January 1984 Volume 14 Number 1
WIC Celebrates
Its Tenth Anniversary
Nutrition and health professionals
throughout the country will be celebrating
the tenth anniversary of the
WIG program this month. ··•••·· Ten years ago, the Special Supplemental
Food Program for Women,
Infants, and Children began as a
pilot project at a few selected sites.
Today, the program is operated by
some 1 ,500 local agencies at more
than 7,000 site..s. .. .......
In this issue, we visit a number of
these local agencies and meet some
of the people who make WIG work
so well. We also meet some of the
mothers and children who have
benefitted from WIG, including
some of the very earliest participants.
~ .. ~-·--··--~·J
.. "
Depos.tor)
...
WIC
Celebrates
Its Tenth
Anniversary
This month marks the tenth anniversary
of the Special Supplemental
Food Program for Women, Infants,
and Children, popularly known as
WI C.
To celebrate this milestone in the
history of one of USDA's best regarded
programs, the Department is
joining state health departments
across the nation in saluting more
than 100 WIC administrators and
nutritionists for their exceptional
contributions to serving people.
These local operators, selected by
their state agencies, are receiving
special certificates to honor their
achievements.
The Department recognizes the
outstanding achievements of all
local program operators, without
whose help WIC would never have
touched so many lives so effectively.
With vision, creativity, and diligence,
thousands of dedicated men and
women have worked at the community
level to provide needed food
assistance to our country's most
nutritionally vulnerable grouplow-
income pregnant and postpartum
women, infants, and young children.
Working under the general guidance
of state and federal administrators,
it has been the local WIC
administrators and nutrition professionals
who have had the greatest
impact on the evolution of WIGdeveloping
it from the idea phase
2
first conceived by Congress, to a
food assistance program remarkable
both in its degree of personalized
nutrition aid as well as in its ability
to produce measurable improvements
in the nutritional status of its
clients.
Unique features ...
WIC is unique among all the federally
administered food assistance
programs. It's the only food program
that provides individually tailored
food packages along with nutrition
education to a specific audience in a
health care setting.
Congress had a very special target
group in mind when it first funded
WIC as a 2-year pilot project in September
1972 under Public Law 92-
433. A growing awareness of the link
between malnutrition and physical
and mental development fostered
concern on the lawmakers' part that
the nation's low-income women and
children might not be receiving the
nutrition assistance they needed
during critical phases of development.
In spite of the food programs already
available in the 60's and early
70's, research suggested that many
women, infants, and young children
were lacking in vital nutrients.
Accordingly, Congress targeted the
pilot program to provide special supplemental
foods to low-income pregnant
and lactating women and children
to age 4 whom competent
health professionals found to be at
nutritional risk. This established at
the outset that WIC food assistance
would be closely tied to medical evaluation
and health care services.
The WIC foods themselves were
to be prescribed on an individual
basis to meet recipients' specific
health needs. They would be carefully
selected to provide the vitamins,
minerals, and other nutrients that
had been found lacking in the diets
of mothers and babies.
Furthermore, Congress hoped to
see the WIC program go beyond simply
distributing supplemental foods
on a one-to-one basis. The lawmakers
envisioned nutrition education
as a key service provided to
program participants-a service
which could enable recipients to
establish better food habits to last a
lifetime.
From the start, WIC was to have
an evaluation component. Results
were to be measured, with participants'
health status evaluated longitudinally.
Today's WIC program has built
upon and refined all of these features.
The target group has been
expanded to include children up to
age 5, with benefits especially directed
Food and Nutrition
toward pregnant women and infants,
who are particularly vulnerable to
the effects of inadequate nutrition.
Available WIG foods have increased
in number and variety, and the WIG
food packages have been increased
from two to six.
Administrative funds are now earmarked
for nutrition education purposes,
enabling state and local program
managers to devote greater
staff and resources to this effort.
Finally, advancements in health
screening, research, and evaluation
have greatly contributed to the body
of knowledge pertaining to the nutrition
and health status of low-income
mothers and children. This knowledge
is being used today to improve
the effectiveness of the WIG program
-and WIG participants are the chief
beneficiaries.
Health spin-offs_.
WIG has produced some unexpected
benefits that have delighted
nutrition and health professionals.
The availability of free supplemental
foods has drawn many lowincome
women into the health services
system and helped make regular
health care part of their lives. Participating
mothers are now much more
conscious of the value of preventive
care and the need to protect their
children's health before they
become ill.
Pregnant women are now seeking
prenatal care significantly earlier
January 1984
than 10 years ago. Many local WI C
administrators say they see expectant
mothers as early as the second or
third month now, as opposed to the
eighth or ninth month 10 years ago.
Breastfeeding, generally unpopular
among low-income women during
the past decade or so, is experiencing
a revival in popularity thanks in part
to efforts by WIG nutritionists.
And, infants and children on WIG
are not only experiencing better
health, but they're also learning better
food habits from childhood.
WIC administrators
recall a decade of progress
New Year's 1974 is a day WIG
manager Dorothy Kolodner
remembers vividly. Hospitalized for
surgery that morning, she recalls
hearing the excited voices of two
close friends as she came out of the
recovery room. They had great news
for her that just couldn't waitKolodner's
proposal to test the pilot
WIG program in Allegheny County,
Pennsylvania, had been approved.
The previous July, Kolodner had
spotted a Federal Register notice
inviting communities to take part in
the pilot WIG project. She was
working as a nutritionist at the time
at a maternity hospital, and was
aware that many expectant and new
mothers were having difficulty affording
an adequate diet.
Kolodner knew the WIG supplemental
foods would be a godsend, if
the county health department could
just win approval for a pilot in the
Pittsburgh area. It did, and the rest
is history. Since the Allegheny project
began with a caseload of 11 ,000 participants
and two basic food packages,
more than 70,000 women,
infants, and children have been
helped by WIG's supplemental foods
and special nutrition services.
Many of today's WIG managers
have been with the program since it
began in 1974 . Theyrecountexpe~
iences similar to Dorothy Kolodner's,
and of fighting hard to win approval
as pilot project areas.
In St. Helen's Parish, Louisiana,
WIG administrator Elizabeth Lee
recalls that the state had made its
selection of nine project areas to
take part in the pilot. St. Helen's
Parish was not among them. But Lee
felt there was a great need for the
supplemental food program, especially
for infants born in the parish.
St. Helen's is a rural area, with just
a single town (population: 600), and
many families didn't have refrigerators.
As a consequence, it wasn't uncommon,
Lee says, for families to feed
newborn babies a diet of dry cocoa
mixed with water.
Nutrition education was not by
. itself enough to change the diets of
the parishioners. No one had the
money to purchase the foods they
really needed, and this was taking
its toll on their health. Infants and
children, in particular, were very
anemic. After thinking it over, Lee
decided to fight for a program for St.
Helen's Parish. She appealed to the
state health department and convinced
them to add one more project area
to the nine they had previously
selected.
Today, Lee says, you can really
see a difference in the nutritional
status of the parish's babies. Not
only are they much less anemic, but
when WIG children enter first and
second grade, teachers are noticing
a big difference in their learning
ability.
Allegheny County and St. Helen's
Parish were just two of the more
than 250 project areas approved to
start WIG programs in 1973 and
1974. These approved areas were in
45 states, Puerto Rico, and the
Virgin Islands.
Today's WIG program, funded at
more than $1 billion annually,
reaches nearly 3 million participants
at more than 7,000 clinic sites. Fifty
states participate in WIG, as do 31
tribal bands and organizations, Puerto
Rico, the Virgin Islands, Guam, and
the District of Columbia. Each community
has further adapted the
program to serve its own local
needs, so the program has grown
not only in size, but in experience
as well.
WIC meets the
needs of many
different communities
In 10 years, the WIG program has
evolved to serve its clientele with
creativity and sensitivity. Urban programs
differ from rural programs,
and the food habits, preferences,
and needs of participants vary from
community to community.
In Gary, Indiana, fow-income
mothers start their babies on solids
much sooner than health experts ad-
3
...
vise. "Moms have the perception
that a big baby is a healthy baby, so
they start them on solids as soon as
2 to 4 weeks after birth," says WIC
coordinator Edwanna Webb.
The WIC staff explain why too
much weight gain is unhealthy and
encourage mothers to delay the
introduction of cereals until their
babies are 4 to 6 months old.
In Puerto Rico, however, WIC nutritionists
have to "pull out all the
stops" to persuade clients to eat the
food package cereals at all. There
the emphasis is placed on using
cereals as part of other dishes, and
the WIC staff use food demonstrations
and recipes to show mothers
how cereals can become tasty additions
to their children's meals.
In some communities, grocers
have gotten involved in helping WIC
participants buy and prepare healthful
meals. In Pittsburgh, Pennsylvania,
for instance, the Giant Eagle chain
agreed to work with the county health
department as part of a USDA-sponsored
demonstration project.
4
In an 18-month storewide campaign
called "Keeping the Cost of
Eating Down," flyers, demonstration
booths, and call-in hotlines were
used to help area WIC participants
improve their nutritional status.
In meeting the needs of migrants,
a number of WIC offices use special
scheduling arrangements to accommodate
the migrant workers' need
for flexible clinic hours. Because
migrant workers are often called to
work on short notice, they frequently
miss regularly scheduled visits to
WIC clinics. To help migrants come
in for visits at unscheduled times,
WIC clinics in Miami leave open
space in their afternoon schedules
for walk-in appointments.
When transportation is a problem,
home visits are sometimes the best
way to meet with clients. In rural
Louisiana, for instance, there is no
mass transportation to help clients
get to clinics. So, nutritionists in
some parishes make selective
home visits.
Many WIC managers, such as
those in Missouri and Kentucky, find
they can serve participants better by
"co-locating" with public health facilities
and using an integrated service
approach to meet the needs of their
clientele. By placing WIC certification
and issuance activities under the
same roof with the medical and
''After 10 years, we're still
discovering ways to integrate
new ideas into what we're
trying to do. Mothers sense
the sincerity and feel we're
doing something positive ... because,
really, we're building
on a very old idea. One that
says, 'I care about you enough
to share my food. ' '
-Dorothy Kolodner, Allegheny
County, Pennsylvania
Food and Nutrition
health screening services offered by
local health departments, administrators
in both programs find they
can broaden and streamline the
scope of their services.
In Missouri, for instance, local
health offices can count on frequent,
regular visits from WIC
clients who must come in monthly
to pick up their WIC vouchers. Participants
who would not ordinarily
make an effort to bring in their
babies for regular immunizations
find it easy to combine a doctor visit
with a stop off to pick up their
vouchers.
Wherever WIC clinics are located,
administrators and nutritionists
make the program work so that it
uniquely fits with local needs.
Nutrition education
is a crucial part of
the local agency's job
In many respects, the heart of the
WIC program is its nutrition education
component. In the early years,
local administrators managed the
best they could to perform this important
job. Staffing was limited,
and administrative money was scarce.
But in 1975, P.L. 94-105 amended
earlier legislation to permit program
managers to use administrative
monies for nutrition education purposes.
In 1978, the law was changed
again-this time requiring at least
one-sixth of each state's administrative
expenses be spent for nutrition
education.
Over the past 10 years, program
administrators have been able to devote
increasingly more staff time
and resources to providing their
clients with nutrition counseling . WIC
managers feel that the nutrition information
and preventive health care
provided to clients is crucial in
helping them achieve lasting longterm
benefits.
In today's WIC program, local
agencies provide nutrition education
to mothers, expectant mothers, the
caretakers of participating children,
and to the children themselves whenever
possible. WIC nutritionists strive
to teach the relationship between
good nutrition and good health, help
participants develop better food
habits, and show participants how to
make the best use of the WIC foods
to supplement their diets. WIC cliniJanuary
1984
* * Highlights of WIC History * *
January 15, 197 4 was the day the
first WIC site officially opened. But
WIC history began in September
1972, when the original WIC legislation,
Public Law 92-433, authorized
the program to operate on a pilot
basis for 2 years. Some key dates in
WIC history are:
*July 1973
USDA issues regulations requesting
applications from agencies interested
in operating the program. * November 1973
Public Law 93-150 authorizes WIC
through fiscal year 1975. The law
also allows Indian tribes, bands, or
groups recognized by the Department
of Interior or the Indian Health Service
to act as their own state
agencies. * January 197 4
The first WIC program opens in
Pineville, Kentucky. * October 1975
Public Law 94-105 continues WIC
through fiscal year 1978. The law
sets a new age limit for children,
allowing them to participate up to
their fifth birthday. It also increases
state administrative funds to 20 percent
of the federal funds provided
by USDA.
For the first time, nutrition education
and start-up expenses become
allowable administrative costs. The
law also establishes the National
Advisory Council on Maternal, Infant,
and Fetal Nutrition. * November 1978
Public Law 95-627 extends WIC
through fiscal year 1982. The law
establishes income guidelines, requires
each state agency to spend
no less than one-sixth of its administrative
funds for nutrition education
activities, and includes state
plan requirements. * April1979
Special grants are awarded to state
agencies to serve migrants.
* December 1979
USDA sponsors a national forum
on program management, bringing
together WIC directors from all state
agencies to discuss state-level
administrative issues. The meeting,
held in Albuquerque, also includes
state directors of the Commodity
Supplemental Food Program
(CSFP), another federal food program
serving mothers and children. * Apri11980
Special grants are awarded to state
agencies to serve an influx of IndoChinese
refugees. * August 1980
Wyoming is the last state to enter
the program. * December 1980
Public Law 96-499 extends WIC
through fiscal year 1984. * January 1981
A second national meeting provides
a forum for WIC and CSFP state
agency directors to share information
on food delivery systems.
*June 1981
Washington, D.C., begins serving
participants. * May 1983
Guam begins serving participants. * February 1984
A national meeting sponsored by the
National Association of State WIC
Directors provides a forum for state
agency directors to discuss program
issues.
Eighty-five state agencies currently
operate the program. They include:
agencies in all 50 states; 31 Indian
agencies; and agencies in Wash- .
ington, D.C., Puerto Rico, the Virgin
Islands, and Guam.
Working with these state agencies
are approximately 1,500 local
agencies and 7,100 clinics.
...
5
cians also counsel pregnant women
on the benefits of breastfeeding.
Some groups of WIC participants
need extra assistance and understanding.
Pregnant teenagers, for
example, are often at the greatest nutritional
risk, due to poor e<!tting
habits. Low income further compounds
the problem, making it even
more difficult for these young
women to obtain adequate diets.
Barbara Toth, a WIC nutrition consultant
overseeing the program in 15
Pennsylvania counties, says her nutritionists
use 24-hour recall sheets
to help encourage their young
clients to keep working at improving
their diets between visits to the clinic.
Because pregnant teens often fear
the weight gain that accompanies
pregnancy, the clinic staff also uses
visual aids and booklets to reassure
teens that it's important to eat well
and gain weight "for the baby."
In some communities, WIC teens
are among the most receptive clients
to nutrition counseling. Breastfeeding,
for instance, has caught on
especially well among teenage
mothers in Puerto Rico. "Younger
mothers are more motivated to
breastfeed than older mothers," says
Maria de los Angeles Dias, of Puerto
Rico's state agency. "They're very
interested in all the new techniques
in infant feeding. It's the fashion."
To encourage breastfeeding,
6
many WIC clinics in Puerto Rico
hold group meetings where they
have breastfeeding mothers come
talk about their experiences.
Sometimes they invite guest
speakers from national or local
organizations.
Program managers have found
WIC participants themselves a great
source of ideas for nutrition education
programs. In many communities,
WIC nutritionists ask clients for
feedback on program efforts.
"We solicit responses from 5 percent
of our caseload on a nutrition
education form," says Barbara Toth.
"The form explains to clients what
nutrition education is and asks them
what they'd like more of-films,
group classes, etc." Using eval-uation
forms helps clinics adapt
their nutrition education efforts to
make them more useful and acceptable
to clients.
WIC gets results
In just a decade, the WIC program
has significantly improved the
health and nutritional status of millions
of women and children. A vital
testimony to the efficacy of WIC can
be seen in the babies born to WIC
mothers. Numerous studies, including
one published by the Massachusetts
Department of Health in 1981,
showed positive trends in the reduction
of both neonatal mortality and
in the incidence of low birth weight.
Low birth weight has long been
associated with a higher frequency
of developmental abnormalities, increased
medical costs and longer
hospital stays. An evaluation prepared
for the Harvard School of Public
Health in 1979 suggests that WIC
is cost-effective in terms of its potential
to reduce medical costs
associated with low birth weight.
Some studies show infants and
children participating in WIC have
decreased rates of anemia and accelerated
rates of growth. And, research
published in 1982 in the American
Journal of Public Health has suggested
that WIC may also be contributing
to improved mental performance
by participants.
Testimonials from hundreds of
local administrators and other
health professionals also speak of
WIG's ability to get results. According
to Dr. Alvin Mauer, medical director
of St. Jude's Research Hospital in
Memphis, virtually everyone who is
close to the program feels that WIC
has been effective in achieving what
it set out to do.
"WIC has been extremely well received
by participants, has received
high marks from administrators, and
is seen as an effective mechanism
by Congress if you look at its
funding history," he says.
Effective management
gets WIC benefits
to those who need them
In the past decade, WIC has grown
to a more than $1 billion program
serving nearly 3 million participants.
This rapid expansion has demanded
an equally rapid increase in the level
of sophisticated management
needed to oversee growing case- loads and budgets.
Because WIC is a fixed grant program,
the number of clients that can
be served is dependent upon the efficient
management of limited resources.
Because of this, WIC administrators
have been quick to employ
the latest management tools to ensure
that funds are used to the maximum
benefit.
For instance, in Dade County,
Florida, as many as 12,000 participants
are served each month in 14
Food and Nutrition
clinics. In this large urban project
area, three full-time specialists are
employed to attend exclusively to
financial matters and internal auditing,
giving the local WIC administrator,
Denise West, excellent control
over the program's operation.
In sparsely populated, rural areas
like much of Alaska, administrative
dollars are extremely tight, and WIC
managers like Joan Pelto make
heavy use of volunteer help and the
mail to bring WIC to 1,500 rural participants
spread out over one-half
million acres of land.
The state's high cost-of-living and
travel costs would make many administrative
functions very difficult
to carry out without the dedication
and ingenuity of the program's
administrators.
Administrators in all parts of the
country are looking for ways to
improve service to clients, while
halting any abuses that may be discovered.
Many states and communities
have found ways to use computers
to protect their clients' food
benefits as well as their health.
For example, computers are currently
being used in many areas of
the country to identify grocers who
are overcharging WIC customers for
food package items, accepting WIC
vouchers in exchange for ineligible
items, or illegally engaging in discounting
WIC vouchers. WIC managers
have found computerized vendor
monitoring very effective in keeping
program monies from getting into
the wrong hands, since dishonest
vendors can now be promptly
dropped from the program.
In California, state WIC director
Jack Metz and his staff have set up a
"vendor specific" program, which requires
a WIC participant to select a
specific vendor from a list of grocers
under contract with the state. The
vendor's name and WIC authorization
number are imprinted on the
participant's WIC vouchers, and the
participant buys WIC foods only at
that store.
Because the grocer's authorization
number is printed on each
voucher, a computer can trace a particular
voucher to the store where it
was used, and it can show how
much a grocer charged for each
WIC food . The system makes it easy
to identify and take action against
grocers who are overcharging WIC
customers.
Computers are also being used to
enhance WIG's service to clients
January 1984 7
through nutrition surveillance. In
Bradford, Rhode Island, assessment
data for each WIC client-including
height, weight, and blood analysisis
computerized and ~ent to the
Center for Disease Control (CDC) in
Atlanta.
CDC is then able to alert the clinic
of high-risk clients who need special
followup, and also high-risk groups.
"Nutrition surveillance is great for
intervention purposes," says
Gemma Gibbs, Rhode Island's public
health nutritionist. "It helps us
put our energy where the prob-lems
are."
Upcoming directions ...
As WIC enters its second decade,
program administrators will need to
continue prudent management of
their resources. Working with state
and local program managers to help
them get the best mileage out of
their administrative funds, USDA's
Food and Nutrition Service will be
doing administrative cost analyses
to identify "best practices"-techniques
that can be shared among
the state and local operators.
Federal administrators will also be
drawing upon the states' experiences
with vendor monitoring to see if
vendor abuses are a significant prob-
8
lem needing more attention.
More research and evaluation projects
will be underway in 1984, and,
as this research is completed, it may
suggest new policy directions. Some
of the questions being asked are:
What are the actual demographic
characteristics of the current WIC
population? Is WIC serving those at
the greatest nutritional risk in the target
population? Are there better
screening techniques-.that can be
used to identify high-risk
participants? And, what is the
impact of nutrition education in
WIC?
Much remains to be learned about
WIC, and while some of the answers
will come from formal evaluations,
many more will come from the
people in local agencies who make
WIC work.
"After 10 years, we're still discovering
ways to integrate new
ideas into what we're trying to do,"
says Dorothy Kolodner. "Mothers
sense the sincerity and feel we're
doing something positive ... because,
really, we're building on a very old
idea. One that says, 'I care about
you enough to share my food. "'
article by Carol M. Stansfield
Questions and
lA.nswers
onWIC
What is WIC?
WIC is a supplemental food program
operated by state and local
health agencies in cooperation with
the U.S. Department of Agriculture
(USDA) . The program provides
specially tailored packages of food
along with nutrition education to participating
women, infants, and
children .
WIC participants are eligible lowincome
persons who are determined
by competent professionals (nutritionists,
nurses, physicians, and
other health officials) to be at " nutritional
risk" because of inadequate
nutrition, health care, or both.
Through WIC, USDA provides federal
funds to participating state
health departments or comparable
state agencies, which in turn
distribute funds to participating
local agencies. The funds pay for
supplemental foods for participants
as well as specified administrative
costs, including costs of nutrition
education.
Indian tribes, bands, groups, or
their authorized representatives may
act as state agencies if they are
recognized by the Bureau of Indian
Affairs of the U.S. Department of the
Interior, or the appropriate area
office of the Indian Health Service of
the U.S. Department of Health and
Human Services.
Who is eligible for WIC?
Pregnant, postpartum, and breastfeeding
women, and infants and children
up to their fifth birthday are
eligible if they: (1) meet the income
standards; (2) are individually determined
to be at nutritional risk and in
need of the supplemental foods the
program offers; and (3) live in an
approved project area (if the state
has a residency requirement) or
belong to special population groups
such as migrant farmworkers, Native
Americans (Indians), or refugees.
Length of residency is not an
eligibility requirement.
"Nutritional risk" is a term used to
Food and Nutrition
indicate abnormal weight gain
during pregnancy, a history of highrisk
pregnancies, low birth weight,
inadequate growth, obesity, anemia,
or an inadequate dietary pattern.
When a local agency has limited
funds to serve additional participants,
applicants are classified
according to a priority system based
on nutritional need, and placed on
the program if space becomes
available.
What supplemental foods
do participants receive?
Infants through 3 months of age
receive iron-fortified formula. Older
infants (4 through 12 months)
receive formula, iron-fortified infant
cereal, and fruit juices high in
vitamin C. An infant may receive
formula that is not iron-fortified or
special therapeutic formula when it
is prescribed by a physician for a
specified medical condition.
Participating women and children
receive fortified milk and/or cheese;
eggs; hot or cold cereals high in
iron; fruit and vegetable juices high
in vitamin C; and either peanut
butter, dry beans, or peas. WIG
provides breastfeeding women with
a food package to meet their extra
nutritional needs.
Women and children with special
dietary needs may receive a
package containing cereal, juice,
and special therapeutic formulas.
For a participant to receive this
package, a physician must determine
that the participant has a
medical condition that precludes or
restricts the use of conventional
foods and requires a therapeutic
formula.
How do participants
obtain supplemental
foods?
In most states, WIG participants
receive food vouchers to purchase
the supplemental foods at local
grocery stores. These vouchers are
"food-specific," meaning they can
be used only for the foods prescribed
by the health or nutrition
professional at the local WIG
agency. In other areas, the foods are
delivered to participants' homes, or
participants pick up the foods from
warehouses.
Each state agency can design a
January 1984
food delivery system to meet its
needs. Some state agencies use a
combination of delivery systems.
What kind of nutrition
education do participants
receive?
Nutrition education is available
to all adult WIG participants, to parents
or caretakers of participating
infants and children, and whenever
possible, to participating children.
This nutrition education is designed
to have a practical relationship to
participants' nutritional needs,
household situations, and cultural
preferences.
The goals of WIG nutrition education
are to teach the relationship between
proper nutrition and good
health, to help the individual at nutritional
risk develop better food
habits, and to prevent nutritionrelated
problems by showing participants
how to best use their supplemental
and other foods. WIG
agencies encourage breastfeeding
and counsel pregnant women on its
nutritional advantages.
Federal regulations require local
agencies to provide each WIG
participant with two nutrition education
"contacts" per certification
period, which is usually 6 months.
How are local agencies
selected for funding?
Every state agency must rank
areas under its jurisdiction (such as
counties, health districts, or special
populations) in order of greatest
need based on economic and health
statistics. States must target funds
in this order of rank. The state
agency selects a local public or
private nonprofit agency based on
the type of service and capabilities
of the agency and the needs of the
local area. Consideration is given to
each agency according to a priority
system.
The priorities are as follows: (1) a
health agency that can provide both
health and administrative services;
(2) a health or welfare agency that
must contract with another agency
for health or administrative services;
(3) a health agency that must contract
with a private physician in
order to provide health services to a
specific category of participant
(such as women, infants, orchildren);
(4) a welfare agency that
must contract with a private
physician in order to provide health
services; and (5) a health or welfare
agency that will provide health
services through referral.
For the WIG program, the term
"health services" means ongoing,
routine pediatric and obstetric care
(such as infant and child care and
prenatal and postpartum examinations)
or referral for treatment.
Can eligibility decisions
made by the WIC
program be appealed?
Every state agency is required to
have a fair hearing procedure under
which adult applicants, and parents
or guardians of infant and child applicants,
can appe.al a denial of
eligibility or a termination made by
the local agency.
9
Ten years ago, on January 15,
1974, Debbie Holland became the
first participant in the nation's new
WIG program. Like many residents
of Pineville, Kentucky, Mrs. Holland
was facing hard times when she
applied for WI C. Her husband had
been laid off from the mines where
he worked, and they were having
trouble affording the food she
needed during pregnancy.
"WIG is a good program," she
says today, "because you and your
children get the food you need when
times are rough. My son Marlin was
on the program for about 3 months
until my husband went back to
work."
Today, things are better for the
Hollands. While they still use food
stamps occasionally when Mr.
Holland is laid off, Debbie has
worked as a grocery cashier and
recently completed an employment
training program that will enable her
to work in retail sales at a nearby
shopping center. Their two sons,
Marlin, 11, and Shannon, 9, are both
healthy and strong.
Officials see
much progress
Dr. Emmanuel Rader, health consultant
for the Bell County Health
Department, says he's seen a lot of
progress over the past 10 years-a
lot of kids, like Marlin Holland, who
have gotten a chance for a healthy
start in I if e.
"With the beginning of WIG," he
says, "we started to solve the problem
of improper nourishment. There
have been many times when health
problems, such as severe cases of
failure-to-thrive in infants due to an
intestinal milk allergy or formula
intolerance, have been detected because
of participation in WIG. Most
people could not have afforded the
special formula needed if it had not
been for WIG."
Dr. Rader, who worked with the
first WIG program operated by the
Maternity and Infant Care Project
(M & I) in Bell County, feels that
adequate nutrition for infants is a
critical part of the WIG program.
10
"Proper nutrition is one of the most
important roles of health care, and
providing specific foods, such as the
ones in the WIG program, is the
most effective way to target help to
those who need it ."
Nutritionist Mary Ruth Thacker,
who has been with the Pineville WIG
program since 1975, has also seen
many changes. Because of some of
the mountain traditions that have
been passed down, she says it has
been-and still is-a challenge to
educate clients.
"Some infants are fed gravy and
eggs at 3 months since that is what
granny did," she says. Effective
nutrition education decreases
parents' dependence on these
traditions.
WIC is part
of total care
The Pineville clinic is part of the
Cumberland Valley District Health
Department, where WIG is an important
part of an integrated health
care approach. Herman Johnson,
administrator of Cumberland Valley
explains, "We want to provide every
service we can once we get the children
into the health departments.
Without WIG, the services of _our
other programs would not be fully
utilized."
Janie Gambrel learned first-hand
about the benefits of integrated
health services. Janie was one of the
earliest WIG participants, and every
one of her four children has been on
WIG. Jennifer, 9, and Marcus, 6,
were both on WIG for a year. Russell,
3, and Brian, 3 months, are still
onWIC.
The WIG program has been especially
helpful to Russell because
pyloristenosis, a serious constriction
below the stomach requiring surgery,
was diagnosed in an M & I
clinic. "If Russell had not been on
WIG, I would not have known about
his problem since I did not come in
very often for other services," says
Mrs. Gambrel.
As an infant, Russell also needed
a special formula that might have
been too expensive for the Gambrels
to buy. "Without the help of
the WIG program, our children
probably would have gone hungry,"
' ' Proper nutrition is one of
the most important roles of
health care, and providing
specific foods, such as the
ones in the WIC program, is
the most effective way to target
help to those who need it.''
-Dr. Emmanuel Rader, Bell County,
Kentucky
Food and Nutrition
Mrs. Gambrel says.
Martha Blair, who was the director
of nursing for the M & I program, is
now director of health services for
the Mountain Trails Health Services,
a health maintenance organization
in Harlan, Kentucky. She is well
educated and successful, but grew
up in extreme poverty and remembers
when she actually went without
food for several days.
She no longer sees the hunger
she experienced as a child and feels
that the quality of life has improved
significantly over the past 10 years
due to people who care and
programs like WIC.
State nutrition director Peggy
Kidd, who also serves as WIC coordinator,
is proud of the health professionals
who work with WIC
throughout the state. The program
is available in all counties and is
serving close to 60,000 women,
infants, and children each month.
"WIC continues to be a vital part
of an integrated health care system
in Kentucky," Kidd says. "It is there
when it is needed."
For more information, contact:
Peggy Kidd
State Nutrition Director
Department of Health Services
State Cabinet for Human
Resources
275 E. Main Street
Frankfort, Kentucky 40621
Telephone: 502-564-3827
article by Kent Taylor
photos by Larry Rana
January 1984
The Gambrel children have all benefitted from
WI C. Jennifer, who is now 9, was one of Pineville's
earliest participants. Marcus (far right). who
is 6, was a participant for about a year. Threeyear-
old Russell (center) and baby Brian (not
pictured), 3 months, still participate. Above, Jennifer
holds a photo taken when she was a WIC
participant.
11
Changing
Habits. Through
Nutrition
Education
Over the years, WIG managers and
nutritionists have found a variety of
ways to give their clients helpful,
practical nutrition advice, as well as
instruction on using WIG foods.
Here's how a number of local WIG
agencies are tailoring nutrition
education to the particular needs of
their clients and making the activities
meaningful, interesting, and fun.
Motivating participants
-Joyce Garrick, in Chicago,
employs what she calls a "quality
assurance" technique in both her individual
and class counseling. Using
this technique Garrick sets education
goals for her clients.
"The participant must understand
both the 'why' and 'how' of her
medical condition and nutritional
needs before we can ever hope for
dietary change," Garrick says.
If a woman is anemic, for example,
Garrick explains what
anemia is and how vitamin C and
iron help eliminate it. This helps the
participant understand why she
needs to eat more foods containing
these nutrients.
"I show the client that, in fact, the
reason she might feel so tired and
irritable is directly related to her
specific dietary habits," Garrick
says. To make sure the education
goals with the participant have been
met, she verbally tests the client's
comprehension and asks her to
make a verbal commitment to
improve her dietary habits.
Garrick uses visual aids whenever
she can. "I like using the Dairy
Council's comparison cards that contain
pictures of 50 to 60 different
foods," she says. These cards illustrate
some of the nutrients the foods
contain and their percentage of the
National Academy of Science's
recommended dietary allowances
(RDAs).
"Sometimes I show medical pictures
of people and animals who are
12
Mary Owen, WIC coordinator in Waterville, Maine,
plans a variety of activities for children and adults.
suffering from nutritional deficiencies.
I want my clients to understand
and see for themselves the
relationship between diet and
disease."
-Ruth Ryan of Richmond, Virginia,
also personalizes instruction.
"Whatever we do to educate WIG
participants," she says, "we try to
get them involved as much as
possible."
One way she has been successful
in doing this is by having the participants
play games during nutrition
education classes. In one of the
games, she uses the Dairy Council's
comparison food cards. She covers
up the name of the food but shows
the nutrient it contains. Then she
asks, "Which food group is it? What
food is it?"
In another game, Ryan fills
mystery bags with Dairy Council
food models, which are cardboard
pictures of foods. The foods in each
bag comprise a meal that has something
wrong with it. Participants
each receive a bag and paper plate
to put the food on. They then
discuss how they can improve each
meal by balancing it according to
the four food groups and improving
its texture and appearance. This is a
lesson in meal planning.
Circling 10 foods out of a list of 15
Here, she serves fruit juice to the children as part
of a lesson on vitamin C.
or 16 is a shopping list game participants
play. They are told they only
have enough money to buy 10 of the
foods on the list. After they circle
the foods they would buy, they
discuss the nutrients the foods contain
and the food groups the foods
belong to.
The 24-hour recall game makes
the mothers focus on what they
have been doing in their own
homes. In this game, the mothers
write down what their children have
eaten over the last 24-hour period.
They then have to evaluate these
foods in terms of the four food
groups and missing nutrients.
-Motivating participants with
fun and fitness is what Kathy Hoy of
Richmond Heights, Missouri, did
with the "WICnic" she held last
summer. About 125 WIG participants
in this St. Louis county area
came out to a local park to enjoy an
afternoon of nutrition games and
physical activity.
One of the games was "Nutrition
Bingo," in which participants
received cards with five food categories
on them. These categories
were: high fiber, low sodium, low
sugar, high nutrients per calorie,
and low fat.
On the cards were pictures of
foods associated with these
Food and Nutrition
categories. As the participants
played the game, their knowledge of
the foods pictured and the benefits
of these foods were reinforced.
While the moms played bingo, the
children could watch cartoons on
nutrition.
There were also games for the
young ones to play. The 2- to 4-
year-olds played "Pin the Tail on the
Cow," which was both educational
and fun. "This game gave us the
opportunity to teach the kids about
milk," says Hoy, "where it comes
from and its importance."
A scale where participants could
weigh themselves was also at the
park that afternoon. Lists of ideal
weights for different heights were
posted near the scale.
Teaching children
-In Maine, Polly the Kangaroo
(also known as Polly's Pocket) has
been teaching nutrition education to
preschoolers since October 1982.
This colorful exciting character will
continue performing for children in
the Waterville and Skowhegan WIG
offices and in day care and Head
Start classrooms until April1984.
At least once a week an employee
with basic nutrition knowledge and
an understanding of young children,
dresses in a kangaroo's costume.
Aided by foods she carries in her
"pocket," Polly teaches young
audiences about vitamins and minerals,
protein, the importance of
eating breakfast, and why some
foods are good for your teeth and
others are not.
The activities are coordinated with
the monthly nutrition themes at the
clinics so that mothers receive the
same nutrition messages as their
kids and the messages reinforce
each other.
Stickers, posters, plastic cups,
and placemats children can color
are educational materials used in
the project. The kangaroo character
appears on these, depicting a
nutrition concept. The performing
kangaroo uses these materials to
reinforce the nutrition message in its
activity of the day.
Information sheets highlighting
the nutrition concept and the nutrition
activity are available for
parents. They also contain suggestions
for follow-up activities at
home.
Describing why she began the
kangaroo project, Mary Owen, the
WIG coordinator, says, "Recognizing
that it is much easier to develop
healthy eating habits than to change
poor ones, we want to help children,
in an exciting way, explore various
foods and learn how these foods will
help them grow and be healthy."
Part of this project also includes
producing a "WIG and You" video
series that uses the kangaroo and
WIG foods. This series will focus on
the WIG foods and their importance
in the child's diet. An evaluation of
the effectiveness of the project will
be conducted at the end of the
school year.
Using newsletters
-As an ongoing means of
educating participants about good
nutrition, many WIG managers
throughout the country use
newsletters to keep participants
informed.
-In Missouri, Kathy Hoy sends
a newsletter to her nine St. Louis
County sites each month. Each
A performance by Polly the
Kangaroo makes learning
fun for kids and parents alike.
Polly's lessons reinforce the
nutrition theme of the month.
newsletter features a different topic
that is related to food and nutrition.
Her newsletter for July, for example,
was on nutritious snacks and for
August it was on food purchasing.
Participants receive the newsletter
when they come in to get their
monthly vouchers.
-Karen Klein in Waterbury,
Connecticut, uses a newsletter every
2 months as a secondary contact
with her participants. With the newsletter
and a questionnaire, a
nutrition aide reviews the nutrition
information with the participant to
make sure she"understands it. In this
way, the newsletter is used as a
teaching tool.
-Rebecca Maxwell in Farmville,
Virginia, has a section in her
monthly newsletters set aside for
WIG participants to share information
with each other. Some ideas
they have been sharing include
recipes for using WIG foods in
nutritious snacks for children.
At the beginning of September,
Maxwell got two participants from
each of her seven counties to test
submitted recipes in their homes.
They tried them to see how easy
they are to follow and how well their
children like them.
The easiest, most popular recipes
will be included in a 12- to 15-page
mimeographed cookbook that
should be available to all
participants by March.
Managing large caseloads
-Group classes and effective
management of staff are keys to
Cheryl Kenady's success in teaching
nutrition education to a large
caseload of 8,000 in Dayton, Ohio.
Five licensed practical nurses allow
the eight nutritionists (one of these
is half-time) to concentrate on
nutrition education. The nurses do
the medical screenings and help in
encouraging breastfeeding, which
allows the nutritionists to counsel
twice as many participants.
Due to a lack of space and staff,
for the past 2 years Kenady has
used a combination of classes and
individual counseling. All participants
receive individual counseling
at initial certification, and more than
half-64 percent-have individual
appointments at mid-certification
as well.
Classes are held once a month for
both children and mothers. They are
on such topics as anemia, the over-
14
weight and underweight child, and
dental care. Topics for the prenatal
woman include breastfeeding,
formula preparation, feeding your
baby, and basic nutrition. Postnatal
classes include budgeting, breastfeeding
and feeding in general, and
recipes and cooking ideas. There
are also classes for older children.
One of the subjects included is
snacking, which is taught with the
help of a film, "The Snacking
Mouse."
Recipes on the back of dairy
calendars are another way Kenady
informs participants about nutrition.
In Dayton, milk, eggs, cheese,
cereal, peanut butter, juice, and
baby formula are delivered to participants'
homes by authorized dairy
companies.
Participants receive dairy calendars
every 3 months when they
come in for their appointments. On
these calendars are recipes that
either the participants or nutritionists
have offered.
Kenady feels her efforts have paid
off. "Kids who were anemic or overweight,"
she says, "are no longer
this way. The beauty of WIG is that
these foods become a habit for the
kids. The kids ask for them and the
parents aren't inclined to deny
them."
-In Knoxville, Tennessee, some
carefully planned teamwork helps
WIG nutritionists at the main clinic
handle a caseload of about 4,700.
The four nutritionists who work at
the main clinic divide up the caseload
and work on a buddy system so
they can help each other out.
"Each nutritionist under this
system has a buddy who will help
her if she needs it or will handle the
caseload if she is not there," says
nutritionist Susan Brokaw. "As a
result, two buddies share the caseload
and are a real support for each
other."
Being located close to the University
of Tennessee has also been
a big help in handling a large
caseload. Brokaw benefits from the
help of students in the Department
of Food and Nutrition at the
university who initiate projects and
do field work at the WIG clinic.
Brokaw provides the field work and
directs their projects.
In addition, the clinic has benefitted
from the help of paraprofessionals,
who have also been
university students. They have
assisted in plotting growth measurements
for participants' records.
They also have helped the nutritionists
develop and teach classes,
allowing the nutritionists time to
work individually with participants.
Educating teenagers
-"Being housed in a hospital
where our teenagers can get the
support of other social service agencies
has helped teenagers on the WIG
program enormously," says WIG director
Kit Plourde of Bristol, Connecticut.
"The other social services agencies
in the hospital and in the community
back up our nutrition information,
and we back up their prenatal information.
We share with and reinforce
each other. As a result, the girls can
take care of themselves and their
babies better."
High-risk prenatal cases, a category
that some teenagers fall into,
receive the best coordinated help
the social service agencies can offer.
Representatives from these agencies
get together once a month to discuss
a patient's total care.
Food and Nutrition
Above and opposite page: Chicago nutritionist
Jimmye Smith counsels a young mother on her
baby's growth and development. When the baby
Representatives include a medical
social worker, a nurse practitioner at
the prenatal clinic, a WIG nutritionist,
a PACE (Prevention of Child
Abuse-A Community Effort) coordinator,
the head nurse on the
pediatrics and obstetrics/ gynecology
floor, and a representative of
the Girls' Young Parent Program.
This coordination among the social
services extends to nutrition education
as well. "As a nutritionist, I not
only educate these girls through the
WIG program but also through the
Young Parent Program," says Jean
Kostak, a nutritionist at the Bristol
clinic.
The Young Parent Program is a
support group for pregnant teenage
girls and teenage mothers. As a
regular part of the program, social
service professionals come and
counsel the girls on such topics as
how to stay in or get back to school,
prenatal care, and caring for a new
baby.
Sometimes using films, Kostak discusses
nutrition needs during pregnancy.
She talks about how food affects
the health of a growing fetus
and how smoking, drugs, and alcohol
can hinder a fetus' development.
To give each girl as much individual
attention as possible, Kostak asks
the girls to write a diet journal
2 weeks before a class starts. In the
journal they write down everything
they eat during a week or as many
January 1984
I
is 4 months old, she explains, the WIC food
package will include iron-fortified cereal as well as
formula and juices high in vitamin C.
days as possible. A week before the
class begins, they hand in the journal.
Then Kostak does a complex
nutritional assessment of each girl's
dietary intake where she evaluates
the strengths and weaknesses of the
girl 's diet and makes recommendations
for improvement.
' 'The participant must understand
both the 'why' and
'how' of her medical condition
and nutritional needs
before we can ever hope for
dietary change .. .! show the
client that, in fact, the reason
she might feel so tired and
irritable is directly related to
her specific dietary habits., '
-Joyce Garrick, Chicago
"An example of what I might tell
them," Kostak says, "is this: 'Some
ways to increase your calcium
would be to drink more milk or eat
more dairy products during the
week.'"
The teenagers also learn about
benefits of breastfeeding in these
classes. Says Kostak, "The girls are
very receptive. They are not inhibited
about asking questions and sharing
information.''
"As a result," says Kit Plourde,
"we've had a big increase in breastfeeding
teenagers. Four years ago,
before our coordinated education
program started for teens, the majority
of them were not breastfeeding.
Now the majority are breastfeeding
from 2 to 6 weeks. And, if the girls
want to breastfeed when they go
back to school , the schools are supportive.
I know of at least one teenager
who went back to school and
was able to breastfeed in a room
provided by the school nurse."
Sharing resources
A common bond that all WIG
directors and nutritionists share is
that they don't work in a vacuum.
They are part of the community they
serve. As a result, they participate in
a give-and-take: giving of their services
and taking the services of
others to benefit the community as a
whole.
Some of the service agencies WI C
personnel regularly use are: the Cooperative
Extension Service, Dairy
Councils, the Red Cross, the March
of Dimes, the La Leche League, lung
associations, state departments of
health and nutrition, community
action programs, food banks, and
public health departments.
Many WIG offices receive materials
from the Cooperative Extension Service.
In addition, in some communities
the Extension Service refers
possible participants to the WIG
office, and the WIG office refers participants
who might need additional
information and attention to a home
economist working in Extension's
Expanded Food and Nutrition Education
Program (EFNEP). In some communities,
Extension Service personnel
do food demonstrations at
the WIG offices as well.
From the other service agencies
the WIG offices receive printed materials
and audiovisuals on such
topics as prenatal nutrition and
health, breastfeeding, and smoking
and pregnancy. When appropriate,
WI C personnel refer their participants
to these agencies for information ·
and help. They also gain new participants
from referrals these agencies
make to them.
article by Bonnie W. Polk
photos by George Robinson
15
A Look At
Barbara Fritz, Hilda Whittington,
and Jean Davis direct large urban
WIC programs in Cincinnati and
Chicago. All ttiree have been with
WIC since its beginning, and their
enthusiasm and support for the
program have continued unabated.
They have a lot to say about the
changes they've seen over the years,
the challenges they've faced, and
the successes they've had .
Before the WIC program began in
January 1974, Jean Davis had spent
5 years working with "Operation
Nutrition" in the suburbs of Chicago.
This program involved the distribution
of USDA surplus commodities
to needy pregnant women.
"But after travelling from suburb
to suburb, sometimes 200 miles a
day, I wanted a change and a chance
to work in more of a community
setting," says Davis. A registered
dietitian with a master's degree in
public health, Davis found that setting
when she took the position of
WIC director in 1974 at the Mile
Square Health Center (MSHC), a
nonprofit community health center
on Chicago's west side.
While Davis was contemplating
her career shift in 1973, Barbara
Fritz was coordinating school and
community relations in Cincinnati,
Ohio. Fritz had become involved in
public housing and education issues
during the 1960's and learned about
WIC through a friend.
"I had never heard of any program
that made such sense," Fritz recalls.
" It hit me like the proverbial ton of
bricks." She applied for and obtained
a staff position in the Hamilton
County WIC program of the Cincinnati
Board of Health (COM) , and a
year later was appointed WIC director.
Hilda Whittington came to the
Chicago Department of Health
(CDH) as a public health nutritionist
in the fall of 1973 and was asked to
develop the WIC program and counsel
clients who received various
health care services. She had just
completed her master's degree in
public health, having already
become a registered dietitian.
''The city's WIC program began in
16
Hilda Whittington (left) directs the WIC program
operated by the Chicago Department of Health.
She has seen it grow from one site a decade ago
a storefront clinic on the lower west
side," she remembers. "When we
started, I was certifying and counseling
clients, and we were given a
temporary CETA worker who helped
give out the food vouchers."
Programs have
grown and changed
For Barbara Fritz, spreading the
word about WIC has been her biggest
challenge and ultimate success. "In
an urban area like Cincinnati, the
most important thing I can do is to
develop communications networks
to let every possible person know
about WIC," she says.
"For 10 years, I have been building
networks with community groups,
churches, and over 300 human resource
agencies and organizations
in Hamilton County." Ten years of
hard work, full of meetings, outreach
efforts and appearances before the
media, have paid off.
"Although Cincinnati is only the
third largest city in Ohio," she says,
"it has the largest WIC program in
the state, serving about 15,000
clients."
The Chicago Department of Health's
WIC program is also large. At the
end of its first year of operation, the
storefront clinic was serving about
to 10 sites today. Here, she talks about the day's
schedule with her assistant, dietitian Min-I Lee,
one of 84 people Whittington supervises.
3,000 women and children. Today,
CDH has 10 WIC sites serving approximately
27,000.
Getting information out to the
public was not a problem in Chicago,
according to Whittington , who is
now acting director of CHD's nutrition
division. "Clients found out
about WIC, either through word of
mouth or through referral to our
clinic from other clinics in the department,"
she says.
"We were initially overwhelmed
with referrals and had not anticipated
that the program would catch
on as fast as it did. What kept us
busy in those first years was building
up our recordkeeping, reporting statistics,
and, of course, obtaining
enough staff," she adds. "We had to
pull nutrition staff from other city
clinics to help out."
At the Mile Square Health Center,
Jean Davis saw about 1,000 WIC
clients in 1974. "To me, Mile Square
was like a piece of cake compared
to reaching clients in the far-flung
suburbs," she says.
At that time, the Mile Square
Health Center served what its name
implies, a square-mile area, extremely
impoverished, on Chicago's
west side. "It was easy to contact
patients because of the housing
Food and Nutrition
situation, with mostly apartments
and housing projects close together,"
says Davis.
Until1982, both Mile Square and
the Chicago Department of Health
operated WIC programs within designated
geographical areas of Chicago.
"We had many complaints about the
geographical boundaries, which
were difficult to explain," says Whittington.
"Many potential clients felt
discriminated against."
She remembers cases in which
one neighbor living across the street
from another was unable to participate
in WIC while the other was,
"just because she was outside the
boundary limit and the other was
inside."
During 1981, the Illinois Department
of Public Health and local WIC
agencies worked on an expansion
plan. As a result, there are now 13
WIC sites serving all of Chicago. In
addition to Mile Square and the 10
CDH clinics, there are two smaller
WIC sites at Roseland Hospital and
the Altgeld Clinic.
Two delivery
systems used
Once certified as eligible for WIC,
participants are authorized to receive
a food package worth an average of
from $25 to $35 a month. But how
they actually obtain their supplemental
foods varies from community
to community.
In Cincinnati, a dairy truck delivers
WIC foods to program
participants. The delivery man is
given a list of WIC participants and
the food packages that have been
specifically tailored for them by a
WIC nutritionist.
For example, a woman and her
infant may receive a carton with
milk, eggs, cheese, orange juice,
infant formula, and cereal. In order
to prevent spoilage, any fresh foods
in the WIC package, such as milk or
eggs, are delivered once a week.
"For Cincinnati, the dairy delivery
system has worked very well," says
Barbara Fritz. "There are no big
superstores in the inner city where
many participants live, and prices
tend to be sky high at smaller corner
grocery stores."
In Ohio, each county decides
whether it wants to use the dairy delivery
or the food voucher system. In
1974, the Cincinnati Board of
Health, which operates the WIC
program in all of Hamilton County,
decided to use the dairy delivery
system.
January 1984
The Ohio Department of Public
Health then solicited bids from
dairies and awarded a contract to
the lowest bidder. For items such as
infant formula and dry cereal, the
dairy subcontracts with suppliers of
these products.
"When a family reports that it
didn't receive its monthly food package,
we can check with the driver,"
explains Fritz. She works on keeping
a good relationship with the dairy
company, and out of about 14,000
deliveries a month has found only a
few mistakes. "Besides being convenient
for participants, the dairy
system assures, by law and by contract,
that only the proper foods are
delivered to participants," says Fritz.
At the Chicago Department of
Health WIC sites as well as the Mile
Square Health Center, participants
receive vouchers listing the supplemental
foods they may purchase at
local grocery stores. They pick up
their vouchers during the first week
of each month, on a day designated
according to the first letter of their
last names.
"More than 400 local stores are
under contract with us to provide
WIC foods," explains Hilda Whittington.
These include chain stores,
independent grocers, and even drugstores
that sell infant formula. One
person on Whittington's staff
devotes full time to monitoring the
retailers to make sure they are providing
the foods specified in their
contracts.
Cincinnati's Barbara Fritz supervises the largest
WIG program in Ohio. Ten years of hard work
At Mile Square, Jean Davis has
arranged for 51 stores in her now
expanded service area to accept
WIC food vouchers from participants.
"I train the vendors myself
about what foods they can allow,"
she says, "and once in a while I have
to counsel grocers who I've found
may be breaking the rules."
Nutrition education
makes a difference
"One of the happiest moments for
me was when one of my grocers
made a special trip to my office to
see 'who is in charge of this WIC
program,"' recalls Davis. "He said
that prior to WIC, many of his customers
would just come in and
shop. "Now, his WIC customers read
labels on cans and packages. He
told me he had seen the change in
the clientele and wanted to know
'why all of a sudden people were
talking about brands and quantities
and quality in the foods they were
getting.' That made me feel so
good!"
What had happened was that participants
at Mile Square, like those
everywhere else, were receiving
nutrition education on a regular
basis. In Chicago, as in Cincinnati,
WIC clients are counseled individually
during their initial visit, then
take part in a variety of group
activities. Davis, Whittington, and
Fritz view nutrition education as a
vital part of WIC and give it high
priority in their programs.
have paid off, she says, and she's proud of the
huge referral system she's helped build.
17
Jean Davis is WIC director of the Mile Square
Health Center on Chicago's west side. A firm
believer in staff development, Davis has hired and
trarned a number of former WIC participants.
Another shared interest is dental
health, and all three directors
include information on diet and
dental health in their educational
activities.
"Before I would see the patients referred
to me by a physician," says
Davis, " I wanted them to see the
Mile Square dentist because so
many of them had bad teeth."
She recalls many mornings when
mothers would bring in children
who complained of pains and stomach
aches but who were really suffering
from toothaches.
Her push for dental care paid off
when the Mile Square management
hired a children 's dentist in 1980.
"We now have a pedodontist here
because of the WIC program," she
states proudly. In addition, all children
on WIC see a pediatrician.
"The head of pediatrics here is very
happy because all of the kids now
get immunization shots."
18
Planning for
the future
With all their administrative responsibilities,
the three WIC directors
admit they miss working with
clients. "I become dismayed sometimes
because I feel removed from
the patients," says Fritz, who
manages a staff of 40. "But I do talk
to a mother or two occasionally and
go on visits to different clinics."
Davis concurs. "In this field, you
have to like dealing with people and
hearing about their problems. I miss
that one-on-one contact. "
Hilda Whittington also misses providing
direct service to clients. But,
she says, " I became interested in
administration because I wanted to
influence the delivery of health care
services to clients ."
In the future, Whittington, whose
staff includes 84 persons, sees more
emphasis on teamwork. In clinics
providing WIC services, there will be
more coordination with social
workers, nurses, and hypertension
screening specialists.
Also, the clinic staff will be working
to make WIC clients more aware of
the availability, at larger neighborhood
health centers, of such specialty
services as podiatry, internal
medicine, and X-rays. "We will be
serving more clients and expect, in
1984, to reach our assigned caseload
of 35,000," says Whittington.
A local agency's caseload, or the
number of persons that may be
served, is dependent on available
funds and is assigned by the state
agency. At Mile Square, the number
of WIC clients has grown from 1,000
persons in 1974 to an assigned caseload
of 12,000 in 1984.
" I have always been able to convince
the state agency in Springfield
that I will be able to fulfill our caseload
as assigned," says Davis. "We
will work on Saturdays if we have to
in order to reach our caseload. As
long as I can add additional caseload,
that means more people can
be served."
Davis has kept in touch with a
number of her former clients and is
proud of their progress. Over the
past 10 years, 15 former WIC participants
have worked at various times
in the program.
"I also remember meeting several
years ago a couple who had come to
the clinic to enroll their new baby in
the WIC program," says Davis. Recently,
she saw them again and
learned that they had both received
college degrees.
A firm believer in continuing education,
Davis emphasizes staff development
and encourages her
employees to further their educations.
"If they have finished high
school , I tell them to go further, to
get more schooling and tra ining that
will help them grow," she says.
" I have three women who are currently
working for me as clerks who
were once WIC participants. All
three are taking college business
courses!"
At the Cincinnati Board of Health,
Barbara Fritz continues building
and maintaining networks to let the
public know about the WIC program.
In 1984, her caseload will be
about 16,000 persons. She is pleased
that, after a decade, Cincinnati has a
huge referral system, involving community
groups, churches, private
hospitals and 11 health centers.
Fritz will also be focusing her efforts
on reaching pregnant women
early, in their first or second trimester.
"Usually, we see them in
their last tr imester, but if we can get
to more of them in time, we can
make a difference in their having
healthier babies."
At times, Fritz feels frustrated with
the bureaucracy inherent in running
any large social service program.
"But when I've had it up to here with
the bureaucracy," she says, "what
renews me is how well the WIC program
works and what a solid, practical,
humane, and cost-effective
program it is."
For more information, contact:
Barbara Fritz, Director
Hamilton County WIC Program
Cincinnati Board of Health
4860 Reading Road
Cincinnati , Ohio 45237
Telephone: (515) 242-4133
Jean Davis, Director
Nutritional Services and WIC
Mile Square Health Center
2045 W. Washington
Chicago, Illinois 60612
Telephone: (312) 942-3700
Hilda Whittington, Acting Director
Chicago Department of Public Health
Nutrition Division, WIC Program
Richard J. Daley Center, Room CL-88
Chicago, Illinois 60602
Telephone: (312) 744-3867
article by Victor Omelczenko
photos by Richard Faverty
and Victor Ome/czenko
Food and Nutrition
MC
in Rural
Colorado
The Colorado WIG program provides
an excellent opportunity to
observe a variety of delivery systems
designed to meet the unique
demands of rural communities.
WIG currently serves 45 of Colorado's
63 counties, most of them
rural, and each one poses a specific
set of environmental and demographic
challenges. Consequently,
each requires an innovative and
adaptive response at both state and
local administrative levels.
To illustrate the wide range of circumstances
in which the WIG program
has flourished in Colorado's
rural plains and mountain communities,
this article focuses on three
local agencies: Prowers County
(with its clinics in Lamar and
Granada), Bent County (with its
clinics in Las Animas and McClave),
and Gunnison County (with its clinic
in the town of Gunnison) .
The clinics in these three
counties, like most rural health programs,
are operated by county nursing
services. In one small office it is
not unusual to find a public health
nurse who, with a staff of paraprofessionals,
is responsible for anumber
of different services: WIG, family
planning, immunization, maternal
and child health; prenatal and
well-child care; nursing for the
elderly; and Medicaid-as well as
the school nursing service.
As Colorado WIG director Bill
Eden says, "Rural public health services
like having WIG because it is
often the big draw-the carrot that
brings people in. Then they can receive
immunizations or other services
they might need."
Under Eden's direction, the Colorado
Department of Health has developed
an excellent training and certification
system for rural and nonrural
WIG paraprofessionals. The system
includes a detailed series of selfteaching
modules, an efficient communication
network providing
access to Denver-based nutrition
consultants, and instructions on
how to inform potential participants
of WIG services.
In addition, Eden has collaborated
January 1984
with Margie Hargleroad, nutrition
consultant to the state's migrant
health program, to establish an effective
WIG delivery system for migrant
farmworkers. The system, developed
specifically for Colorado, is now
being applied in other states with
large migrant populations.
A major strength of the delivery
system is its successful integration
with other, existing health services
for migrants. Nutritionists, partially
funded by WIG, now join nurses and
dental hygienists to form 12 interdisciplinary
teams which travel to
migrant centers throughout Colorado.
Prowers County
One of the centers of migrant
activity is the small town of Granada.
The WIG program in Granada is
actually a satellite of the program in
Lamar, one of the larger towns (pop.
8,500) in the fertile Arkansas River
Valley of southeastern Colorado.
Based in Lamar, the Prowers
County nursing service
provides WIG benefits
to about 460 women,
infants, and children
throughout the
county.
The staff consists of WIG coordinator
Norma Rogers, who is a
registered nurse; Mary Jane Torres,
full-time WIG clerk; Veronica Losa,
part-time WIG clerk; and Mary Guiney,
migrant health services nutritionist,
who spends about 60 percent of her
time on WIG.
"Well over half of Prowers County
WIG participants are Hispanic, and
20 percent-about 100 of our clients
Lamar, one of the larger towns in the fertile Arkansas
River Valley, is the center of the Prowers
County WIG program. From Lamar, WIG coor-
-are migrants," says Rogers. The
greatest numbers of migrants participate
during the harvest season,
but participation drops back in
the fall.
Many migrants come to the farms
around Granada from their home
base in Texas to harvest the large
onion and potato crops. One of the
main residences for migrants is a
housing project on the outskirts of
Granada called Nueva Vista, and it is
there, in a unit reserved for migrant
health services, that the satellite
WIC clinic takes place every Tuesday.
The migrant community is very
close-knit, and information spreads
quickly by word of mouth. So it is
for WI C. Rogers says that WIC is
extremely popular among migrants,
and she feels confident that her staff
reaches virtually all of the eligible
migrant women and children in
Prowers County.
Those who don't live at Nueva
Vista manage to find transportation
to the clinic. Every Tuesday cars
and trucks filled with mothers and
children arrive in slow, steady
succession.
Reaching migrants
is first priority
"Migrants are our top priority,"
says Rogers. "We never know if we
will see them again after their first
visit, so our main goal is to get the
20
dinator Norma Rogers and her staff operate special
satellite clinics in nearby Granada for migrants
who go there during harvest season.
pregnant and breastfeeding women
on the program immediately."
The result is that Rogers' staff
uses an abbreviated application
procedure for migrants. "No
appointment is necessary," says
Rogers. "We take them in immediately.
We've learned to be flexible."
However, for their expedited
service migrants also pay a price.
Unless they come back for follow-up
visits, they often go without the testing,
monitoring, and counseling provided
under more conventional circumstances.
"It's not the kind of
quality care we like to give," says
Rogers, "but getting them the food
is our main goal."
For instance, Denise Cruz, a
young mother of four from near Lubbock,
Texas, came in just long
enough to register her two older
children, having registered her two
younger ones the week before.
After she had gone, Rogers
examined one of the certification
forms. Only the birthday and birth
weight (5 pounds, 6 ounces) were
filled in. The blanks for height,
weight, and hematocrit were filled
with the number "99"-the code for
"unknown ." Rogers says, "That's the
story of the migrant."
To compensate somewhat for the
migrants' transient and undocumented
lifestyle, Rogers says clinics
now provide them with "verification
of certification" (VOC) cards, which
they can carry from one location to
the next. The VOC card, which is
used by all WIC agencies serving
migrants, helps to establish some
history and continuity for the
migrant WIC participant when she
arrives at a new clinic. It also helps
WIC personnel avoid needless and
wasteful duplication of service.
To compensate for incomplete
office visits, nutritionist Mary
Guiney visits almost all pregnant
and postpartum migrant women in
their homes. She also has contact
with migrants at the local migrant
school, day care facilities, and
weekly night clinic, but it is in the
home that the most effective
counseling takes place.
Guiney discusses with the mother
the nutritional needs of her child,
learns of any health problems in the
family, and gives brief lessons in
general nutrition and consumer
education. "For instance, I explain
the merits of iron fortification in
formula. And I compare the cost of a
glass of milk to a glass of soft drink
to show that milk is cheaper and
more nutritious. I do the same with
an apple and a candy bar."
''Migrants are our top priority.
We never know if we will
see them again after their first
visit, so our main goal is to get
the pregnant and breastfeeding
women on the program
immediately., '
-Norma Rogers, Granada,
Colorado
Guiney adds that migrant families,
though poor, maintain traditional cultural
values and, therefore, are very
polite and receptive of her educational
efforts. "The ones who have
settled out (left the migrant stream)
are less receptive. They've become
Americanized ."
Ironically, it is this Americanizing
process that is responsible in part
for some of the common migrant
health problems. "Migrants characteristically
show symptoms of a
basic nutritional inadequacy
brought about by a deterioration of
their traditional diet and a growing
Food and Nutrition
tendency to select 'junk foods,' "
says Guiney.
Guiney has observed that migrants'
diets are frequently deficient
in calcium and vitamins A and C,
and they are too high in sugar and
starch. Half of all the migrant
children seen at the Granada clinic
are anemic. Forty percent are overweight.
Diabetes and hypertension
are common among adults.
Language presents
special problems
Efforts by the nutritionist and WIC
staff to correct these problems are
hampered by some formidable obstacles.
Language is one of them. To
overcome the language barrier, the
state agency has worked hard to
make its WIC education materials
accessible to migrants. All Colorado
WIC publications are now available
in Spanish.
Yet, for most migrants the
majority of nutrition education
occurs orally-either through counseling
during office visits or during
Guiney's trips to their homes. Practically
all conversation at the
Granada clinic is in Spanish, with
Mary Jane Torres, the most fluent of
the WIC staff, doing most of the
talking.
For migrants who speak little or
no English, even an activity as
routine as shopping in a grocery
store can be an intimidating experience.
Unable to ask questions, read
labels, or seek help, they have difficulty
selecting nutritious and
economical foods. Though WIC
clients are aided by their itemized
food vouchers, they occasionally
run into problems, too.
It is not uncommon for small, rural
grocery stores to run out of certain
items if demand surges unexpectedly.
The Granada IGA market has
run out of some WIG-eligible foods,
such as juice, formula, even milk,
when migrants arrive en masse. In
those instances the store issues a
rain check for the item, which
generally means a delay of 2 or 3
days.
Still other factors aggravate the
problems brought on by marginal
nutrition. Teenage pregnancy is a
relatively common circumstance
among migrants. One girl who came
in to the clinic inquired for her
sister, who was 14 with a 1 0-monthold
baby. Guiney also recalls having
seen one 4-day-old child in Granada
with a birth certificate from Lubbock,
Texas. "That child traveled a
January 1984
long way in its first 4 days of life,"
she says.
Few migrant mothers breastfeed
their children . Rogers puts the
number at less than 40 percent. The
reasons are not clear, but Rogers
conjectures that, because many
mothers work long days in the
fields, breastfeeding just isn't convenient.
They also may feel that
breastfeeding is a backward, stigmatizing
practice.
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Las Animas is headquarters for the Bent County
WIG program. At a satellite clinic in an elementary
Rogers, Guiney, and the rest of
the WIC staff attempt to dispel
erroneous ideas and explain how to
express and store milk, but so far
they have met with little success.
All the more reason, says Rogers,
why WIC is vital to the well-being of
the migrant community. The food
package with its iron-fortified
formula, the referral system giving
migrants access to the entire
network of migrant health services,
school in McClave, WIG clerk Donna Lucero
weighs and measures a young participant.
21
the nutrition education provided by
Mary Guiney and her counterparts
on other interdisciplinary teams
across the state-all are essential
components in WIG's effort to
improve the quality of life among
migrants in Colorado.
Bent County
Traveling west from Granada and
Lamar along Route 50, one leaves
behind the area of migrant concen-
. tration , but the character of the landscape
remains unchanged: vast, cultivated
plains of the Arkansas River
Valley punctuated at intervals by
small towns.
One of those towns, Las Animas
(pop. under 3,000), is headquarters
for another rural WIG program. This
one is operated by the Bent County
Nursing Service and staffed by
Priscilla Nielsen, registered nurse
and WIG coordinator; Donna
Lucero, full-time WIG clerk; and
Bonnie Miller, part-time WIG clerk.
The Bent County WIG caseload
is currently 275 to 300 and growing
slowly. It comprises almost equal
numbers of Anglo and Hispanic
participants, a third of whom are
unemployed. Those who do work
are mainly farmworkers, staff at the
VA hospital, or assemblyline
workers at Neoplan, a German bus
manufacturing plant in Lamar.
As in Prowers County, WIG
reaches a high percentage of the
eligible population-"about 90 percent,"
says Nielsen-because the
program is well known and the population
is fairly stable. "Sometimes
we miss farming families who can
go a couple of years without showing
any income and yet might not
think of themselves as qualifying for
WI C."
She adds, "We like to stress that
WIG is a nutrition and education program
rather than welfare. WIG is
well integrated into the structure of
the county nursing service, and so it
is a nonthreatening way to make
contact with the other health
programs."
Service geared
to clients' needs
Nielsen sees advantages to having
a small program. "In a small office
like this we can be more flexible and
more intimately involved with our
clients," she says. "Our counseling
is one-on-one, and we adapt to the
needs of the individual, treating not
22
Bent County WIC coordinator Priscilla Nielsen
and her staff work out of this community services
building in Las Animas. "WIC is well integrated
only nutritional problems but an
entire spectrum of health disorders."
Mothers are willing to meet with
WIG paraprofessionals because
quite often they know each other on
a social basis. Nielsen says, "Bonnie
greets everyone like a long-lost
daughter. These are people she
knows. We have pregnant women
who come in for WIG who haven't
seen a doctor because they have no
money. We help them get on Medicaid
and work out payment plans
with physicians if possible."
The popularity and high visibility
of WIG also help the Bent County
Nursing Service reach prospective
clients in outlying areas. "There are
some families in the McClave area
we've been trying to immunize for
years. When WIG moved in, we had
a more frequent and prominent
presence. We were able to remind
these people of their need for
immunizations."
Once a month, Donna Lucero and
Bonnie Miller load up Lucero's compact
station wagon with client
charts, vouchers, scales, and other
program paraphernalia and drive 25
miles east of McClave to conduct a
satellite WIG clinic.
A room reserved at the elementary
school serves as the monthly WIG
clinic, and it is here that Lucero and
Miller set up their equipment and
into the structure of the county nursing service,"
says Nielsen. As in Prowers and Gunnison Counties,
the program is popular.
begin what will be a full day of
issuing vouchers, recertifying
clients, and providing nutritional
counseling. The school is otherwise
vacant, but clients arrive, one after
another, at their appointed times. In
all , the McClave satellite operation
serves about 40 women, infants, and
children .
One of the mothers, Connie
Enciso, comes in with her four
children and a translator (Connie
speaks only Spanish) . Her husband
is a farm laborer, and all of her
children are on WIG.
For the children, Lucero brings
out some toys and some small paper
cups filled with vitamin-fortified
cereal and unsweetened fruit juice.
It is an effective way to introduce
WIG participants to new and nutritious
snack foods.
Asked if she likes WIG, Enciso
answers, through her translator,
"Yes, I like WIG because it helps me
get milk and cheese for my children
that I wouldn't be able to afford."
Other participants respond with
similar enthusiasm. Becky Atkinson,
mother of a 3-week-old boy, says,
"I've learned a lot about what is
important nutritionally for the development
of the baby."
Patty Odell, mother of two boys,
admits she was skeptical at first. " I
thought people would just continue
Food and Nutrition
to eat the way they always had. But I
think the program does change the
way you eat. It offers you new foods,
and you learn to eat and enjoy
them ."
Despite encouragement from
the WIC staff, the number of Bent
County WIC participants who nurse
their babies remains under 50 percent,
as in Prowers County.
Nevertheless, Lucero says that more
mothers are at least considering it.
Progress in other areas, such as
lowering the incidence of anemia,
will undoubtedly come as WIC
reaches into the remote corners of
the county and slowly alters eating
habits, as it did for Patty Odell and
Becky Atkinson.
Gunnison County
If one continues to follow Route
50 west from Las Animas, it eventually
winds its way up into the
Rocky Mountains where the small
towns, though still deriving their
livelihood from the land, assume a
character quite different from those
of the Arkansas River Valley. Those
differences are reflected in the WIC
clientele and the way the program is
delivered.
''We like to stress that WIC
is a nutrition and education
program rather than welfare.
WIC is well integrated into
the structure of the county
nursing service, and so it is a
non threatening way to make
contact with the other health
programs.''
-Priscilla Nielsen, Las Animas,
Colorado
One such mountain community is
the town of Gunnison, similar in size
to Lamar and nestled in a high valley
between mountain ranges at an
elevation of almost 8,000 feet above
sea level. Gunnison is in a historic
mining area, and the mines are still a
major source of income for the
town. However, Gunnison is also the
home of Western State College and
a thriving recreational and tourist
trade supported by the Crested
Butte Ski Area nearby.
The convergence of these diverse
forms of employment in one small
town makes Gunnison's population
atypical in some respects: the
average education level is higher
than normal and the average age
lower. Nevertheless, the job market
is relatively slow and low paying,
especially now when the mines are
operating far below capacity. As a
result, it is a common practice in
Gunnison for residents to work two
or three jobs in various local cottage
industries to make ends meet.
That is true even for WIC coordinator
Donna Nielsen and her staff of
one, Melissa O'Connor. They run
their program 1 day a week in a
converted house just off the main
street of town, and they share facilities
with other health programs of
the Gunnison County Nursing
Service. WIC in Gunnison may be a
part-time job, but it is one, as
Nielsen explains, they take very
seriously.
More mothers
seeking help
In spite of its small size (current
caseload is 89) , the Gunnison WIC
program has more than doubled
over the past 9 months, due largely
to the lull in mining. "The recession
is reaching us in kind of a delayed
reaction ," observes Nielsen. In April
Above: Gunnison WIG coordinator Donna Nielsen
operates her WIG clinic 1 day a week in fa-cilities
shared with the other health programs of
the Gunnison County Nursing Service.
Left: WIG foods and posters are displayed against
a wall in the Las Animas clinic.
23
1983, Nielsen increased WIC service
days from one Tuesday a month to
three.
She interprets the recent growth
in her program as an ever-stronger
mandate for the services she provides,
but it is taxing the limits of the
Gunnison office's capabilities. "As
the caseload increases, the quality
of care suffers," says Nielsen.
"We just don't have as much time
to devote to each person. We used
to see every client at every clinic
(once a month) for counseling . Now
we counsel them every other month,
though they still come in once every
month to get their vouchers."
Nielsen's frustrations over limits of
time and money disappear when she
talks about her clients. "We have an
extraordinary group here, to be
sure. They certainly are not well off
economically- meeting the income
guidelines is almost never a problem-
but they are well educated.
"Very few have not graduated
from high school. They are extremely
health conscious, inquisitive,
and interested in the nutrition
education we have to offer. Most are
f irst-time moms, and they're motivated
to provide high quality care
for their children."
To illustrate the exceptional character
of Gunnison's WIC clientele,
Nielsen cites a surprising statistic:
"Close to 95 percent of our mothers
nurse their babies."
This is a much higher percentage
than in the two Arkansas River
Valley communities and especially
surprising because most of the
clients in Gunnison must work more
than one job to make ends meet.
Participants see
positive changes
The mothers who come in for their
appointments say WIC has made a
difference in what they eat and how
they feel. Teresa Kooiman, mother
of a 4-month old girl, says, "I love
WI C. The nurses here are more helpful
and ask more questions than the
doctors do. And I think I'm a lot
healthier than I would have been
without the program."
Barb Sabin, a single mother of a
3-month-old son, says, "WIC is
great. The staff are very supportive,
and their program is educational. I
don't like just cooking for myself,
but their literature shows many
recipes that are quick, easy, and
nutritious. WIC has altered my
eating habits."
24
Nielsen concentrates on printed
nutrition education materials for her
clients. "Our administrative budget
goes for two things primarily: wages
and publications," she says. " I
spend about 2 to 3 hours a month
assessing publications. They are an
important tool for us."
Nielsen displays some of the brochures
she likes. One is from the
American Dental Association warning
mothers that their babies can
develop dental caries ("nursing
mouth") if allowed to keep bottles of
milk, juice, or other fluids in their
mouths for long stretches at a time.
Another publication, Recipes That
Please, was published specifically
for WIC participants by Kellogg.
"We get quite a few publications
from large companies like Kellogg,"
says Nielsen. "I may hear of one that
sounds good, and I'll write to the
company to send us a COJ?Y·"
Nielsen saves her pride and joy for
last: an original , locally produced
silk-screened poster about the
Gunnison WIC program . The poster
has a picture of a mother with two
small children , a brief description of
the program, a list of some WIC
foods, and the clinic's address and
phone number.
"We put it up in laundromats,
banks, day care centers, and a few
other places where it might reach
prospective clients. The ones in the
laundromats have been a great
success."
Like her counterparts in Bent and
Prowers Counties, Nielsen tries to
get the most out of every dollar
available to her.
" It is true that there are problems
in delivering WIC to rural communities,"
says state WIC director Bill
Eden, "principally higher costs,
shortages of health care providers,
fluctuating populations, isolation,
and long traveling distances.
"But if we are to provide equitable
high-quality service, we must
continue to support these rural
clinics. They are an important
vehicle for preventive health care as
well as WIC services."
For more information, write:
Bill Eden
WIC Program Administrator
Colorado Department of Health
4210 East Eleventh Avenue
Denver, Colorado 80220
Telephone: 303-320-6137 Ext. 233
article and photos
by David Lancaster
Setting Up
tA Multi-County
WIC Program
It wasn't until May 1983 that Coles
County in rural southeastern Illinois
saw the beginning of the WIC program.
By August 1983, WIC was
serving 728 participants, not only
from Coles County but also from
four surrounding counties-Clark,
Cumberland, Douglas, and Edgar.
How the Coles County Health Department
was able to provide WIC
services in five counties is another
example of the effort and coordination
needed to make WIC services
available in sparsely populated
rural areas.
Part of a state
expansion plan
In January 1982, the Illinois Department
of Public Health contacted
Fred Edgar, commissioner of the
Coles County health department
and now also commissioner of its
mental health department. The state
agency had embarked on an ambitious
plan to make WIC available in
all of Illinois' 102 counties. However,
limited administrative funds for WIC
and the lack of public health departments
in some rural Illinois counties
made this goal difficult to achieve.
"The state turned to us and asked
if we would be interested in providing
the WIC program to Coles County
and also to residents in adjacent
counties," recalls Edgar.
Under the plan , Coles County was
to serve as the administrative hub
for the other counties, which did not
have formal public health structures.
Coles County had had a public
health department since 1977.
"I saw a lot of need out there and
defin itely wanted to bring the benefits
of WIC to this area," Edgar says.
After persuading his county health
board to accept the program, Edgar
put together a plan and a budget
and approached officials from the
surrounding counties. Nearby Douglas
County, which had a county
health staff of two persons, agreed
to have one registered nurse work
part time on certifying WIC clients
and to let Coles County handle the
administrative paperwork.
Food and Nutrition
Cathie Reynolds, director of nursing
for Coles County with responsibility
for prenatal classes and immunization
clinics, began the search
for a WIC coordinator. Reynolds
found Nancy Barnett, a nurse with a
degree in both health education and
special education.
"I was hired in April 1982 and
began seeing my first clients in
May," Barnett recalls. "After several
months, I was doing physical assessments
and nutrition counseling
sessions for more than 450
participants."
Staff works to
meet the need
Word of WIC had spread quickly
through the five-county area. "We
had flyers put into monthly mailings
of public aid checks and food
stamps," says Reynolds. "Newspapers
and radio spread the word,
too. Our biggest problem was
serving all the people coming in."
Through careful scheduling, Barnett
and Reynolds managed to serve
the ever-increasing number of persons
coming in for WIC. But for
Barnett, frustration grew as she
realized that rural transportation
problems were affecting the delivery
of WIC services.
"WIC participants already have
low incomes, and I knew that those
outside of Coles County sometimes
had to traVel 100 miles roundtrip to
come in to be certified," she says.
'Then, they would have to drive in
again every month to pick up their
food vouchers."
To better meet the needs of residents
throughout the area, the Coles
County staff developed a plan for
satellite WIC clinics. Once again,
Fred Edgar sought the cooperation
of officials and organizations in surrounding
counties, and this time, the
approval of the Illinois Department
of Health as well.
By the spring of 1983, Barnett and
Reynolds were overseeing the opening
of satellite WIC clinics in Clark,
Cumberland, and Edgar Counties.
The satellite clinics have been
operating now for almost a year.
In Clark and Edgar Counties,
registered nurses with the visiting
nurses association certify clients for
WIC twice a week. In Cumberland
County, which now has a oneperson
health staff, the licensed
practical nurse sees WIC clients one
full day a week. In Douglas County,
where the health department has
January 1984
grown from one to three persons, a
licensed practical nurse sees clients
a half-day each week.
"Now all WIC clients can pick up
their food vouchers in their own
counties and don't have to travel the
long distances to our office," says
Barnett.
Nutritionist
works full-time
Since June 1983, Coles County
has had a full-time WIC nutritionist,
Brenda Franklin, who had previously
worked with a multi-county WIC program
in southeastern Iowa. Franklin
provides new WIC participants in
Coles County with their first nutrition
counseling sessions and also
arranges for later group sessions.
She also visits the four surrounding
counties during the week food
vouchers are distributed in order to
provide WIC participants with their
second nutrition education contact.
The first nutrition education session
for participants in the surrounding
counties is done by the part-time
staff who do the initial certification.
"I'm planning activities several
months in advance so that the outlying
counties can sign up participants
for my group sessions," says
Franklin. She has scheduled a new
class on the importance of nutrition
during a teen 's pregnancy and is
beginning a newsletter which will
include recipes using WIC foods.
Franklin also draws upon volunteers,
both students and faculty,
from nearby Eastern Illinois University.
"I've had six volun-teers
so far who've done /
food demonstrations, 1 ;
decorated clinics,
and made posters
on good nutrition,"
she says. She
will also be
having a
volunteer
from the university's department of
dietetics demonstrate how to make
baby food.
Benefits extend
beyond food
The Coles County staff agree that
food is what first brings participants
into WIC. But, they say, the benefits
extent far beyond food. For one
thing, WIC has brought a more
formal and effective system of nutrition
education to residents in the
area who previously had little access
to nutrition information.
Also, says Nancy Barnett, "The
program has brought in an influx of
persons who didn't know about the
other services our health department
offers, such as prenatal
classes and immunization clinics.
We are constantly referring our WIC
clients to these services, and the
satellite clinics in the other counties
also do referrals."
During 1983, the WIC program will
be serving about 900 participants a
month in the five-county area. From
his post as county health commissioner,
Fred Edgar says, "We're
helping infants get off to a good
healthy start in life, which I think will
prevent a lot of problems later on
down the road."
For more information, contact:
Nancy Barnett
WIC Coordinator
Coles County Health Department
P.O. Box 604
Charleston , Illinois 61920
Telephone: (217) 348-0530
article by Victor Omelczenko
photo courtesy of the Illinois
Information Service
Nancy Barnett supervises WIG
services in five southeastern
Illinois counties.
Navajo
anagers
einforce
~radition
Two-year-old Brandon Johnson is
a Navajo. Each month, he, his
younger sister Briana, his mother
and grandfather make the 90-minute
drive from Two Gray Hills to the
WIC clinic in Fort Defiance, one of
81 WIC clinics operated by the
Navajo Tribe.
Brandon joined WIC in the summer
of 1982 when he was just a year
old . At his initial certification his
weight was so low.it didn't appear
on the growth grid, and he was short
for his age. Brandon's mother,
Sylvia, began collecting the full WIC
package for him, and within 6
months his weight and height had
improved dramatically.
After a year of participation,
Brandon was continued on WIC
because of borderline anemia and
his history of health problems.
Brandon's mom has been learning
how foods rich in iron and vitamin C
will help him recover quickly and,
the WIC staff say, he will probably
need to be on the program for only a
few more months.
Three years ago, the Navajos took
over the administration of their WIC
program from the state of Arizona.
Today, they serve Brandon, his
sister, and close to 15,000 other
Navajo mothers and their young
children.
"Operating our own WIC program
is part of our desire for overall selfdetermination,"
says Kathy Arviso,
who is in charge of food and nutrition
services for the tribe. "The program
is more efficient this way. We
are closer to our people than a state
agency can be, and better able to
gear the program directly to the
needs of the Navajos."
Navajos have
direct control
The switch to a tribally operated
program has given the Navajos
direct control of funding and management.
WIC coordinator Linda
Christensen feels the tribe's experience
with the state of Arizona prepared
them well for the job.
26
"The people at the Arizona Department
of Health were very thorough,
conscientious program managers,
and we benefitted tremendously
from their administration," she says.
"They did an excellent job getting
the program established, and we
have carried over many of their
methods."
The Navajo Nation, the largest
Indian tribe in the country, lives on a
primarily rural reservation about the
size of West Virginia. Its population
of 200,000 is spread over parts of
New Mexico, Utah, and Arizona. The
WIC caseload includes members of
the Hopi Indian reservation surrounded
by the Navajo lands, and
several hundred Navajo families who
live in areas adjacent to the
reservation.
"Most Navajos live in scattered
clusters of a few families at most,"
says Christensen, "so we literally
have to take the program to them."
The tribe operates 17 major clinics
with regular hours and 64 field
clinics, which serve clients once or
twice a month.
"There is no typical clinic,"
Christensen explains. "Many are in
trailers, some are co-located with
local health clinics, one is in a Head
Start center, and another is in an old
hospital building."
Severe winters and lack of transportation
present problems for
clients and clinic staff alike. Only a
fourth of the roads on the large
reservation are paved. "During bad
weather many roads are impassable
and families are stranded, unable to
reach fresh food or water or to obtain
medical help," says
Christensen.
"The bad roads make pick-up
trucks and four-wheel drive vehicles
necessary. The high cost of these
vehicles, the poor gas mileage they
get, and the gas prices on the reservation
really limit the travel
possible."
Staff emphasizes
nutrition education
Arviso and Christensen place
their greatest emphasis on nutrition
education. "We're not just giving
away vouchers," Arviso says. "We
teach these people something about
food before they get it." Much of the
staff training focuses on nutrition
education, and Christensen is
developing competency standards
for the clinic staff which will help
her standardize nutrition instruction
among the clinics.
1, 'Operating our own WIC
program is part of our desire
for overall self-determination.
The program is more efficient
this way. We are closer to our
people than a state agency
can be, and better able to gear
the program directly to the
needs of the Navajos. ' '
-Kathy Arviso, Navajo Nation
One major thrust of nutrition
education is breastfeeding. "We're
pushing breastfeeding for a couple
of reasons," says acting head nutritionist
Ann Heist. "It will solve some
of our major health problemsdiarrhea,
for example-and it is
within the grasp of most WIC
mothers, once we dispel the
misinformation."
Digestive and respiratory infections
are the third most frequent
cause of hospital visits on the reservation.
In 1980, the Navajo infant
mortality rate due to infections and
parasites was six times the national
average. Half of those deaths were
due to diarrhea alone.
Until recently, sanitation problems
made it difficult for mothers to
protect their babies' health. Some
mothers were unknowingly mixing
formula with bad water. Others, without
refrigeration, were giving their
babies bottles that had spoiled
between feedings.
"It's hard to expect a mother to
get up in the middle of the night,
light a fire to sterilize a bottle, boil
water for the formula, and then
discard whatever is not consumed
just so she can repeat the process a
couple of hours later," says Heist.
Before 1960, virtually all Navajo
infants were breastfed. Studies after
1960, however, showed a drastic
drop in breastfeeding. This change,
says Linda Christensen, is just one
example of how contemporary practices,
superimposed on traditional
lifestyles, have had an adverse affect
on the Navajos' health and dietary
habits.
In the mid-1970's, when the WIC
program opened on the reservation,
nutritionists began efforts to
educate Navajo mothers about the
benefits and methods of breastfeeding.
By 1981, a Ford Foundation
Food and Nutrition
study was reporting renewed
interest in breastfeeding among the
Navajos and attributing these
increases in part to the efforts of the
WIC program.
Other traditions
also reinforced
The WIC staff reinforce traditional
eating habits in other ways, too. For
generations, Christensen explains,
the Navajos enjoyed good health as
gatherers and hunters and were free
from many of the health problems of
city dwellers.
Sheep and cattle herding provided
plenty of fresh meat, and the native
diet included a variety of fruits and
vegetables. During the last 20 years,
however, native foods have been
replaced with modern convenience
and snack foods, and the nutritional ·
quality of the Navajos' diet has
deteriorated.
Nutrition education in the WIC
program includes instruction on
how to create a balanced diet of
traditional foods. "We have analyzed
January 1984
Kathy Arviso, director of food and nutrition services
for the Navajos, is pleased with the tribally
operated WIC program. The Navajos began ad-ministering
their own WIC program 3 years ago.
80 of the traditional foods for their
nutritional value," Christensen says,
"things like blue corn mush, fry
bread and yucca fruit, and have
organized them into a unique set of
the four food groups."
The cultural and religious beliefs
of the staff and clients have also
prompted some unique approaches
to health education. "The human
body is sacred to the Navajos so
many clients are uncomfortable
using pictures or models,"
Christensen says. " Instead, we use
diagrams of sheep to teach WIC
mothers about their bodies and the
organs within them."
Medicine men are still very much
a respected part of the health care
of many Navajos. "The medicine
man's role today is primarily a
spiritual one," says Ann Heist.
"Some health facilities maintain
room for them to counsel patients
and their families."
The health of the Navajos has
improved significantly during the
past few years. One sign of this is
the drop in infant mortality. According
to Dr. Jerry Nasenbenny, chief
of pediatrics at the Indian Health
Service Hospital, there has been a
50-percent drop in the number of
infant deaths caused by diarrhea.
WIC administrators can take part
of the credit for this improvement,
but they are quick to point out that
many programs have made a difference
in the conditions on the
reservation.
As Christensen says, "WIC is one
of a network of food and health
assistance programs which have
only recently become available. Together,
they have had a significant
impact on the health of the tribe as
a whole."
And, Dr. Nasenbenny adds, "Sanitation
has improved dramatically,
there is better access to health care,
and about half the population has
good water at last."
Changes make
a difference
Bob Kragh, federal WIC program
27
This young girl is one of the
nearly 15,000 WIC participants
served through the Navajo
Nation's WIC program.
director for the western states, feels
the Navajos are extremely capable
administrators. "There's no question
the Navajos can run their own program,"
he says. "They're doing it,
and very well. The tribe has a larger
caseload than ever before, and they
are using the additional administrative
monies they receive to improve
outreach and nutrition education."
Last year, Navajo WIG administrators
reduced the cost of the average
food package by more than a dollar,
in spite of inflation, by eliminating
vendors who were charging excessive
prices. The change resulted in
savings of $14,000 per month compared
to the previous year.
Kathy Arviso is pleased about the
success of the program under tribal
direction. "The Navajo people
accept the program very well," she
says. "They recognize it as an opportunity
to improve the health of their
families."
The program has proved a benefit
to the entire community. According
to Arviso, vendors are stocking more
foods-and better foods-because
WIG mothers are asking for them.
Joann Smith is one Navajo mother
who has seen WIG improve her
28
family's health. Each month Joann
and her husband Danny drive the 15
miles to Gallup, New Mexico, to take
their 6-month-old daughter Tiffany
to the WIG clinic.
Joann's sister had told her about
the program that would give her
"good nutrition help" during pregnancy.
Joann was encouraged to
join because of her young age and
because she was underweight during
pregnancy.
She says the best part of the program
is the "lessons about what to
eat" and "checking the baby-keeping
track of Tiffany's health."
Joann and Tiffany have no idea of
the history of the program or how
it's run. They come to Gallup, just as
Brandon Johnson and his mother go
to Fort Defiance, because there are
Navajo people there who are helping
them live healthier, happier lives.
For more information, write:
Katherine Arviso
Division of Health Improvement
Services
The Navajo Nation
P.O. Box 1390
Window Rock, Arizona 86515
Telephone: 602-871-4941
article and photos by Tino Serrano
Mobile
iWIC Teams
Go Where
the Need Is
To most people the initials W-1-C
stand for the Special Supplemental
Food Program for Women, Infants,
and Children, but to some WIG managers
in Texas, New Mexico, and
Arkansas, WIG also means travel.
Although the areas these managers
work are vastly different, the
reasons they travel are basically the
same. Either the existing health care
system is incapable of handling the
expanded caseloads that seem to
follow WIG or the population is so
scattered it is financially impossible
to have full-time WIG staff in each
locality.
Travel in teams
and individually
Poorly staffed county health
clinics already bursting at the seams
with patients made it clear from the
beginning that some alternative
would have to be found to bring
WIG to the people around Victoria
County, Texas. "Cramped quarters
with wall-to-wall humanity" is the
way Victoria City-County WIG project
director Art Fuston describes it.
His alternative method is two
mobile WIG teams consisting of registered
nurses, licensed vocational
nurses, community service aides,
and clerks. The teams, totaling 12
people including Fuston, are based
in Victoria and travel seven surrounding
counties carrying WIG
services to about 4,000 participants.
Population density dictates the
travel method for Gwen Bounds and
Millie Mondale. Bounds, a public
health nutritionist, serves about 400
WIG participants who live in and
around Silver City, New Mexico.
One day each week, she takes WIG
to close to 100 additional clients in
Lordsburg. The two cities are separated
by 50 miles of wide open
space with hardly any population.
Mondale works the heart of
Arkansas' Ozark Mountains. Her
caseload of roughly 1,000 is fairly
evenly distributed throughout the
six-county area she covers. That
translates into extremely small
Food and Nutrition
caseloads when viewed on a countyby-
county basis. Mondale travels to
each county at least twice a month
and more often if the caseload
demands it.
Clients served
in various ways
Bounds provides all facets of WIC
from medical screening to issuing
vouchers and giving nutrition education.
There are certain advantages to
having all services provided by the
same person, she says. "I get to
know each participant better, which
makes follow-up easier and basically
improves the quality of care each
person receives."
Fuston agrees with that concept,
but points out that special efforts
must be made to make sure participants
are also being seen regularly
by other health care providers.
Local health clinics do not have
room to house Fuston's WIC teams.
"We set up shop wherever we can
find a place to hang our hats," he
says. "Our offices are located in
church buildings, schools, a public
library, and in one county we're
located at city hall.
"Our separation from local health
clinics is purely physical," he says,
"since philosophically, we're on the
same wave length."
Fuston's staff requ ire written proof
of pregnancy from the health clinic
or a private physician for all prenatal
participants. "That assures us that
the participant has at least made the
initial contact for medical care
during pregnancy," he says. His
staff maintain close contact with
local health care providers, making
and accepting referrals as the need
arises.
Local networks
are helpful
Fuston also uses his close ties
with the local health clinics to build
and maintain his WIC caseload .
"When we get approval from the
state health department to expand
into a new county, our first contacts
are made with the city and county
government officials and with
county health departments.
"Getting them involved makes
WIC their project, too, and lessens
the anxiety or reluctance we might
otherwise encounter," he says.
Mondale cultivates a strong relationship
with county health providers,
too, but does so under a different
set of circumstances. She
works along side the clinic staff on
January 1984
"WIC day" and relies on them for
medical screening of participants.
Local clinic staff members play a
critical role as far as referrals go, but
when it comes to reaching out into
the community for potentially eligible
participants, Mondale relies on
word of mouth. Most of the communities
in her northern Arkansas
area are extremely small.
"There is a tremendous network
among the people here," Mondale
says. "I make it a point to stress in
my nutrition education lessons that
we want to get women and children
on the program if they need it.
Within a few weeks, I'll begin to see
new participants who heard about
WIC through friends or relatives."
Basic nutrition
concepts stressed
Mondale feels she is reaching the
majority of the people. "It's very difficult
for me to figure out who we're
not reaching," she says. " If I knew
who they were, I'd certainly make
the attempt to bring them in."
State health department statistics
show that Mondale's "feeling" on
the subject is right on target. She is
reaching over 95 percent of the
area's potentially eligibie population.
Her caseload remains fairly
stable, she says, except for some
fluctuation during the spring and
summer when people's gardens are
producing and their cows are giving
lots of milk.
"Many of the women in this area
shop for food and cook just as their
mothers did. WIC gives them a new
and usually better alternative to the
traditional diet," Mondale says.
"Most of the people are receptive to
new ideas and appreciate learning
more about nutrition, but occasionally
they revert back to the old
way of doing things."
Bounds has also made significant
progress toward improving the eating
habits of participants through
nutrition education. In recent years,
the acceptance of breastfeeding
among young Hispanic women has
been extremely low. Since Bounds'
caseload is predominantly Hispanic,
she emphasizes the advantages of
breastfeeding for both mothers and
infants in her classes. She's seen a
significant increase in the number of
mothers willing to try breastfeeding.
The majority of nutrition-related
problems Bounds sees result from
lack of income. The area's major
industry is copper mining. When the
mines were forced to close recently,
unemployment reached as high as
40 percent.
"When there isn't even enough
money for the bare necessities, the
children, of course, get less to eat
and medical care becomes out of
the question except for emergencies,"
Bounds says. The economy is
better now, but the improvement has
presented Bounds with a new and
unexpected challenge.
Many of the infants and children
are now living with their grandparents
while their parents look for
work in other areas of the state, and
Bounds finds herself in the process
of repeating basic nutrition concepts
for the new caretakers. No
doubt she views the minor inconvenience
as just a part of the job.
One quality all three WIC managers
share is a firm belief in the program.
"I 'm proud to be associated
with WIC," says Art Fuston. "All of
us-my staff and myself includedbenefit
from the nutrition education
and the awareness of how nutrition
affects our health.
"A strong commitment to the program,"
he adds, "helps you over the
hurdles-the constant travel, the
crying babies, the hot crowded
clinics. A commitment to the WIC
concept is about the strongest
motivation anyone could have."
For more information contact:
Art Fuston, Project Administrator
2205 Lone Tree Road
Victoria, Texas 77901
Millie Mondale, WIC Coordinator
Area 2 Regional Health Office
Second Floor, Old Federal Bldg.
Corner of Vine and Rush Streets
Harrison, Arkansas 72601
Gwen Bounds
Public Health Nutritionist
P.O. Box 2575
Silver Spring, New Mexico 88062
article by Kay Blakley
• •
29
eamwork
elps Prevent
endor Abuse
Part of getting WIC food help to
participating mothers and children
is making sure grocers are complying
with program rules. If grocers
overcharge WIC customers, discount
WIC coupons, or sell iheligible
items, they deprive participants
of the food they need and waste
valuable program dollars.
Most grocers authorized to accept
WIC coupons are eager to comply
with the rules, but what about those
who do not?
State and local WIC managers in
North Carolina are getting some
expert help in learning how to deal
with problem grocers. In a pilot
project to prevent vendor abuse in
WIC, they've teamed up with the
people who monitor grocers in the
Food Stamp Program-the field staff
of USDA's Food and Nutrition
Service.
FNS specialists
provide experience
In one part of the project, completed
last summer, state and local
WIC managers accompanied
Raleigh FNS Officer-in-Charge
Gerald Holt and her staff on visits to
140 stores scheduled for food stamp
monitoring reviews. During the
visits, the FNS compliance staff
modified the food stamp interview
and added an extra section on WIC.
Alice Lenihan, nutrition programs
administrator for the North Carolina
Division of Health Services, says the
visits were tremendously helpful.
"We needed to learn how to look a
vendor straight in the eye and
handle those situations that are
uncomfortable."
The FNS field staff have been authorizing
and monitoring grocers for
compliance with federal food stamp
rules for more than 20 years, often
confronting grocers who may be
abusing the program. Lenihan feels
the food stamp compliance staff provide
a good role model for nutritionists,
who normally perform the
vendor monitoring in the local
agencies.
"Obviously nutritionists are
trained in nutrition and patient
30
Betsy Davis (left), WIG coordinator of the Lincoln
Community Health Center in Durham, talks with
Gerald Holt of the Food and Nutrition Service's
education," she says. "To approach
a vendor concerning compliance is
somewhat out of the realm of our
training and experience."
Franklin County WIC director
Diane Price already had a successful
vendor monitoring program
underway before the joint project
began. She had monitored vendors
routinely and had required them to
attend training sessions. In order to
learn more about monitoring, she
visited stores with the FNS staff.
"Learning how to word your conversation
with the store manager is
important," she says, "because you
don't want to put him on the defensive,
but you do want him to
know you mean business.
"I had always told my grocers that
USDA representatives could come
into the store at any time," she adds.
"When I did walk into a store with
the FNS specialist, it backed up
what I had said and made my position
more credible."
Debra Goode, nutrition director of
the Cumberland County Health Department,
also found the visits helpful.
"They gave me the opportunity
to see the way FNS specialists approach
the vendor and the way an
interview is conducted," she says.
Raleigh field office. Davis and other North
Carolina WIG managers are learning more about
how Holt and her staff work with grocers.
Help each other
spot problems
FNS food program specialists
Teresa Trogdon Anderson, Elijah
Haddock, and Paula Kerman, who
did the grocer visits, found a high
degree of professionalism in the
local health officials who handle
vendor monitoring.
While the FNS specialists were
able to share their expertise with the
WIC staff, they also gained a greater
knowledge of the WIC program.
Elijah Haddock became so impressed
with the program that he
now carries a card listing the WIC
cereals and buys only those cereals
for his family.
"When we started the project, our
knowledge of WIC was book knowledge,"
says Teresa Anderson. "With
the WIC staff, we went to stores and
learned about the WIC foods, the
forms used in the program, and how
the program operates at the retail
level.
"I also observed the certification
of a WIC client to understand better
the program differences between
food stamps and WIC," she adds.
"We now have a very beneficial
mutual relationship with the state
and local WIC staff. We try to share
Food and Nutrition
as much information as we can
about problem food stamp stores,
and the WIC staff reciprocate by
telling us about retail problems
occurring with WIC."
The FNS specialists can now
quickly spot-check WIC food supplies
during food stamp store visits.
If the WIC foods are low, they informally
notify the WIC staff. This .
often leads to a follow-up visit to the
vendor by the WIC staff. Stores that
are found to be seriously violating
WIC rules may lose their authorization
to accept food stamps as well
as WIC vouchers.
According to Alice Lenihan, local
agencies have responded enthusiastically
to the joint monitoring,
requesting that it be expanded to
other parts of the state. The state
staff is also eager to continue the
cooperative arrangement, which has
helped them in their education
efforts.
Efforts geared
to prevention
An additional part of the pilot
project involved a compliance investigation
of approximately 20 WIC
vendors by FNS compliance specialists.
The stores were chosen based
on computer reports that showed
high risk factors such as higherthan-
expected redemptions of WIC
coupons.
Six of the 20 investigated stores
were found to be overcharging for
WIC foods, and disqualification procedures
were begun on those
vendors. Other problems that were
uncovered included sales of some
ineligible foods and failure by
retailers to follow proper identification
procedures.
Frequently, stores were allowing
WIC participants to buy ineligible
foods that were similar to eligible
foods, such as fruit drinks instead of
fruit juices. These vendors were sent
warning letters.
Like food stamp compliance efforts,
North Carolina's monitoring
system for WIC is closely tied to
vendor education. Monitoring is not
always punitive, but a way to teach
and correct problems.
"People in public health are interested
in prevention ," says
Lenihan. "We would rather prevent
problems than prosecute the vendor
if we can, so our materials and
efforts are aimed at prevention of
problems."
If grocery clerks and managers do
not understand why the WIC proJanuary
1984
gram allows only specific foods,
time is taken during visits to explain
to grocers why substitutions cannot
be made.
The state's colorful poster picturing
eligible and ineligible WIC foods
has been a very successful tool for
vendor compliance. The grocers are
pleased with it since it is an ideal
way to show participants what foods
are allowed. Other tools developed
include a cashier's booklet that
allows clerks to troubleshoot problems
on WIC transactions.
Some advice
for other states
For other states developing compliance
programs, Lenihan recommends
allowing enough time to
develop and print vendor materials
properly. Also, she says, it's important
to use the expertise of the
state legal staff in developing contracts
and procedures and preparing
for vendor hearings.
' 'Obviously nutritionists
are trained in nutrition and
patient education. To
approach a vendor
concerning compliance
is somewhat out of the
realm of our training and
experience.' '
-Alice Lenihan, North Carolina
Division of Health Services
" If you take an adverse action
against a vendor," she says, "you
are talking about a good deal of
money irwolved in that vendor's
business and h