofit, Many and no other responsibilities, etc. Location of Clinic; clinic flow. Frequency of Clinics – daily, weekly, less Fiscal Management – reimbursement; set budget
Successful Collaboration
Approaching WIC
State Agency Local Agency
WIC staff are “helping” oriented.
Successful Collaboration
Collaboration and work
Balance enthusiasm and passion with reality of the environment.
Important to clearly articulate what the collaboration involves. Regulatory and legal issues.
Successful Collaboration
Most WIC staff wear several hats. Communicate from a Public Health perspective. Mission focus. Explain your focus. Remember the WIC focus. Understanding is the foundation of a successful collaboration.
The world is full of Opportunities.
Rhode Island Collaborations
Ann Barone Rhode Island WIC Program Ann.barone@health.ri.gov
Integration of WIC Services
Incorporate WIC Services at the policy, community and individual level, to promote healthy lifestyles in the WIC Population.
Goals
Better coordination of services for clients Expand existing services to meet the needs of the community Gather input from community partners to improve services Share data to avoid duplication of services
Rhode Island WIC Program
26 WIC Sites that are administered by Eleven Local Agencies Average caseload of approx. 27,000 clients Approximately 100 Local Agency Staff
Community Collaborations
Breastfeeding Support and Promotion
Statewide Breastfeeding Coalition
Farmers’ Market
Veggin’ Out Program
Clinic Collaborations at the Health Centers
Point of Entry Performance Measures
Policy Level Collaborations
New Food Package Implementation
Advisory Group
Vendors (Chain, medium & small stores) LA Staff Farmers’ Client Survey’s
State Agency Collaborations
RI Kidsnet
Data sharing Developing policies and protocols Training
Initiative for Healthy Weight
Community Grants Goals align
Lessons learned
All parties need to understand the rules
Identifying the purpose Identifying the timelines Understanding who ultimately will make the final decisions
Local Level Coordination of WIC and MCH Programs
What a Difference Teamwork and a Memorandum of Understanding Make
Missoula City-County Health Department Health Services
Bone Health
Home Visiting
Communicable Disease
FICMR Breastfeeding
Farmer’s Market
Missoula City-County Health Department Nutrition Services Division
Bone Health
Breastfeeding
Farmer’s Market
Missoula City-County Health Department Nursing Services
Home Visiting
Communicable Disease
FICMR Breastfeeding
Initial Sheet Used to Refer WIC Families to MCH
Missoula County Enrollment for WIC and MCH In 2005
WIC Participation
MCH Participation 300 2500 Overlapping Participation About 10% of WIC clients also enrolled in MCH
Memorandum of Understanding
Elements in document Whereas……………. What WIC will do What MCH will do Compensation Signatures & dates
co.missoula.mt.us/healthservices/WIC/
Request for MCH Services Completed by WIC Client
Release of Information
Missoula County Enrollment for WIC and MCH In 2005
WIC Participation
MCH Participation 300 2500 Overlapping Participation About 12% of WIC clients also enrolled in MCH
Missoula County Enrollment for WIC and MCH In 2008
WIC Participation
MCH Participation
2600
600 Overlapping Participation About 23% of WIC clients also enrolled in MCH
Monthly Referral Tracking by WIC
MCH Referrals
14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 1 2 3 4 5 6 7
Lessons Learned Pertained to
Marketing of one another's services Staff accountability enhanced through feedback Use of Motivational Interviewing to sell MCH Quality assurance design WIC staff learned how “WIC is public health” MCH staff learned about the “production and caseload” pressures of delivery of WIC services WIC & MCH realized expanded services & benefits to families Attitude of productive teamwork and interdepence
For more information, contact Joan Bowsher Montana State WIC Program Director MT Public Health & Human Services 1400 Broadway, C-314 CHelena, Montana 59620 406-444-4533 406- 444bowsherj@mt.gov Mary Pittaway, MA,RD,CLC WIC Director Missoula City-County Health Department City301 W Alder Missoula MT 59802 406-258-4837 406- 258pittawaym@ho.missoula.mt.us Trudy Mizner, BSN MCH Director Missoula City County Health Department 301 W Alder Missoula MT 59802 406-258-4298 406- 258miznert@ho.missoula.mt.us
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Questions?
If you have ideas or examples of collaborative work between WIC and public health programs or of innovative policies to support the new WIC food package implementation, please include them in:
Web cast evaluation, or Contact either eschleicher@astho.org or ecox@naccho.org