In This Issue
Over the past four decades, the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) has become one of the most widely researched child nutrition programs. WIC research creates a foundation of knowledge that helps policy makers, advocates and frontline staff to make good decisions based on strong evidence. In addition, such research helps keep the WIC mission moving forward and ensures that we are prepared for whatever lies ahead by understanding what has happened in our past. The goal of this quarterly newsletter is to help our community connect with new research and stay informed on research activities that provide opportunities for continued learning.
What’s in WIC Research to Practice? Each edition will have a Hot Topic where we’ll explore how different state and local agencies are addressing pressing issues through innovative research. We will also have a WIC Researcher Spotlight where we will highlight the research experience of a WIC staff. Finally we want to keep you in the loop on opportunities to learn from and share new research, so we’ve put together a calendar of conferences and calls for abstracts. Before jumping into the Hot Topic and WIC Researcher Spotlight, we want to share with you or perhaps reintroduce you to the NWA Research Needs Assessment.
Each year the National WIC Association (NWA)’s Evaluation Committee publishes a Research Needs Assessment (RNA). The RNA aims to highlight areas of research that have the potential to provide essential information to document the program’s impact on its participants and to improve the program’s effectiveness. These recommendations come from within the WIC community and, therefore, reflect the desired information from the frontline staff. The 2015 priorities fall into four main categories:
Strides are already being taken toward studying these issues. View the full Research Needs Assessment. (Note: A full list of USDA-funded research projects is also available in the Appendices of the RNA.)
A recent article published in USDA’s Amber Waves, considers the factors that have influenced national WIC caseload decline. Specifically, the article considers the macro level issues, attributing caseload decrease to the declining birthrate and upturn in the economy. The decline is significant: Recent preliminary numbers from FNS show that earlier this year, national caseload dropped below 8 million for the first time in over a decade. A key theme within the issue of caseload is ‘retention’ – why are eligible people either not entering the program or choosing to exit the program?
An earlier report from ERS investigating delayed entry and early exit from WIC, found that of the 79.1% of eligible families participating in WIC within the first year of their infant’s life, 17.6% did not enter the program until the infant was born and 22.9% exited the program when the infant turned one. In addition, the report found common traits of participants that exited the program early. For example, families with higher income and higher levels of education were more likely to exit the program, then participants on lower incomes.
The national picture reflects similar trends on the state and local levels across much of the country. Given the diversity of WIC programs across the US, there is great value in looking at local level research to add context and build a clearer picture of what we are seeing on a national level. Some state and local agencies have been looking at retention and the issues that cause participants to drop off the program to try and understand decreasing caseloads in their specific locales.
In 2010 - 2011 when the continuing drop in caseload became apparent, the State of Oregon WIC program conducted telephone interviews with a random sampling of participants who had exited the program in the prior month but were still categorically eligible. The interviews included questions about what originally motivated participants to enroll, their experiences with WIC staff, shopping with WIC vouchers, community perceptions of the WIC program, their reason for leaving WIC and what if anything would make them return.
Most participants enrolled in WIC for the food. Experiences with WIC staff were largely positive and participants were grateful for what they had received.
“The WIC staff were always very supportive and provided useful items from pregnancy through babyhood.”
“Really like the new guidelines, 100% whole wheat bread and the fruit and vegetable program.”
A change in life circumstances was a commonly cited reason for no longer participating in the program. Participants also mentioned dropping off the program unintentionally by missing an appointment or having difficulties finding an appointment that worked with their schedule.
“Since my kids are older now plus we currently have two incomes, I think we’re able to support them, it’s not a problem at this time.”
“My son is older. It helped with formula when he was young. He doesn't use as much milk anymore and I don't want to take it when someone else could use it.”
“Missed last appointment. I didn't have the chance to reschedule. I have been busy. I have a busy schedule and it's difficult to know when is a good time to make an appointment. I was actually going to call today and make an appointment.”
Conducting the in-depth interviews with former participants helped Oregon WIC staff to explore multiple aspects of the WIC experience for those who had exited the program. After sharing findings with local agency coordinators, approaches for retaining families who may perceive themselves as no longer needing services were discussed. In addition, local agencies took steps to actively track and reach out to participants who missed appointments and unintentionally dropped from the program.
Further south on the West Coast, a recent analysis of caseload in California looked specifically at participation levels of women, infants and children in LA County to examine whether or not there were identifiable trends in participation decrease. The analysis took birthrate into account and surmised that the cumulative effects of the steady decline in birthrate since 2008, was now being felt. This is reflected in the decrease across all children age groups between 2008 and 2014. Additionally, the LA County analysis reflects findings from the 2009 study conducted by ERS, specifically the likelihood that families with higher incomes will exit the program early. Families with incomes below 100% FPL have not decreased, but families with income between 100% FPL and 185% FPL have decreased.
Not all agencies are experiencing caseload decline. The Inter-Tribal Council of Arizona (ITCA) have bucked the trend and increased caseload by 6%. Mindy Jossefides, Director of ITCA WIC, attributes the increase in caseload to working intensively to address retention of children in the program. ITCA noticed caseload was down in 2014 and implemented an outreach campaign that focused on making sure families were aware that WIC could provide valuable resources for children. Outreach activities included postcards to families who had left WIC, Public Service Announcements, posters and newspaper advertisements and an idea sheet that gave local clinics ideas to make their clinics more children friendly. Reinforcing the fact that WIC is not only a program that supports pregnant women and infants helped improve caseload for this agency.
When it comes to deciphering the factors that influence caseload, it is clear that the picture is mixed. The local level research and the macro level research all play into our understanding around the downward trend in caseload.
In the coming years, there will be new research that considers the issue of retention and will hopefully shed more light on the reasons why some families exit WIC early. Both the National Survey of WIC Participants II and the Feeding My Baby Study will explore the experiences of families who exit WIC.
The implications of decreased caseload are serious. Not only is the WIC community concerned that eligible families are missing out on important nutrition support, but the number of participants served directly impacts the level of funding states and local agencies receive, which in turn could limit the reach of local programs to engage those that are exiting early or not entering. To mitigate what could become a vicious cycle, understanding why caseload is decreasing is crucial. There are obvious factors that may impact caseload which cannot be controlled, for example, weather, and macro issues such as birthrate and the economy, but research conducted by local state agencies provides hope that there are aspects of caseload decrease that can be addressed through better understanding of the issues at hand.
Local agencies and states that are currently focusing on outreach efforts but are still seeing caseload going down, should consider the fact that we don’t know what the decrease would look like without those efforts. We are heartened by states and agencies not settling for the decreases being the ‘new normal’ – sharing examples of how WIC communities are trying to learn more about caseload decrease and respond is useful. If your local agency or state has been looking into this issue, please let us know what you’ve found by emailing Georgia Machell at email@example.com.
If you would like to learn more about any of the research mentioned in this article, please contact Georgia Machell.
The hot topic in our next edition will be “EBT – how will we harness the future goldmine of WIC data."
“You have to care about your job and you have to care about what you do. You can’t fake that.” -- Martha Meza
Recruiting and retaining participants for any study can be challenging. Martha Meza, Executive Assistant to Special Projects at PHFE WIC, spoke with us about her experience in data collection for a study taking place in California. The study, titled Online Nutrition Education: WIC in the 21st Century evaluates at the impact of online nutrition education vs. in person nutrition education. The research is a collaboration between UC Berkeley and Public Health Foundation Enterprises (PHFE) WIC. Martha collected data from WIC participants in the form of telephone interviews in both English and Spanish. The return rate for participant engagement was around 98%. We had the pleasure of speaking with Martha about her approach to this type of data collection and her techniques to getting such impressive return rates.
It is clear that Martha is a huge WIC enthusiast. With over 20 years of experience working for the program in different capacities, Martha has seen how the program has developed and understands the crucial role that research plays in shaping the experience of WIC participants.
“Every participant has something to share and we have to remember that all this funding, all these different research projects – it’s all to better WIC.”
The experience of participating in research can make or break the participant’s enthusiasm for getting involved in future research or staying involved in studies that require follow-up. To a local agency or individual participant, one research project can represent the whole WIC research community– having a positive experience and engaging participants with the value of that project is essential. Martha offered the following advice to anyone embarking on a WIC research project:
“It’s really important to remember that when we’re doing research, one bad experience will make it that much harder to get that participant again.”
Martha’s positivity is infectious, and it’s clear to see that her success is in part due to the fact that she loves talking to people, and people love talking to her. Although she collects specific details defined by the scope of the study, she does so in a way that comes across to the participant as less about fulfilling a task and more about connecting on a human level and being helpful.
“It’s establishing that I care, not just about getting the numbers. It was very rewarding for me, and the participant -- I think they feel like they’re being acknowledged.”
Martha’s experience in WIC means she appreciates the various realities that often make it challenging for participants to engage with a research study and described the occasional need to get creative, when it is proving challenging to initiate or sustain participation.
“You also have to use all your resources, not every participant I call on the phone, am able to connect with, sometimes I have to send them postcards or emails. You have to be very creative.”
By being creative, Martha nails the balance of persistence with support to meet her research objectives and help participants to have a valuable experience. Good qualitative researchers are trusted by their interviewees. They communicate respectfully and understand where their interviewees are coming from. After speaking with Martha, it is no surprise that she is a successful telephone interviewer. From Martha’s interview, it is evident that having the combination of WIC clinic experience and an understanding of research processes and needs makes for a successful qualitative researcher in the field of WIC research.
This is a link to the research project Martha is contributing toward. The data collected by Martha is currently being analyzed and a final report is anticipated by the end of 2015.
If you hear of a new research project or opportunity or if you’re having an article or report published and would like us to highlight it, please email firstname.lastname@example.org or Tweet @NatWICAssoc using the hashtag #WICResearch.
Association for Public Policy Analysis and Management: 37th Fall Research ConferenceThe Golden-Age of Evidence Based Policy Making
Adverse Childhood Experiences Southeastern Summit 2015: Building Resilient, Interdisciplinary Workforces, Communities & Families
2015 NWA Biennial Technology and Program Integrity Education & Networking Conference and Exhibits
WIC at the American Public Health Association Annual Conference
Transforming Food Access Summit: Accelerating Affordability with Nutrition Incentives
NWA 2016 Annual Education and Networking Conference
Maternal and Child Health Journal: Special Issue Call for Papers: Postpartum Health and Wellness
Journal of Public Child Welfare: Call for submissions – Administrative/Big Data Sets and Child Welfare Research
Presentations for NWA Annual Education and Networking Conference
Stay Connected: #wicresearch
As part of our research communication efforts, over the coming months we will be updating the research page on our website and regularly posting links to newly published articles and reports on WIC as well as tweeting about them using #wicresearch.
Regardless of whether a research project is a multi-year, national level analysis or a case study taking place in a local clinic, all research projects start with a question that needs an answer. We encourage you to share your research and research questions with NWA to help us connect the dots and keep the community informed of new developments in and new knowledge and understanding of WIC. NWA hopes that this quarterly newsletter will help reinforce the strong link between research, policy and practice.
NWA's mission: NWA inspires and empowers the WIC community to advocate for and promote quality nutrition services for all eligible mothers and young children, and assure effective management of WIC.
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