Food & Nutrition [Volume 21, Number 3-4]

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Food & Nutrition
MARCH 1992 VOLUME 21 NUMBERS 3-4
What can we do to
help children'?
In communities across the United States, people afl asking how we as a
country can help children thrive and succeed. While no one can guarantee that
a child will succeed, there are ways to maximize tbe chances.
Here, at USDA, we're proud to be working with o r partners in state and
local agencies and the private sector to make sure that children have access to
nourishing food. Without adequate nutrition, t ey cannot grow, learn, 'Or fully
discover their talents.
In this issue of Food and Nutrition, we focus on how the food assistance
programs serve children. Our lead article gives an overview of the federal
government's commitment to the food programs and outlines some recent
actions USDA has taken to strengthen them. It also looks at results of studies
that show the programs are making a difference for children who participate.
In addition, in a variety of features from around the country, we look at the
food programs in action. And we see that in addition to getting food to kids,
they often help get kids to other services and activities that benefit them.
As a member of New York City's Human Resources Administration says
about a project that gives homeless children opportunities to take part in a
variety of cultural activities, the kids learn from and love the activities, but
"it's the food that gets them there."
2 Food and Nutrition
Working together for their future ...
Getting Food Help
To Children Is A
Job For All Of Us
"As a nation," President Bush said
on National Children 's Day in October
1989, "we have no greater obligation
than to help provide every child with
the opportunity to grow up healthy,
safe, and well-educated."
Throughout his Administration,
President Bush has called for wise
and carefully developed measures
that strengthen the family and protect,
educate, and nourish children.
The food assistance programs­and
the people they serve-are an
important part of federal, state, and
local efforts to help children, particu­larly
low-income children, and give
them a better chance for a bright
future.
"In describing our programs," Food
and Nutrition Service (FNS) adminis­trator
Betty Jo Nelsen said at special
Congressional hearings on children,
"we often speak in terms of rules and
budgets and spending ... Those things
are measurable.
"But behind those dry statistics will
be the reality of the infants who thrive
because of USDA food supplements,
of children who are alert in school
because of breakfast and lunch
programs, of adults who are better
parents and more productive citizens
because of food stamps. The true
measure of our food policies is how
they change people's lives ...
"The Bush Administration is com­mitted
to working with all levels and
branches of government, advocacy
groups, the private sector, community
organizations, and individuals in a
partnership to improve services to
at-risk children."
March 1992
Programs rest on
solid foundation
The Food and Nutrition Service, the
USDA agency Nelsen heads, was set
up in 1969 specifically to administer
domestic food assistance programs.
The programs rest on a solid
foundation. This year's funding for
FNS programs totals more than $32.6
billion, representing more than half of
USDA's total budget.
President Bush's budget proposal
for 1993, announced the same week
as his State of the Union address in
January, calls for $39 billion for FNS
programs.
From their start, the food progr<;lmS
have relied on a partnership with state
and local agencies. While authorized
by national legislation, they are
operated by people in state and local
governments together with schools,
day care centers, health agencies,
charitable organizations, and other
sponsors.
The programs couldn't exist
without the cooperation of the private
sector-food stores, for example, to
accept food stamps and WIC
coupons-and without the support
of the American people.
This young boy stands a better chance of being
ready for school thanks to the nourishment he
is getting now through WIC, one of several
food assistance programs administered by
USDA together with state and local agencies.
When the National Commission
on Children released its findings, it
reported that most children have a
bright future, but a sobering number
are at risk:
• One child in four is raised by a
single parent.
• One in five is poor.
• Each year a half-million children are
born to teenagers.
• An increasing number of children
are impaired before birth by their
parents' substance abuse.
• Some children live amid violence
and exploitation, much of it fueled
by an illegal drug trade.
• Many children are poor; some are
homeless; some are hungry.
Among the Commission's conclu­sions:
problems can overwhelm
individuals, families, or even govern­ment
programs, but by working
together we can make a difference.
We can make
a difference
The President's domestic agenda
calls for working together in many
ways to make a difference in the lives
of children. And the best approach,
he believes, is to start early.
That's why the first of the six
national education goals the President
developed with the governors is
"Readiness for School." It states: "By
the year 2000, all children in America
will start school ready to learn."
Working toward this goal, the
President supported and Congress
3
passed major child care legislation
that will enhance educational opportu­nities
for pre-schoolers.
For example, the Human
Resources Reauthorization Act of
1990 authorizes full funding for the
Department of Health and Human
Services' Head Start Program by
1994. At the time the legislation was
passed, Head Start was serving only
one in four eligible children, which
means it has the potential for tremen­dous
growth in coming years.
Expanding Head Start and other
child care services will mean new
opportunities to get food help to
young children who need it through
USDA's Child and Adult Care Food
Program (CACFP). Most children in
Head Start receive meals under
CACFP.
This is just one example of how
FNS programs are central to improv­ing
services for children and helping
them be ready for school. There are
many others:
• The Food Stamp Program is the
cornerstone of America's food help
efforts. It is available nationwide, and
everyone who qualifies is guaranteed
benefits. In federal expenditures for
benefits, the Food Stamp Program
ranks second among the means­tested
programs, behind Medicaid.
In 1992, the program is expected to
serve more than 25 million people on
average each month and provide
more than $21 billion in benefits over
the year.
Families with children have always
been the major beneficiaries of the
Food Stamp Program. In fact, more
than half of all food stamp participants
are children, and more than 82
percent of all food stamp benefits go
to households with children.
In addition to working to make sure
the program is adequately funded and
managed with integrity, USDA is also
stepping up efforts to provide partici­pants
with nutrition education and to
coordinate services with other agen­cies
that assist families and children.
4
• The WIC program makes a vital
contribution to maternal and child
health. Officially called the Special
Supplemental Food Program for
Women, Infants, and Children, WIC
provides supplemental foods, nutri­tion
education, and health care
referrals to participating low-income
women and young children.
Despite constraints of a "pay-as­you-
go budget," the President's 1992
and 1993 budget proposals singled
out WIC for additional funding. His
1993 budget proposal calls for $2.84
billion a year for WIG-enough to
increase monthly participation to
nearly 5.4 million mothers, infants,
and young children.
As we'll see in a more extensive
article on WIC beginning on page 12,
a major study has shown that WIC
makes a big difference to the mothers
and babies it serves.
In that article and companion
features, we111 also look at how WIC
"As a nation, we have
no greater obligation
than to help provide
every child with the
opportunity to grow
up healthy, safe, and
well-educated."
is part of national, state, and local
initiatives to encourage mothers to
breastfeed; help children get needed
immunizations; and, through educa­tion
and referrals to treatment centers,
help pregnant women avoid endan­gering
their babies through drug and
alcohol abuse.
Food and Nutrition
• Each year millions of nourishing
breakfasts, lunches, and snacks are
served through USDA's child nutrition
programs by schools, child care
facilities, summer recreation centers
residential institutions, and other '
sponsors.
For many low-income children,
these may be the only nutritionally
balanced meals they receive all day.
In addition to providing needed
nutrients and energy, these meals
also offer children an example of what
makes a lunch or breakfast nourishing
and well-balanced.
Along with states and local spon­sors,
USDA is working to improve
the nutritional quality of the meals
served through the child nutrition
programs and to develop more
opportunities to provide children
with nutrition education.
Meals served by schools, child care centers,
summer camps, and other child nutrition pro­gram
sponsors help provide children with the
nutrients and energy they need. For many
low-income children, these may be the most
nutritionally well-balanced meals they eat
all day. Sponsors receive financial support,
USDA commodities, and technical assistance.
March 1992
• Through its Food Distribution
Program, USDA donates a variety of
federally purchased commodities to
food assistance efforts. USDA
commodities, for example, help
schools and other child nutrition
program sponsors serve nourishing
meals at low cost. In fact, more than
70 percent of federally donated food
goes to schools participating in the
National School Lunch Program.
USDA-donated foods are also
close at hand to help victims of
natural disasters and people getting
meals or emergency food help
through charitable organizations.
Some Native American families
choose to get USDA commodities
instead of food stamps.
USDA and its partners in state and
local agencies are working in a variety
of ways to strengthen the child
nutrition programs and improve the
nutritional quality of meals served
through them. Here's a more detailed
look at some major steps being taken:
Expanding the Child And
Adult Care Food Program
The Child and Adult Care Food
Program (CACFP) is the fastest
growing Food and Nutrition Service
program, thanks in part to increased
funding and efforts to enlist additional
sponsors.
CACFP provides funds and USDA­donated
food, year-round, to help
provide meals to children in day care
centers, family day care homes, and
afterschool programs. (It also pro­vides
support for meals served to
impaired and elderly adults in non­residential
care centers.)
During fiscal year 1991 , approxi­mately
1. 7 million children received
nourishing meals and snacks through
the program-up from 23,000 in 1969,
the year the program began. Between
fiscal years 1989 and 1990 alone,
average daily participation increased
by 8 percent and total funding by
17 percent.
Program managers expect partici ­pation
to reach nearly 2 million this
year, with continued growth in coming
5
years as Head Start and other child
care services expand.
Because nourishing meals are an
important part of quality child care­and
because CACFP is such a valu­able
tool in getting food help to needy
children-FNS is working closely with
the Department of Health and Human
Services and other agencies to
provide information about the pro­gram
to child care providers.
Through three demonstration
projects, FNS is also looking at ways
to encourage greater participation
among sponsors serving low-income
children:
• One demonstration project, in
Kentucky and Iowa, is testing the
effect of a change in eligibility
requirements for private "for-profit"
centers in CACFP.
Currently, for-profit centers may
participate in CACFP if 25 percent
of the enrolled children are Title XX
beneficiaries. (Title XX funds of the
Social Security Act are used by
states to purchase child care
services for low-income children.)
Under the demonstration,
instead of having to meet the Title
XX requirement, for-profit centers
may participate if 25 percent of the
children meet the income eligibility
guidelines for free and reduced­price
meals.
Results of the demonstration are
currently being evaluated.
• The second demonstration is
looking at ways to encourage
CACFP participation among family
day care homes located in low­income
areas or serving primarily
low-income children. Traditionally,
this group has been under­represented
in the program.
6
Among the strategies being
tested are: helping low-income
homes get properly licensed; giving
them individual attention through
the use of mentors; and designing
program materials to be easily
understood by people who have
limited reading skills or who don't
speak English.
This demonstration was com­pleted
in October. Results are
currently being evaluated.
• The third demonstration will deter­mine
the best means of providing
year-round food assistance to pre­school
children in homeless shel­ters.
Several sponsors of homeless
shelters are taking part; two of
them are the Archdiocese of
Philadelphia and the Joan Kroc
Center for homeless people in
San Diego.
Reaching Out With
School Breakfasts
In addition to expanding CACFP,
FNS is also working to reach more
children with school breakfasts.
The school breakfast program
provides assistance to states to
initiate, maintain, or expand nonprofit
breakfast programs in eligible schools
and residential child care institutions.
As in the school lunch program,
FNS provides reimbursement for
meals, with higher rates paid for meals
served to needy children. It also
provides USDA-donated food and
technical assistance.
Recognizing the importance of
breakfast to children's ability to
concentrate and learn, FNS has a
number of initiatives to enlist more
schools to offer morning meals.
"When I came on board at the
Food and Nutrition Service," Betty Jo
Nelsen said at the Congressional
hearings on children, "I was struck by
the difference between the number of
schools that participate in the National
School Lunch Program and in the
school breakfast program. We simply
need to do more to encourage
schools to implement a breakfast
program."
Nelsen directed all seven FNS
regional offices to work with the
states in their regions to expand
school breakfast, especially in low­income
areas.
In addition, in 1990 FNS began
awarding a series of breakfast out­reach
grants. To date, $13 million has
been awarded to more than half the
states in the country to help defray
the costs of starting a breakfast
program. An additional $10 million
Food and Nutrition
will be awarded between fiscal years
1993 and 1994.
For schools that already have lunch
programs, the amount of new equip­ment
needed for breakfast is minimal.
The logistics of serving morning meals
are often of greater concern to school
administrators.
But with some scheduling adjust­ments
and by being flexible-serving
breakfast in classrooms or multi­purpose
rooms, for example, if early
morning cafeteria service is not
feasible-schools can help make sure
their students start the day with the
energy they need.
More schools are serving breakfast.
The number of schools and institu­tions
with breakfast programs in­creased
a total of 32 percent between
1985 and 1991, and further increases
are expected as a result of recent
outreach efforts. During fiscal year
1992, the school breakfast program
is expected to reach more than 4
million children each day, and the
great majority of them will be low­income
children.
Improving The Quality
Of School Lunches
The National School Lunch Pro­gram
(NSLP), the largest and oldest of
USDA's child nutrition programs, has
come a long way since it was created
in 1946.
Nearly 90,000 schools nationwide
take part, serving lunches to approxi­mately
24 million children every
school day. The program is available
in 95 percent of all public schools­representing
98 percent of all public
school children. It also operates in
many nonprofit private schools.
NSLP's goal has always been to
help schools provide affordable,
nourishing and well-balanced lunches
to children. And to make sure no child
goes without lunch because his or her
family cannot afford it, the program is
specifically structured to give schools
extra support for the meals they serve
to needy children.
Schools receive a basic reimburse­ment
for each lunch they serve plus
March 1992
additional reimbursement at special
rates for each lunch they serve free or
at reduced-price to eligible students.
Of the approximately 23.6 million
children who participated in the
program last year, 12.1 million paid
full price, 1 0 million received free
meals, and 1.5 million paid a
reduced price.
USDA commodities make up about
25 percent of the food served through
NSLP. More than 60 different com­modities
are available to schools,
including canned and frozen fruits and
vegetables, cheese, chicken, ground
beef, peanut butter, enriched flour,
and grain products. Schools may also
order quantities of other "bonus"
commodities when they are available.
USDA commodities are whole­some,
nutritious foods that are
subject to strict quality standards.
In recent years, the Department has
made many improvements, including
reducing the amount of fat, salt, and
sugar where feasible.
Continuing these efforts, USDA is
taking some additional steps in line
with the 1990 Dietary Guidelines for
Americans that for the first time
recommend a quantitative standard
for fat.
The guidelines recommend that
healthy adults and children over the
age of 2 consume no more than 30
percent of their total calories from fat
and less than 1 0 percent of calories
from saturated fat. These goals for fat
apply to the diet over several days,
not to a single meal or food.
Many school food service teams are making
changes in menu planning and meal prepara­tion
to bring their lunches and breakfasts more
in line with recommendations contained in the
Dietary Guidelines. Improvements in federally
donated foods and new technical assistance
materials will help them do this.
. The following are examples of
Improvements that have been made
in USDA commodities to reduce fat:
• The ground beef the Department
has been purchasing has an
average fat content of 20 percent.
Beginning a little more than a year
ago, hamburger patties with only
1 0 percent fat were tested in
schools in six states. Because the
comments USDA received from the
test schools were very favorable,
the Department is distributing low­fat
beef patties this year.
The amount the Department will
be able to purchase and distribute
during the current school year
depends on several factors
including how much the m~at
industry can supply.
• Frozen ground turkey is now
available with an average of 12
percent fat. As a new option,
USDA is testing the use of this
product in turkey burgers.
• The maximum fat of canned pork
was lowered from 21 to 18 percent.
• An option of diced, frozen poultry is
now offered.
• Fish products have been added
including canned tuna and salm~n.
. Also in line with the Dietary Guide­lines,
USDA is offering more foods
with complex carbohydrates includ­i~
g whole wheat flour, bulgu;, brown
nee, dried fruits, pasta products, dried
bean products, split peas, and lentils.
In many areas, states or school
districts arrange to have USDA
commodities processed into finished
products-for example, pizza made
with USDA ingredients such as
enriched flour, oil, tomato sauce, and
cheese. USDA is cautioning states
and school food service directors to
be careful not to lose the nutritional
benefit of the improved commodities
by using them in end products high in
fat, salt, and sugar.
Over the years, as the school lunch program
has grown and changed, so have the challenges
faczngfood service directors. USDA is working
on several research pro;ects that will, among
other thzngs, look at what today's students
choose to eat and how meal preparation prac­tzces
affect the acceptability of these foods.
8
Helping Schools Meet
The Challenge
In addition to making changes in
USDA-donated foods, USDA is
working in other ways to help school
food service directors serve meals
that more closely follow the latest
nutritional knowledge.
To ensure that school meals set an
example of good nutrition, the "Year
2000 Nutrition Objectives for the
Nation" established the following goal:
by the year 2000 at least 90 percent
of school food service and child care
meals programs will have menus that
are consistent with the nutrition
~rinciples in the 1990 Dietary Guide­lines
for Americans.
"That is a major challenge for food
service operators," Betty Jo Nelsen
told the state directors of school
nutrition programs at their biennial
meeting in San Diego in December.
"To reduce the fat content of food
and still give children the calories they
~eed , may require significant changes
1n menu planning, food purchasing,
and preparation."
Secretary Madigan, she added,
has promised that by the end of 1994
all food service personnel will have '
the tools and training they need for
that task.
As a first step, USDA and the
Department of Health and Human
Services have jointly developed a
publication to help food service
professionals in the child nutrition
feeding programs prepare meals
consistent with the Dietary Guidelines.
Called Nutrition Guidance for the
~hild t:Jutrition Programs, this publica­tion
Will be out this spring.
In addition, FNS has revised its
Nutritive Value of USDA-Donated
Foods for Schools and Institutions
Food and Nutrition
..
..
and developed and distributed a
poster-sized chart. Both contain a
complete nutrient profile of each
USDA commodity provided to
schools.
Future technical assistance materi­als
will include new menu planning
guides and other manuals as well as
video tapes to help local food service
personnel select and prepare safe,
nutritious food.
Measuring Progress
And Setting Goals
A major study conducted in the
early 1980s-the National Evaluation
of School Nutrition Programs
(NESNP}-showed that school food
service directors have much to be
proud of.
Results indicated, for example,
students who eat school lunches get
greater percentages of Recommend­ed
Daily Allowances (ADA's) for
calories and all nutrients except for
vitamin C and iron. It also showed
that participating students under age
15 eat less sodium at lunch than other
students, and that among 5- to 14-
year-olds, protein intake is greater for
participants than for nonparticipants.
However, the study also showed
that school meals need to be lower in
fat-about 37 to 40 percent of calo­ries
in the lunches surveyed came
from fat.
As USDA works to help schools
bring their meals more in line with the
Dietary Guidelines, the Department
will be encouraging them to serve
meat and meat alternates that are
lower in fat and a greater variety of
fruits, vegetables, and whole grains.
Many schools are already making
these kinds of changes.
Efforts to improve school lunches
require a solid foundation of facts.
Program managers need to know the
current status of child nutrition to
determine where improvements are
needed and to provide a benchmark
for measuring progress. They also
need to find out what strategies work
best to improve nutrition.
USDA is working on several
research projects designed to supply
this information:
March 1992
• Dietary Assessment Study
The Dietary Assessment Study
is the first major school nutrition
research since the NESNP to
assess the nutrient content and
dietary impact of the school lunch
and breakfast programs. The
study has four main objectives.
One is to compare the nutrient
content of USDA and non-USDA
meals using the ADA's, the Dietary
Guidelines, and food groups. The
"non-USDA" meals include lunch­es
brought from home, meals
bought in off-campus restaurants
and from vending machines, and
a Ia carte items available in school.
A second objective is to deter­mine
what ingredients and cooking
procedures schools are using, and
a third is to determine which foods
students choose to eat. The study
will also examine how meal prepa­ration
practices affect the accept­ability
of these foods.
The final objective is to deter­mine
the contribution of USDA
meals to students' total nutrient
intake.
All together, 4,000 students and
600 schools are participating in the
study. Students, their families, and
school food service staff will all be
interviewed. Data collection-began
in November 1991 and will contin­ue
through May 1992, with the
final results to be published in
December 1992.
By identifying changes over the
past decade, the study will pro­duce
a comprehensive picture of
school meals nationwide.
• Menu Modification Grants
In another research effort, FNS
is testing ways to reduce fat and
sodium in school meals. The study
involves 3-year grants to five
school districts to help them
modify their menus. Here, the
focus is on elementary schools
because eating habits acquired at
an early age often carry over into
adulthood.
For the most part, participating
school districts are making
changes in existing menu items
that children like. For example,
they are substituting low-fat
ingredients in recipes, modifying
cooking methods, and purchasing
products that have a lower fat and
sodium content.
The grants also include nutrition
education for students and training
for food service employees. In San
Bernardino County, California, for
instance, a high school drama
student in a green "Nutrasaurus
Rex" dinosaur costume visits
classrooms along with a nutritionist
to give nutrition lessons.
The menu modification project
is in its third and final year. The
measure of its success will be not
only the improved nutritional
quality of meals but the ability of
schools to keep their customers.
So far, students have accepted
most of the changes.
A number of states and local
school districts are also taking the
initiative to reduce fat and sodium
in their schools by starting pilot
programs of their own.
For example, for 2 weeks in
March 1991 elementary schools in
Chicago served breakfasts and
lunches with only 30 percent fat.
The menus used foods commonly
available to schools, including
USDA cdmmodities.
In Minnesota's "Lunchpower"
program, schools are offering
students food choices that are
lower in fat and sodium. Monthly
menus in participating schools
average 30 to 33 percent of
calories from fat. Another part of
"Lunchpower" is providing training
for school lunch personnel and
nutrition education for students
and parents.
9
Sharing Information
And Technology
Sharing information on strategies
that work will be one of the goals of
the new National Food Service
Management Institute (NFSMI).
Established by Public Law 1 01-4 7
and funded by USDA, the Institute
began operations 2 years ago with the
signing of a cooperative agreement
between the University of Mississippi
and USDA.
NFSMI has three divisions: one for
applied research; one for education
and training; and the third for technol­ogy
transfer.
In its first year, NFSMI established
its physical facilities at both the
University of Mississippi in Oxford
and the Univerity of Southern Missis­sipi
at Hattiesburg. It also established
advisory boards and recruited a staff.
Now at the end of its second year,
NFSMI is working on or has complet­ed
a number of activities, including a
conference with school food service
directors and people in related
research disciplines to determine
future trends in school food service.
It has also started research to identify
which factors have the greatest
impact on productivity and is devel­oping
a "train the trainer" program.
NFSMI has established an informa­tion
clearinghouse in conjunction with
the Food and Nutrition Information
Center of the National Agricultural
Library, accessible through a toll-free
number, 1-800-321-3054.
Plans for the upcoming year
include: providing educational
opportunities through satellite pro­gramming;
developing training
materials that support feeding chil­dren
with special needs; designing
educational projects to implement
the Dietary Guidelines; and hosting
a national procurement conference
to promote quality food service
programs.
10
Dr. Josephine Martin, a nationally
recognized leader in school food
service and program administration
with 40 years experience, is executive
director of NFSMI. (A more extensive
article on NFSMI will be in the next
issue of FOOD AND NUTRITION
magazine, which will focus on nutri­tion
education.)
As the Food and Nutrition Service and other
agencies work together to strengthen links
among programs serving children, it is caring
adults in local communities who are strength­ening
links to children. This Delaware WIC
mother,for example, (top photo, page 11)
makes sure she learns what foods are best for
her baby. And staff at KIDS PLACE in Scotts­burg,
Indiana, (below and opposite page) work
together to identify children who need special
help or attention. (Story on page 20.)
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t ~ .. ~ •
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Food and Nutrition
Strengthening Links
Among Programs
USDA's efforts to reach children
and to enhance nutrition in the food
assistance programs reflect President
Bush's emphasis on helping program
clients. Another USDA priority, im­proving
coordination, further pro­motes
the President's goal.
USDA has a number of activities
to improve coordination within the
Department and with other agencies.
For example, FNS is working with
the Extension Service to more exten­sively
involve the Expanded Food and
Nutrition Education Program, or
EFNEP, in nutrition education for food
program participants. EFNEP workers
teach basic nutrition and shopping
skills to low-income families in the
families ' homes.
FNS is also working with the
Centers for Disease Control to
increase immunization rates among
young high-risk children participating
in WIC. Since WIC mothers bring
their children to health clinics, FNS
and HHS suggested that clinic staff
assess each child 's immunization
status and assist mothers in obtaining
immunization services if needed.
Together with HHS, FNS has also
been working to attack inconsisten­cies
and overlap, particularly in the
Food Stamp Program and Aid to
Families with Dependent Children
(AFDC), and to make it easier for
clients to receive the array of ben­efits
available.
For example, FNS is exploring
ways to better coordinate the Food
Stamp Program's Employment and
Training (E&T) program with AFDC's
Job Opportunities and Basic Skills
(JOBS) program. Both are aimed at
helping people gain self-sufficiency.
Also, FNS and HHS have both
worked with state and local agencies
in launching electronic benefit transfer
(EBT) projects that allow clients to
access benefits from two or more
assistance programs with a single
debit card.
In an EBT project in Baltimore,
Maryland, for example, participants
can use a single plastic card to buy
food with food stamps at specially
equipped food stores and to withdraw
March 1992
benefits at automated teller machines
for AFDC, Child Support Enforcement,
and other cash assistance programs.
In another cooperative effort, FNS
and HHS have developed a model
application form that can be used to
apply for seven maternal and child
health programs, including WIC.
Also to improve and streamline
benefit delivery, FNS is encouraging
state and local agencies to "co­locate"
services. Delaware, for exam­ple,
has 12 "one-stop shopping"
centers that offer a full array of public
health and welfare services at a single
site. The result is fewer lines to stand
in, fewer forms to fill out, and more
comprehensive care.
Looking for ways to help high-risk
children, one Indiana community
created a "one-stop" family services
center that has dramatically improved
coordination and won state and
national recognition.
As we'll see in an article that begins
on page 20, Scottsburg's "Kids Place"
houses three agencies offering a
variety of services-WIG, child care,
parenting classes, immunization
clinics, assessment and therapy for
special-needs children, and more.
The agencies' managers and staff
work as partners to follow children's
progress, identify youngsters who .
need extra help, and make appropn­ate
referrals. And because Kids Place
is centrally located and has solid
community support, more families
learn about and benefit from its
services.
As communities across the country
look for ways to help children, the
food programs are valuable tools.
They are even more valuable when
they are linked to other efforts to help
children thrive, learn, and if they are
poor, grow up to break the chains of
poverty and welfare dependency.
Investing in children means invest­ing
time, energy, creativity, and caring
as well as money. But what better
investment than one that gives
children a chance for a healthier and
more successful future? +
A gateway to health care for many
A Healthy .Start
With WIC Makes
A Big Difference
Maria Foster broke into a wide
smile last February when she spoke
of her new baby, Cindy Vanessa. At
2 months, Cindy was the active, alert
baby Foster hardly dared hope for.
A 23-year-old domestic helper in
Springfield, Virginia, Foster struggles
to keep her weight up. The problem
was more than she could handle
during her pregnancy. But, thanks to
a nutrition intervention program for
at-risk pregnant women, she got the
help she needed to deliver a healthy
7-pound, 7-ounce baby girl.
"In the early months of pregnancy, I
was constantly nauseated," Foster
explained. "When my weight fell to 85
pounds, I had to be hospitalized."
After a week in the hospital, Foster
was discharged, 5 pounds heavier.
But she was not on her own.
Rebecca King, the nutritionist who
worked with Foster, provided nutrition
counseling and enrolled her immedi­ately
in the Special Supplemental
Food Program for Women, Infants,
and Children (WIG}.
WIG provides nutritious food
supplements, access to health care,
and nutrition education to low-income
pregnant and breastfeeding women,
infants, and children up to 5 years of
age who are found to be at nutritional
risk. The program is administered by
USDA's Food and Nutrition Service
(FNS) through state health depart­ments.
Foster was referred to an
Arlington County health clinic.
Maria Foster is glad she was referred to WIC
early in her difficult pregnancy. Her baby,
Cindy Vanessa, was born strong and healthy.
12
"I was afraid
she'd be sickly"
"I thought my baby would weigh
about 5 pounds and I was afraid she'd
be sickly," Foster said, then added,
happily: "But just look at her."
Like a cuddly teddy bear in her
bright print sleeper, Cindy squirmed
gleefully and broke into a big grin at
the sound of her mother's voice.
Cindy was thriving on nature's perfect
food-her mother's breastmilk.
"It's especially important to eat
right while I'm breastfeeding Cindy,"
said Foster. "Ms. King worked with
me on a high-calorie diet. I drink
more milk and eat more eggs and
cheese than I used to.
"We talked about things that are
bad for both me and my baby, too,
like tobacco and alcohol, and Ms.
King was pleased that I don't use
these things.
"I don't earn a lot of money, and
now there are things I need to buy for
my baby. WIG makes it easier to eat
well."
A young mother's joy and a baby's
healthy start in life are program
benefits that numbers don't capture.
Yet, Maria Foster and Cindy are just
two among the millions of American
women and children WIG has helped.
Their story is as close as the
neighbor next door in communities
throughout the United States.
WIC's focused
growth continues
In 197 4, WIG served 88,000
women, infants, and children, at a
cost of $10 million. Today, WIG
serves about 5.3 million participants
each month at a annual cost of $2.6
billion. Those numbers include one in
three babies born in the United States.
Despite current budget constraints,
WIG's pattern of focused growth
continues.
An important source of program
growth has been state efforts to
Food and Nutrition
...
control costs. Most notably, states
have achieved significant savings by
contracting with manufacturers to
obtain price reductions in the cost of
formula for infant food packages.
Unlike the Food Stamp Program,
WIC is not an entitlement program.
States receive federal funds for WIC
in the form of grants, with separate
grants for food and administrative
costs.
States serve as many eligible
women, infants, and children as they
can, using a specific priority system
designed to target benefits to those
most in need. To be eligible, partici­pants
must be determined to be
at nutritional risk as well as in eco­nomic
need.
By saving through rebates on infant
formula and other cost-containment
approaches, states can serve greater
numbers of WIC participants. In
1988, rebates on infant formula pur­chases
added up to $30 million. In
March 1992
1991, savings totaled more than $600
million, allowing WIC to serve a million
more participants each month. The
expected savings for 1992 are about
$650 million.
Increases in federal funding also
allow further growth. In fact, WIC
was one of the few non-entitlement
programs for which President Bush
proposed additional funds in both his
1992 and 1993 budgets.
Study proves
WIC is effective
According to Catherine Bertini,
USDA's Assistant Secretary for Food
and Consumer Services, WIC was
singled out for increased funding
because of its proven value in produc­ing
healthier babies and lower medical
costs.
A study released last year exam­ined
the effect of prenatal WIC par­ticipation
on health care costs for
Medicaid-eligible newborns and their
mothers during the first 60 days after
birth. The study reviewed 1987-1988
data from five different states: Florida,
Minnesota, North Carolina, South
Carolina, and Texas.
"This study offers dramatic evi­dence
that WIC works," says Bertini.
"It tells us what we hoped to hear.
For every dollar spent, WIC saves
from $1.77 to $3.13 in Medicaid costs
for newborns and their mothers.
"It also results in increased birth­weight
and longer gestation. On
average, WIC babies weighed more at
birth than non-WIC babies and the
difference was most pronounced for
preterm births. WIC mothers were
also more likely to carry their babies
to full term.
"I want taxpayer dollars to help
keep babies and children well rather
than to treat them after they are ill.
The WIC program is a sound invest­ment
in children's health."
All study states
showed benefits
In interpreting study results,
' researchers say that two key factors
should be kept in mind: First, results
are specific to the five states involved.
Second, both the Medicaid and WIC
programs have changed dramatically
since the data were collected.
At the beginning of 1987, income
eligibility requirements for Medicaid
ranged from a low of 33 percent of the
federal poverty level in Texas to a high
of 88 percent of this level in Minneso­ta.
Since 1987, Medicaid has
increased the income eligibility
standards for pregnant women and
children.
Currently, states are required to
extend Medicaid coverage to preg­nant
women and children whose
incomes are below 133 percent of the
federal poverty level, and they have
the option to provide coverage up to
185 percent of this level. As a result,
most states, including all of the study
states, have expanded their Medicaid
coverage of pregnant women.
"Many factors affect the stability of
these findings over time," Bertini says,
"including expansions in both WIC
and the Medicaid program. However,
this was a very large and important
study involving a census rather than a
sample of Medicaid births in the
states involved.
13
"And all study states showed clear
benefits despite substantial popula­tion
and program differences. This
study provides evidence of WIG's
effectiveness in improving pregnancy
outcome for both mothers and infants.
"Now we are interested in learning
more about the program's impact on
children. Our research people are
working to design a study to measure
the effects of WIG services on
preschool children."
Although WIG funding has steadily
increased, the program does not
serve everyone who is eligible. As
mentioned earlier, agencies with a full
caseload fill vacancies through a
priority system based on nutritional
risk.
This targets benefits closely to
need, and a high percentage of
eligible pregnant women and infants
participate. However, young children
are less likely than pregnant women
and infants to be in the higher risk
categories.
"More funds will allow WIG to enroll
more unserved children," says Bertini.
"This could mean raising the partici­pation
rate among children. In 1989,
about 45 percent of eligible children
participated in WIG."
Part of many
key initiatives
The proven benefits of WIG give it
an important role in the Bush Adminis­tration's
initiatives to reduce infant
mortality and improve the health of
needy youngsters.
Infant deaths are not a tragedy that
strikes all communities equally.
Therefore, an initiative called "Healthy
Start" has awarded 15 demonstration
grants to communities with dis­turbingly
high rates of infant mortality.
The goal is to reduce infant mortality
in these areas by 50 percent over
5 years.
Administered through an agency
of the Public Health Service, Healthy
Start will target health and social
services according to plans tailored
by each participating community to
meet its special needs and population
groups.
"The Healthy Start initiative will
develop creative new ways to
strengthen WIG's coordination with
14
Many WIC agencies are helping make sure
young children get immunized. This child was
one of thousands in New York City screened
and given referrals for shots. (See page 18.)
other mate'r nal and child support
programs," says Bertini.
WIG also has a role in an Adminis­tration
initiative to help low-income
children start school ready to learn.
This is the first of six education goals
set by the President and the nation's
governors.
Surgeon General Antonia Novello,
asked to address the health compo­nent
of learning readiness, has
identified WIG as the primary food
assistance program involved because
of its access to needy preschool
children.
Members of WIG's national staff,
along with representatives of the
Departments of Education and Health
and Human Services, serve on the
"learning readiness" task force that is
seeking ways to achieve this goal.
The task force organized a national
conference in February that brought
together parents, state officials, and
health, education, and social service
professionals from across the country.
The purpose was to create a stronger
partnership between families and the
programs that serve children's health
needs.
Nutrition education
also a priority
In addition to these joint endeavors,
Secretary of Agriculture Edward
Madigan has identified nutrition
education-with an emphasis on
children and low-income adults-as
one of USDA's four strategic goals.
Nutrition education and helping
children form good eating habits early
are logical concerns for a Department
that spends more than half of its
budget on food assistance.
Of the federal food programs, WIG
is the most actively involved in nu­trition
education.
WIG state agencies must allocate
at least one-sixth of their administra­tive
budgets for nutrition education
and related nutritional services. This
year, that amount will be almost $105
million nationwide. By law, another
$8 million or more must be devoted to
promoting breastfeeding.
WIG's nutrition educators deal with
a wide range of issues. In addition to
teaching pregnant women and new
mothers about the benefits of breast­feeding,
they help them learn about
proper infant feeding practices and
Food and Nutrition
Getting Out The Message: Breastfeeding Is Best
When Maria Foster chose to
breastfeed Cindy, she made a
decision that health professionals
and WIC officials would like to see
become the norm for mothers.
"It's simply the best way to
nourish and nurture babies," says
FNS Administrator Betty Jo
Nelsen.
During a visit to LaCrosse,
Wisconsin, Nelsen visited a WIC
clinic serving Hmong mothers, a
people from the highlands of
Vietnam. Breastfeeding had been
part of their traditional culture, she
was told. But, because they saw
few American women breastfeed­ing
and many tall and healthy
children, they figured babies grew
better on infant formula.
A WIC education campaign
reassured them that, here as
elsewhere, breastfeeding is the
preferred way to protect an
infant's health and development.
And the percentage who chose
breastfeeding climbed back from
19 percent in 1988 to a current 52
percent.
Counseling pregnant women on
the benefits of breastfeeding, and
helping them solve some of the
problems that can come up are
important parts of WIG's educa­tional
message. While WIC has
always emphasized breastfeeding,
program officials are looking for
additional effective ways to get
that message to the public.
"We must do more than identify
breastfeeding as the best choice
for babies. We need a public
climate that supports that choice,"
says USDA Assistant Secretary
Catherine Bertini.
Working to build
a supportive climate
In June 1990, FNS formed a
consortium of government and
private health professionals to
promote breastfeeding.
March 1992
The consortium includes the
American Academy of Family
Physicians, the American Acade­my
of Pediatricians, the American
College of Obstetricians and
Gynecologists, the American
Nurses Association, La Leche
League, the National Association
of WIC Directors, the U.S. Depart­ment
of Health and Human
Services, and other interested
groups.
In its meetings to date, the
consortium has laid the ground­work
for a pro-breastfeeding
media campaign. It has also
focused on establishing a network
of state and local coalitions to
support breastfeeding.
Other FNS efforts that support
breastfeeding include the following
regulatory provisions, technical
assistance activities, and research
and demonstration projects:
• In determining program eligibili­ty,
WIC gives priority to breast­feeding
women.
• States serving a high number of
breastfeeding women receive
additional administrative
funding.
• Breastfeeding women receive a
larger food package than other
postpartum women. The
Department is looking into
further enhancing the food
package for women who
choose to breastfeed.
• Breastfeeding women may
participate in WIC for a full year,
while other women become
ineligible for WIC after 6 months
postpartum.
• Nutrition education for partici­pants
includes information on
breastfeeding. Participants
learn about the benefits of
breastfeeding and techniques
to breastfeed successfully.
They also receive support and
encouragement.
• Recent legislation (P.L. 101-
14 7) establishes standards for
state agencies in promoting
breastfeeding. It also earmarks
$8 million from WIG's annual
appropriation to promote
breastfeeding.
• FNS funds a variety of research
and training projects. These
include support for state
conferences to train WIC and
other health providers to
promote breastfeeding. Spon­sored
research includes a 3-
year study and demonstration
that tested and evaluated ways
to increase breastfeeding by
WIC mothers
. • FNS has awarded small demon­stration
grants to encourage
local agencies to be creative in
developing incentives for
women to breastfeed.
• FNS program guides suggest
effective ways for health
professionals to promote
breastfeeding.
• FNS actively cooperates with
other federal agencies and
private organizations to share
information, develop education­al
materials, and promote
breastfeeding.
"More WIC mothers who
breastfeed means more healthy
babies," says Bertini. "And the
hard work of WIC clinic staff and
other health professionals helps
this happen."
15
the dangers of using tobacco, alco­hol,
and other drugs.
They also inform participants of
health services, such as where to
obtain immunizations, or counseling
and support services to assist them in
making changes in their eating habits
and establishing healthy lifestyles.
Working together
to improve service
From the beginning, WIG has
functioned as a gateway to health
care. Today, social trends such as
teenage pregnancies, single parent
families, and parental substance
abuse place America's children at
special risk. Meeting this challenge
requires a new level of partnership
among government and other health
professionals.
"By coordinating services among
programs that serve women, infants,
and children, we can make the best
use of limited resources and expand
and improve the services we provide,"
Bertini says.
Here are some examples of co­operation
and regulatory changes
intended to achieve simpler, more
consistent rules:
WIC-Medicaid
Study Is One Of
Many At FNS
The WIG-Medicaid study is one of
many products of the Food and
Nutrition Service's Office of Analysis
and Evaluation (OAE). It demonstrates
how research can provide timely,
complete, and accurate information to
policymakers.
In fact, the President's budget cited
the WIG-Medicaid study in requesting
additional funds to expand WIG
participation in fiscal year 1992.
The importance of evaluation in
deciding funding levels and as a
management tool to ensure that
programs are doing their intended job
led FNS to establish its research and
analysis division in the late 1970s.
Today, OAE director Jan Lilja heads
16
"I can't think of any
job satisfaction that
beats seeing a beautiful
baby get the right start
in life."
• WIG rules now require referrals to
Medicaid.
• Anyone who receives food stamps,
Medicaid or AFDC is automatically
income-eligible for WIG.
• FNS and the Department of Health
and Human Services (HHS) have
developed a model application
form that can be used to apply for
seven maternal and child health
programs, including WIG.
• FNS is encouraging state and local
WIG clinics to cooperate with the
Centers for Disease Control and
other Public Health Service pro­grams
to promote immunization of
preschool children.
• FNS is working with the Extension
Service, which will make intensive
nutrition education available to the
a professional team that manages a
research budget of $17 million,
including $5 million for WIG-related
research.
"The credibility of the WIG­Medicaid
findings reflects careful
advance planning and labor-intensive
data analysis," says Lilja.
"From the point of view of statisti­cal
complexity, WIG-Medicaid was
unique," she says. "In each state, we
had to match three different data­bases,
kept in different ways.
"We had to deal with differences in
how Medicaid and WIG are adminis­tered
and documented in order to
know which findings were compara­ble.
And we had to distinguish
between cost savings due to WIG
and those due to prenatal care.
"This required sophisticated
analytic techniques and it required
exceptional support from state
cooperators. The results were a clear
showing that WIG participation by
pregnant, low-income women leads to
healthier mothers and babies and
Medicaid savings."
Of great interest
to many groups
Lilja points out that interest in the
WIG-Medicaid study extends beyond
USDA and the cost implications for
Medicaid: "The study is of great
interest to all those persons and
organizations working to reduce infant
mortality and improve the health and
welfare of children at risk."
An initial printing of 1 ,000 copies
did not begin to meet requests, she
says. Several states did their own
printings, and some distributed cop­ies
to their entire state legislatures.
FNS also provided briefings at
the request of committees of the
U.S. Congress, the federal Office of
Management and Budget, the Depart­ment
of Health and Human Services'
Low Birthweight Prevention Work-
Food and Nutrition
group, the National Association of
WIC Directors, regional meetings of
WIC agencies and Maternal and Child
Health Programs, and other agencies
and organizations.
As additional funds allow WIC to
target more benefits to young chil­dren,
OAE is addressing a new
research challenge. The narrowly
focused WIG-Medicaid study shed
light on one aspect of the program,
but much less is known about WIG's
effect on children.
"We have begun work on a study
of WIG's impact on children," says
Lilja. "Potentially, this could be the
largest evaluation we have ever done.
It's an opportunity to answer many
questions of concern both to health
research and to educational studies
that follow children over a period of
years."
She says the 'child impact' study
has already galvanized the interest of
Head Start, Environmental Protection
March 1992
neediest WIC participants. The
President's 1993 budget request
includes funds to enable Extension
to serve 50,000 more WIC partici­pants
through the Expanded Food
and Nutrition Program (EFNEP) in
addition to the approximately
91 ,000 now being served.
• FNS supports state and local
efforts to provide "one-stop serv­ice"
in delivering benefits. The idea
is to co-locate health, welfare, job
training, and nutrition services, and
to reduce overlapping and incon­sistent
forms and rules in assis­tance
programs serving the same
populations.
• FNS is working with the HHS
Office of Substance Abuse Preven­tion
to develop an extensive series
of resources to help participants
learn about the dangers of smoking
and using drugs during pregnancy.
Manuals and videos will be avail­able
this summer for use in WIC
clinics.
Healthier babies
are the reward
WIC is one piece in a larger picture
that public assistance professionals
Agency staff concerned with lead
poisoning among children, the Cen­ters
for Disease Control, and other
federal and non-federal agencies and
programs.
"The challenge will be to meet our
primary goals of evaluation and to
satisfy other interests at the same
time. We are laying the groundwork
very carefully to ensure solid data,"
says Lilja.
A field test of two research designs
was recently completed to test data
collection procedures and ways to
implement the study.
Studies provide
valuable information
Through these and other studies of
WIC and other food assistance
programs, OAE continues to supply
information that affects all aspects of
program funding and operation.
The studies identify what works
and what doesn't, how to target
draw on to meet maternal and child
health care needs.
"When Maria Foster reported for
her first appointment at the Arlington
Nutrition Intervention Clinic last year,
we looked at all her needs," says
Rebecca King. "And one by one, we
helped her find the resources to
support a healthy pregnancy.
"The nutrition information we
provided was important," King adds.
"But even more important was
building a trusting relationship, which
encourages clients to stick with our
advice.
'~I can't think of any job satisfaction
that beats seeing a beautiful baby get
the right start in life." +
For more information, contact:
Ron Vogel, Director
Supplemental Food Programs
Food and Nutrition Service
U.S. Department of Agriculture
Alexandria, Virginia 22302
article by Wini Scheffler
photos by Pamela Faith,
Mary Jane Getlinger
and Martin Boner
benefits where the need is greatest,
what is cost effective and what isn't,
and how to intervene with high-risk
populations.
"It's easy to appreciate the upfront
role of WIC nutritionists who weigh
and measure babies, refer them for
shots, prescribe food packages, and
advise moms on good nutrition," says
Lilja.
"The research that backs up this
wonderful first line of workers is less
visible. Yet, when government
policies involve a tradeoff between
competing interests, good numbers
are the basis for effective advocacy.
"Everyone wants healthy babies
and children. We are proud that our
study shows conclusively WIG's
important contribution to reaching
that goal."+
17
In a special effort in New York
WI C Agencies
Help Put Measles
On The Run ...
"Measles Cases Are Epidemic in
the Region" read a New York Times
headline last spring. Some 2,000
cases of measles had already been
reported in the first 3 months of 1991
just 500 fewer than the 2,500 cases
reported in the same area during
all of 1990.
But that's only part of the story.
The measles epidemic could have
affected thousands more children had
not the New York State Health De­partment
identified the potential for a
serious measles outbreak and taken
the offensive with a 4-month immu­nization
project in the fall of 1990.
Local WIG agencies throughout New
York City played a key role in the
effort.
Through the project, all children
enrolled in WIG were screened to
make sure they had received vaccina­tions
for measles, mumps, and rubella
(MMR). If they had not, special
arrangements were made to see that
they got them. In many instances,
their brothers and sisters who had not
been vaccinated were also referred
for shots, even if they were not
participating in WIG.
In all, more than 95,000 children
were screened at local WIG agencies.
As a direct result of this initiative,
more than 3,200 children were
immunized either at the WIG site or
escorted to a nearby agency where
they could be immunized. Another
4,000 were directed through written
referrals to accessible health care
providers.
Outreach and screening
carefully planned
To reach as many children as
possible, the health department
18
developed multi-language information
materials, which were mailed to
participants and given out at local
agencies, and established a system
for screening children.
When a parent visited the local
agency to have a child certified or to
pick up food vouchers, WIG staff
would ask to see the child's measles
immunization card.
If the child had never been immu­nized,
or if the parent did not bring the
immunization card to the local agency
at a subsequent appointment, the
staff would begin the referral process.
If the parent had other unimmunized
children who were not participating in
WIG, they would be given a referral at
this time.
In some local WIG agencies, the
referral process for WIG participants
involved providing written forms
introducing the child to the health
center. In others, public health nurses
working on-site provided the immu­nizations.
In WIG agencies "co­located"
with hospitals and health
centers, WIG staff escorted parents
and participating children to the
immunization clinic.
Escort system
worked well
Two local WIG agencies using this
escort system were the Jamaica
Hospital WIG program in Jamaica and
the Union Hospital WIG program in
the Bronx. WIG directors at both
locations were pleased with how well
it worked.
However, according to Carmen
Rodriguez, director of the Jamaica
Hospital WIG program, there were
some challenges in putting it all
together. Her first obstacle was
getting the cooperation of health
professionals.
"Doctors have their own philoso­phies
in terms of how immunizations
should be handled," she says. "Some
still live by the old school of thought:
'Let the child get the disease and then
be immune.'
"When we told them we'd like these
children to be immunized as soon as
we saw need, they said, 'Wait a
minute here, we're the ones who
make this determination."'
To overcome this, Rodriguez set up
several meetings with doctors and
administrators to explain the state
agency's position. "Little by little,"
she says, "they became more easily
accessible and more willing to give
the shots."
Having enlisted the cooperation of
health professionals, Rodriguez's next
obstacle was selling the idea to
parents. Some, especially those who
did not speak English, were frightened
and intimidated.
"We were able to work around that
by talking to parents in their own
language, letting them know there was
a serious epidemic," Rodriguez says.
"And we were able to let them know
that the immunization was free and
would be done within 20 minutes.
Our agreement with the health center
ensured that when we escorted a
child to get immunized, we went
right in."
Outreach campaign
allayed fears
Mildred Maldonado, director of the
Union Hospital WIG program, had a
different experience in dealing with
parents. Everyone in her neighbor­hood,
she said, seemed to understand
the measles problem and was con­cerned
about it.
"People were very aware of the
situation," Maldonado says. "Besides
the state outreach, we had spent a
week campaigning around the com­munity.
I was on television and radio
telling the community there was a
problem and that there was a need to
come to the WIG clinic."
Maldonado thinks these efforts
removed some of the apprehensions
people had about getting their chil­dren
immunized. "Our outreach
Food and Nutrition
"Our outreach seemed
to convince people we
were worried about
them and their families.
We emphasized that no
one needed anything
from them-only that
their child come to the
local agency."
seemed to convince people we were
worried about them and their families.
We emphasized that no one needed
anything from them-only that their
child come to the local agency."
The response, says Maldonado,
was overwhelming. "We actually
signed up many new WIC participants
as a result of the immunization
outreach. We even had people come
in off the street worried about measles
who weren't qualified for WIC. We
couldn't provide the escort service for
them, but we were able to refer them
straight to the hospital where they
could be immunized."
Like the Jamaica WIC staff, Mal­donado's
team at Union Hospital
worked together to make it easy for
parents to get their children immu­nized.
When the staff identified a partici­pant
who needed to be immunized,
Danny Hernandez, a clerk, would
check the patient's MMR card, ask
the child's mother if an MMR was ever
done, and get some background
information.
"He would take the time to explain
the process and answer any ques­tions,"
says Maldonado. "If an MMR
had not been done, he would fill out a
referral form. One copy went to the
state, one to the clinic, and the third
stayed in the participant's file."
Hernandez would then prepare a
consent form and make sure the
parent understood possible con­traindications
to the shot and what
she should do if she saw any of the
reactions.
March 1992
"We told parents to come right
back to our office," says Maldonado.
"We wanted to make sure parents
were confident we were right here to
help."
Entire process
took 10 minutes
After the screening anc;i referral
forms were completed, Hernandez
would escort participants around the
corner to the clinic. The Union
Hospital Pediatrics Department had
been very supportive of the initiative
from the start and had set up a
special area, the WIC MMR Room,
just for WIC participants.
This was key to encouraging
parents to get their children immu­nized:
WIC participants bypassed the
waiting area and went straight to an
examining room.
A nurse would conduct a routine
evaluation, remind parents of potential
side-effects, and ask if they had any
questions. A doctor would do a quick
check-up, then the nurse would give
the injection. The entire process took
about 1 0 minutes. Danny Hernandez
stayed throughout to provide support
and to translate if necessary.
The process had some added
benefits for some of the children.
"When the physicians got involved in
the project," says Maldonado, "they
wanted to do an overall evaluation of
the patients to determine their medi­cal
needs. The evaluations found
scurvy, influenza, psychological
problems, and even cardiac problems.
"Fortunately, we were able to reach
these children through the MMR
outreach and they could be treated."
The state initiative lasted 4 months.
Its impact, however, will last for years.
So will the new rapport WIC local
agencies established with other health
care providers.
Though only a few local agencies
were able to continue providing an
escort once state support ended,
most continue to screen children and
make referrals. +
For more information, contact:
Mary Warr Cowans, Assistant Director
Supplemental Food Programs
State Department of Health
Division of Nutrition, Room 821
Corning Tower, Empire State Plaza
Albany, New York 12237-0682
article and photos
by Martin Boner
19
A dream come true is now a model
Kids Place Puts
Many Services
Under One Roof
KIDS PLACE, a "one-stop services
center" for children, has brought
Scottsburg, Indiana, into the national
spotlight.
The center brings together under
one roof three agencies-the Scott
County health department, which
offers a variety of services; the Scott
County WIC program, which provides
supplemental foods and nutrition
counseling to low-income mothers,
infants, and young children; and New
Hope Services, which has several
supportive programs for children and
parents.
All three agencies have their own
staff of professionals and paraprofes­sionals,
but they work closely with
each other to make sure their young
clients get the help they need. Being
"co-located," staff members say,
makes it easier to identify needs,
make referrals, and follow children's
progress.
For parents, KIDS PLACE means
getting more comprehensive-and
more convenient-care for their
youngsters. For instance, the WIC
staff can now arrange for a child to
get immunization shots from the
public health nurse on the same day
the child visits the WIC clinic.
Working as a team
to help children
The range of services provided at
KIDS PLACE is impressive. New Hope
Services, for example, works with
children and parents both at KIDS
PLACE and in families' homes.
Among other things, staff do develop­mental
screening and assessment and
offer occupational, physical, and
speech therapy services.
20
They also have mother-and-baby
play groups and parent education
classes, including some for pregnant
teens. They make home visits and
bring "welcome baby baskets" to all
new arrivals.
They also operate a licensed day
care center, which provides regular
child care services, afterschool
kindergarten care, and enrichment
elasses for preschoolers. Schools
contract with New Hope for special
education assessment (and therapy
if it is needed) for all 3- to 5-year-olds
in Scott County.
Carolyn King, New Hope's director,
is pleased with the way KIDS PLACE
agencies coordinate their efforts.
"Close to 1 00 percent of families with
special needs are referred to pro­grams
in Scott County," she says.
"We also work as partners in preven­tion
and intervention efforts with the
Child Protection Service."
New Hope Services and other KIDS
PLACE agencies are well known in
Scott County. "The community learns
about us," King says, "through our
welcome baby project and through
our high visibility on coordinating
councils and at community events."
Community involvement
is key to success
Community involvement is a big
part of the KIDS PLACE story. Five
years ago, the center was just a
dream for Scott County health,
education, and social service profes­sionals.
Concerned about the multi­ple
problems facing low-income
families and how these problems put
children at risk, they had formed an
interagency task force and were
taking a hard look at causes and
possible solutions.
According to King, Scott County
had high unemployment, large num­bers
of teenage pregnancies, and
many families receiving government
assistance. The high school comple­tion
rate for adults was a low 38.6
percent.
"These factors are associated with
problems like premature births, infant
deaths, developmental difficulties,
malnutrition, and child abuse," says
King, who set up and was a member
of the initial problem-solving team.
"We were looking for a plan to help
children have a better start in life. We
decided the county needed a high­profile,
attractive family services
center that would show we value our
children-a place where families
would be proud to come."
But, says King, it could only
happen "if the community would
support the concept both philosophi­cally
and financially."
The committee explored every
possible funding source, applied for
grants, and set out to win local
support. According to Scott County
WIC director Jean Robbins, the
community had to first acknowledge
that there were problems and that
dealing with them was a shared
responsibility.
Being a small rural community in
some ways made that harder. "In an
urban area," Robbins explains, "it's a
little easier to admit there are prob­lems.
But in a small town like this
one, people think it's their fault."
State grant sparked
fundraising effort
The Indiana Department of Mental
Health offered a $375,000 grant if the
small southern Indiana community of
22,000 could raise an additional
$125,000. Task fo~ce members took
their message to tHe people of the
county.
Their message was compelling.
"Every time we made a presentation,"
says New Hope family services
Food and Nutrition
worker Sandy Johnson, "we would
show slides of kids. We'd say,
'They're ours. They're yours. They
belong to this county.' And people
began to realize that."
Local individuals, businesses,
religious and social organizations
raised more than $125,000 in 18
months. "They had bean suppers,
bowling tournaments, rock concerts,
clogging events, roller skating parties,
flea markets, and even a piano bench
race," says King. "Additional fund­ing
came from the Mary and Barry
Bingham Fund, WHAS radio's
Crusade for Children, and Ronald
McDonald Children's Charities."
KIDS PLACE became a reality in
1988. Since occupying their new
home-an inviting, brightly colored
building-block structure-all three
agencies have experienced an
increased demand for their services.
Most children who come to KIDS
PLACE participate in two or more
programs offered. Some services are
provided free through multiple funding
March 1992
sources; others are for a fee.
WIC, for example, is a federal food
program administered by the U.S
Department of Agriculture in coopera­tion
with the state department of
health and local agencies. Partici­pants
must meet eligibility criteria to
receive free supplemental foods and
nutrition education.
"WIC enrolled 363 pregnant
women, 494 infants, and 594 children
under age 5 in 1990," says Robbins.
"This represents a 41-percent
increase since pre-KIDS PLACE days.
It's particularly noteworthy since early
prenatal care and early infant care
can help avoid long-term health
problems."
KIDS PLACE looks like a place for kids. The
brightly colored building-block structure is
home to three agencies serving children-the
county health department, WIC, and New
Hope Services. While the agencies each have
their own staff, they work closely together to
make sure children get the help they need.
A well-child clinic was added this year.
"We decided the county
needed a high-profile,
attractive family serv­ices
center that would
show we value our chil­dren-
a place where
families would be
proud to come."
Many problems can
be spotted earlier
The public health department now
routinely offers immunization clinics,
with both WIC and local physicians
referring all their patients. More than
3,000 Scott County children received
immunizations from the public health
nurse in 1990, a 40-percent increase
since relocating to KIDS PLACE.
In addition, the health department
provides older adult screening,
maintains health records, and oper­ates
a tuberculosis program as well as
a medication program for administer­ing
prescribed injections.
New Hope Services initially offered
special help for children with develop­mental
disabilities, but since moving
into KIDS PLACE has expanded its
clientel and now provides many
additional services to children with
and without disabilities.
"KIDS PLACE has drawn an
impoverished rural community togeth­er
to ensure a better future for chil­dren,"
says Robbins.
Sometimes to help a child, health
and social service professionals need
to consider a family as a whole.
Being at KIDS PLACE makes that
easier. "Due to our proximity to other
services," says Robbins, "we can now
consider the needs of the whole
family and how they are affecting
mothers and children participating
inWIC.
"For instance, a mom who failed
to wean her baby off the bottle said
that all her time was demanded by her
6-year-old, who was cutting up the
curtains and starting fires. WIG
counselors realized the baby's bottle
habits were, for this reason, not one
of the mother's priorities.
"They referred her to the public
school system's special services staff
for help with her child. This is just one
example of how a referral benefited a
family as a whole." The 6-year-old,
who was not a WIG participant, got
the attention he needed, and the
mother was able to focus more on the
baby and what the WIG counselors
were advising.
WIG mother Liza Cline says she
appreciates the services offered at
KIDS PLACE. "WIG food vouchers
really help out," she says, "and the
WIG staff referred my son Christopher
to New Hope Services, where he has
received speech therapy.
"Consultants found the cause of his
problem was his ears and we got
medical attention. I'm happy Christo­pher
will be on schedule when he
enters public school next year."
22
KIDS PLACE has
become a ,m odel
KIDS PLACE is a dream come true
for Scottsburg, and it may also help
other communities as a result of the
attention it has received.
In 1990, KIDS PLACE received the
Indiana Governor's Showcase Award
and this year was selected by the
National Center for Clinical Infant
Programs (NCCIP} in Washington,
D.C., as having one of the nation's
six most promising approaches for
improving maternal and child health.
The NCCIP is funded through a
federal Maternal and Child Health
(MCH) grant and administered by the
U.S. Department of Health and
Human Services. The center chose
KIDS PLACE because of its broad­based
community involvement and
interagency cooperation, its value as a
model for providing quality service to
children in a rural area, and because
children are not labelled or segregrat­ed
according to disability.
The NCCIP will be observing and
consulting with KIDS PLACE over the
next 5 years to develop innovative
ways to screen for and prevent health
and development problems in infants
and toddlers. The project will also
refine procedures for coordinating
early intervention services.
As Robbins explains, recognition
from NCCIP has also sparked some
new activities in Scott County. "At the
same time NCCIP recognized KIDS
PLACE as exemplary, it also identified
a need-KIDS PLACE lacked a
provision for well-child health serv­ices,"
she says.
As they did in 1986, Scott County
professionals looked at needs and
funding sources. Then the three KIDS
PLACE agencies applied for and
received a $55,000 MCH grant to
establish a well-child clinic. The clinic
opened in February. Well-child visits
are scheduled 2 days a week and
coincide with WIG scheduling.
"Well-child care works hand in
hand with WIG and other programs to
serve the whole child," says Robbins.
"And, although WIG already offered an
extensive referral system, adding the
well-child clinic allows more opportu­nity
to help."
Robbins is working with the Indiana
state department of health on a
"memorandum of understanding"
which will allow all three agencies to
share the same patient records.
Food and Nutrition
"KIDS PLACE has
drawn an impoverished
rural community to­gether
to ensure a better
future for children."
During the first 9 months, the well­child
clinic will serve children 2 years
and under who are income eligible.
Then the clinic will expand to poten­tially
serve all of the approximately
1,300 Scott County children 21 years
of age and younger enrolled in Medi­caid.
By 1993, not only will the clinic
be self-supporting, it will also expand
its services to include Jackson and
Washington County children.
Opposite page: Preschool teaching assistant
Johnny Gullion works on listening skills with
a group of children. Below: Carolyn King,
New Hope Services director, and Jean Robbins,
Scott County WIC coordinator, hold a new
"Welcome Baby Basket." Right: Sharon Prall,
Scott County public health nurse gives an
immunization schedule to Liza Cline for her
young son, who comes to KIDS PLACE for
WIC services.
March 1992
Local interest
continues to grow
As KIDS PLACE thrives, local
interest continues to grow. More
community, religious, and student
groups are providing active support,
and interest among business leaders
is increasing.
"Major corporation executive
officers are beginning to realize what
Scott County social service profes­sionals
have recognized since 1986-
the future of economic development
in the community depends on the
quality of life children enjoy," says
Robbins.
Additional support has come from
the county board. "The final commu­nity
commitment was evident," says
King, "when New Hope Services,
which owns the KIDS PLACE building,
was allotted a Scott County 4-cent
tax support rate.
"In prior years, we had to go to the
county board, substantiate our re­quest,
and petition for county money.
The county allotted amounts varying
from $5,000 to $10,000. The 4-cent
tax rate generates approximately
$25,000 support we can count on."
KIDS PLACE directors are also
helping other groups. "In addition to
applying for grants that benefit Scott
County," King explains, "we also
assist other community organizations
in writing their proposals."
King believes KIDS PLACE offers
some solid lessons about working
cooperatively. "One of the secrets of
KIDS PLACE's success," she says, "is
that it has succeeded in overcoming
the turf battles common to community
programs." The common denomina­tor
of all KIDS PLACE programs is to
do what will be easiest for the client.
Like a kaleidoscope's ever-chang­ing
prisms, KIDS PLACE is constantly
changing to meet the needs of young
families. Scottsburg, a small rural
town with big-city problems, has
shown that community commitment
produces results. The results can be
seen at KIDS PLACE. +
For more information, contact:
Carolyn King, Associate Director
New Hope Services, KIDS PLACE
Route 3, Box 9
Scottsburg, Indiana 47170
Telephone: (812) 752-4892
article and photos
by Mary Jane Gettinger
" ... a world outside the hotels"
So Children
Won't Go Without
Summer Meals
Los Angeles is known for its
splendor-the great estates in Beverly
Hills, the Disney glitter. Yet less than
10 miles from Rodeo Drive, the city
feels like a different country. The
streets are dirty and loud, lined with
cheap liquor stores and check­cashing
services. The man winding
through stopped traffic has a green
garbage bag over his shoulder.
On the corner of Stanford and
Ninth Street is a school surrounded
by a 15-foot wire fence. Of the four
gates that enter school grounds, three
are chained and padlocked except
when the children enter in the morn­ing
and leave after classes. The last
is a service entrance, staffed by a
guard.
Despite its foreboding appearance,
the school is a haven for the area's
transient children.
"These kids treat the school as
their sanctuary," says Sally Dunay,
area food services supervisor for the
Los Angeles Unified School District.
"In other schools, you'll see a lot of
graffiti. Here the school isn't
defaced."
Kids need the
help they get
The Ninth Street School offers little
that most of us would consider a
luxury: the site is small; the buildings
mere bungalows: the lunchroom, an
open-air cluster of picnic tables under
a concrete awning. Yet the school
provides three things that are
extremely important to these children:
protection, supervision, and food­year
'round.
For Ninth Street students, these
luxuries are needed. Of the 555
24
children who attend the school, 550
participate in the National School
Lunch Program and 420 eat breakfast
at school. Only one pays full price and
two pay a reduced-price for their
meals. The rest eat for free.
"Basically what we're talking
about," Dunay says, "are very tran­sient
people. These kids are living in
a hotel room with their entire family.
Their only furniture is a milk crate and
mattress on the floor."
Concern for the children - and
cooperation among many interested
people from a variety of agencies -
has translated into a multi-faceted
program, originally set up to make
sure these students didn't fall through
the cracks when their school stopped
having traditional summer vacations
2 years ago.
From its opening in 1984 until 1990,
the Ninth Street School had operated
on the standard, single-track school
year. During the summers, the school
offered breakfast and lunch to nearly
500 children in conjunction with
USDA's Summer Food Service
Program and Para los Nifios (For the
Children), a nonprofit organization
which has been active in helping
transient children for more than
12 years.
The "off-track" students eat breakfast and
lunch at school with the children who are in
classes. On days the children will be on field
trips, the school food service staff provides
sack lunches for the youngsters to take along.
Food and Nutrition
When the school switched to a
year-round, four-track system with
vacations at various times, the chil­dren
who were out of classes-or
"off-track"-were left without a
summer meals program and without
organized activities.
To remedy this, Para los Nifios
worked with the school district, Ninth
Street principal Betty Peifer, and Cleo
Davis of the Food and Nutrition
Service's western regional office to
develop an "off-track" program that
would fill the vacuum.
One of a kind
in the district
Thanks to these efforts, children
who are on break continue to receive
two meals each school day through
the Summer Food Service Program,
even if "summer break" comes in
November or March. They also
receive tutoring in their studies, get
March 1992
swimming lessons at the YMCA, and
go on field trips to museums and
libraries.
According to Sally Dunay, Ninth
Street is the only school in the Los
Angeles Unified School District with a
successful off-track breakfast and
lunch program. The program serves
about 60 children daily, depending on
the number who are on break at the
time. Usually about 80 percent of
children not in classes participate.
Each morning, the "off-track"
children walk to school with those
who are in classes, so they don't have
to walk through the neighborhood
alone. After breakfast at the school,
Para los Nifios buses them to another
site-sometimes on a field trip,
sometimes to the Para los Nifios
center.
They return to the school at noon
for lunch. On full-day field trips,
usually 2 or 3 days each week, the
school provides sack lunches in the
morning for the children to take with
them. They return to the school by
bus in the afternoon so they can walk
home with the other children.
"Para los Nifios teaches these kids
basic skills that we take for granted,"
Dunay says. For many of the children,
learning to swim is as new as arith­metic;
the Museum of Science and
Industry is as exotic as the Far East.
. School principal
reaches out
Although Para los Nifios has been
instrumental in developing the "off­track"
program, it would not have
been nearly as successful without the
support of Ninth Street school princi­pal
Betty Peifer, who has worked to
help the transient children in many
ways.
The school is less than a mile from
a major Los Angeles shanty town and
25
"Para los Nifios is
what makes it work.
This is successful
because the agency
offers planned activities
and a safe place to go."
many of the students have been
homeless in their 6 to 1 0 years of life,
but none is now.
Working with Para los Nifios and
the surrounding hotels, Peifer devel­oped
a voucher system for Ninth
Street students and their families.
Now, when she hears that a child is
living on the streets, she gives him or
her a voucher for the entire family to
move into a homeless hotel.
Peifer tries very hard to keep these
families together. The school's track
system is set up so children from one
family are in the same track, which
lets siblings play and learn together
during their vacations.
Peifer also made sure siblings
would not be divided during meals;
Ninth Street students eat breakfast
and lunch by track, rather than by
grade. This way, Peifer explains,
26
sisters and brothers can eat together
and the older students can help the
younger ones with their food.
Splitting up families may not be an
issue at other schools, but at Ninth
Street, Peifer sees the importance of
keeping them together. Many of the
children are refugees from war-torn
countries in Central America and are
hearing English for the first time.
Often even the Spanish is different
from their own. For children who
move from place to place every week
or month, Betty Peifer's extra efforts
are especially important.
Also important at Ninth Street
School is Carmen Navarro, the
cafeteria site supervisor. "I love these
kids," Navarro says, watching as
student helpers hand out plastic
spoons to the line of children.
Each day, Navarro asks teachers to
send her two children to help set up
and assist in the meal service. Only
those who are doing well in school are
allowed to help, and they can only do
so one day.
"It's a treat for them to help,"
Navarro says. "It helps them feel
important."
Why has it worked
at Ninth Street?
According to Marilyn Fletcher, the
district's senior food services super­visor,
Los Angeles Unified School
District has tried to start year-round
programs in several schools. Only
Ninth Street has been successful.
The district has surveyed parents
whose children attend other schools,
asking whether they would send their
children to a "summer program" for
off-track students. Most responded
Food and Nutrition
This young girl is one of 555 children who at­tend
the Ninth Street School. School prin­cipal
Betty Peifer has made special efforts
to help these children, including arranging
for brothers and sisters to be in the same
"track." This means thetj are on vacation at
the same time and can have meals together.
Para Los Niiios
To Tanya Tull, founder of the
nonprofit service organization Para
los Niiios, the agency's purpose is
straightforward: "We're offering
children a world to live in outside
the hotels."
Many of the children Para los
Niiios serves live in hotels that
serve as interim housing for their
families. Often their parents pay as
much as $500 per month for a
room in which the entire family
must live.
Tull started the organization as a
day care center after reading a
newspaper article on homeless
children in downtown Los Angeles
in 1979. Through donations and
grants, Tull raised nearly $100,000,
and by 1981 her organization was
operating a full-service day care
center for children in the area.
Para los Niiios now operates on
a $1.5 million annual budget. In
addition to day care, it offers
emergency food and shelter for
homeless families with children,
March 1992
negatively to the idea, preferring to
have their children stay in a hotel
room rather than have them walk the
few blocks to school alone.
"In other schools," Fletcher says,
"the first week (of the off-track pro­gram),
we would get 50 kids out of
400. The next week it would be down
to 10."
Sally Dunay attributes the pro­gram's
success to "the need and the
planned activities."
"Para los Niiios is what makes it
work," Dunay says. "This is success­ful
because the agency offers planned
activities and a safe place to go."
Because agency staff drive the
children to their field trips and coordi­nate
activities around times when
other children also go to school, the
parents feel better about letting their
children participate. They know that,
with Para los Ninos involved, supervi­sion
will not end after lunch.
prevention and protection services,
and a variety of youth programs. It
also has a food pantry on site.
Since 1990, it has worked with the
Ninth Street School to provide
special activities for children during
school vacations.
The organization was instrumen­tal
in re-opening the Ninth Street
School in 1984. The school had
been closed in the 1950's due to
the limited number of children in
the area, but with rising housing
costs through the 1970's, families
started using nearby hotels and the
school-age population went up.
When the school re-opened,
Para los Niiios received a state
grant to start an afterschool
program for Ninth Street students
who lived in the hotels. The
program now feeds, tutors, and
cares for about 175 Ninth Street
children from 2:30 p.m., when their
classes end, until 6:00 p.m. when
someone will be home to take care
of them.
Through USDA's Child and
Adult Care Food Program (CACFP),
"If there were more organizations
that helped children throughout the
district," Dunay says, "this program
would be more widely available."+
For more information, contact:
Cleophus Davis
Summer Program Manager
Western Regional Office
Food and Nutrition Service, USDA
550 Kearny Street, Room 400
San Francisco, California 94108
Telephone: (415) 705-1348
Marilyn Fletcher
Senior Food Services Supervisor
Los Angeles Unified School District
P.O. Box 2298
Los Angeles, California 90051
Telephone: (213) 742-7087
article and photos
by Kristen Bole
Para los Niiios serves meals and
snacks to children participating in
their day care program.
In addition, in an unusual
arrangement the Ninth Street
School worked out with the help
of Cleo Davis from the Food and
Nutrition Service's western regional
office, Para los Niiios sometimes
also serves snacks that include
left-overs from the school's lunch
program. Davis says FNS sup­ported
this arrangement so no
food would go to waste in such a
needy area. +
For more information, contact:
Randy Silverstein,
Executive Director
Para los Ninos
845 E. Sixth Street
Los Angeles, California 90021
Telephone: (213) 623-8446
27
For children who are homeless
It's Art For
Kids' Sake In
New York City
At 4 o'clock on Friday afternoon,
Rhonda Mclean-Nur arrives at the
Harriet Tubman Family Living Center
on West 143rd Street in Harlem. A
school bus is parked across the
street.
As she climbs the front steps, she
is greeted by a group of children, who
are obviously happy to see her. "Get
on the bus, we're leaving soon," she
tells them. In twos and threes, the
children jog across the street and
climb aboard.
Entering the shelter, Mclean-Nur
seeks out Sam Haynes, the center's
assistant director of social services,
who briefs her on anything she needs
to know. Ten minutes later, she
boards the bus herself.
As the bus heads downtown,
Mclean-Nur discusses report cards
with the children-who had just got­ten
theirs and the grades that were on
them. She wants to let the children
know she is interested and to find out
who might be having trouble.
At about 90th Street, she gets their
attention and leads a "rap". Its
message: listen to your heart, not the
kids who don't like school. As the
bus winds through Manhattan rush­hour
traffic, the children repeat:
28
"Some say: 'Take a puff of this,
you'll be real cool. Misbehave,
tell lies, don't go to school.
Read a book! What for? I'm not a
scholar.' Can you add or subtract
the value of the dollar?
You've got to try to get along with
the rest of the world.
Got to listen to your heart, not
some boy or girl.
You've got to be yourself..."
Helping children
be themselves
These children are participants in a
special program sponsored by three
New York City agencies-the Depart­ment
of Cultural Affairs, the Human
Resources Administration, and New
York Public Schools-together with a
number of private organizations. It's
called the Cultural Arts Program for
Children Living in Temporary Housing.
The program gives homeless
children opportunities to interactively
experience some of New York City's
cultural resources. Rhonda Mclean­Nur
is project coordinator.
Begun in 1988, the program is a
truly collaborative effort. It was the
brainchild of Department of Cultural
Affairs Commissioner Mary Schmidt
Campbell, who took the idea to the
chancellor of education.
Once the board of education was
a partner, the Human Resources
Administration found ways in which it
could contribute. AT&T provided initial
funding, and the New York State
Education Department also commit­ted
to providing funds.
In addition to taking part in a
variety of active learning experiences,
the children get nourishing meals
through USDA's Child and Adult Care
Food Program.
This year, there are 19 cooperating
cultural institutions in Brooklyn,
Queens, Manhattan, and the Bronx.
These institutions range from the
American Museum of the Moving
Image, to the New York Zoological
Society, Ballet Hispanico, and the
Metropolitan Museum of Art.
Ten weekly and
holiday sessions
The activities are organized in
1 0-week semesters as well as holiday
sessions and are held on-site at
cultural institutions. Children receive
instruction in the visual and perform­ing
arts, humanities, literature, and
science. During a holiday session,
children go to their cultural institution
4 to 6 days consecutively. During a
semester, they attend once each
week after school.
There is a culminating event at the
end of each semester or session as
well as open houses and workshops
for parents. In fact, parental involve­ment
is important-one of the pro­gram's
goals is to help reintegrate
families into the positive aspects of
New York City life and to work toward
family preservation and shared
activities.
The group of children from Harriet
Tubman Family Living Center are
taking part in a 1 0-week language arts
program at the New York Shake­speare
Festival at the Public Theatre.
When the bus arrives, the children
are greeted by their hosts, who will
also be their teachers this afternoon.
For the next 2 hours, as they have for
several weeks, the children will read,
write, act, imitate, and create under
the tutelage of festival staff. They will
have fun, too.
Food and Nutrition
Time out for a
nourishing meal
As the children enter the building,
their hosts remind them they must be
quiet. They are excited, but coopera­tive.
A short elevator ride up and they
come to a room with two long tables
set for dinner.
The meal, provided by New York
Public Schools, includes a grilled
cheese sandwich, potato chips, carrot
and celery sticks, an apple, a cookie,
and milk. USDA provides reimburse­ment
for the meals as well as federally
donated food through the Child and
Adult Care Food Program.
"For some kids, this may be the
last meal of the day," says Ronald
Dabney, coordinator of education
programs for the Department of
Cultural Affairs and head of the
project. "In any case, it's an impor­tant
meal. When they get here, the
kids haven't eaten since lunch-that's
a long break. So, nutritious food is
important and a major concern of
ours."
According to Antonio Rodriguez,
coordinator of special events for the
Human Resources Administration's
crisis intervention center, the meals
""'re basic to the project in two ways.
March 1992
First, the children can 't learn if they
are hungry. And, second, the meal
offers an incentive to participate in the
cultural activities. "The food is what
gets them there," he says.
While the children eat, festival staff
ask questions about anything interest­ing
that has happened since last
week. The children, now well­acquainted
with their hosts, respond
eagerly. Some tell funny stories.
Others tell stories that are not funny­scenes
of unhappiness and violence
they have experienced at school or in
their neighborhood.
This is a place
the children like
The children finish their meal, clean
off their trays, and make their way
over to an adjoining room. Soon they
are on stage, surrounded by a quiet
darkness.
Children from the Harriet Tubman Family
Living Center have fun on stage with staff
from the National Shakespeare Fes tival. Below
and opposite page: Children work on a series
of exercises with one of their teachers. Their
afternoon here began with a meal provided by
New York Public Schools through USDA's
Child and Adult Care Food Program (right).
"Our program provides
the children with a
sense of belonging.
They learn various dis­ciplines
through what
they are doing and
develop a stronger
sense of who they are
and what they can
accomplish."
Some people would feel uneasy
here, but the children do not. They've
been here before and enjoyed them­selves.
As they sit in a semi-circle,
three of their teachers move to one
side, sit down, and pick up musical
instruments.
One strums a zither-like string
instrument. Another gently pats bon­go
drums. The third swings a long
hollow tube producing a lilting
"wooo." The sounds, played quietly,
will be in the background for the entire
class.
Arthur Wilson, director of the
Shakespeare Festival's Playwriting in
the Schools Program, moves to
center stage. A tall man in a flowing
caftan, Wilson does not have to ask
the children to be quiet as he wel­comes
them back and starts talking
about their writing assignment from
the week before. The children had
been asked to describe their vision of
a magic kingdom.
Their stories have been typed and
collected, and a complete set is given
to each child. One by one, the
children come forward to read.
Many magic kingdoms are
described. Some are furnished and
populated as only a child could
imagine: Rap stars, flying horses,
Nintendo, fancy cars, candy, ice
cream, and pet animals. Most,
though, carry an ominous undertone.
"In my magic kingdom," says one
child, "there is love and no wars or
killings." Another says there is "no
violence ... and no drugs ... " One boy
imagines "everybody ... in a home and
not in the street."
A little girl has a similar wish: for
"poor people to have a house, and
some money." And there would be
stability, too, in her kingdom: " ... poor
people could stay how long they
want," she reads.
Each reader is applauded and
praised. Many, in the spirit of the
place, act out their reading, raising
their voices, gesturing, and ending
with a flourish. When all the children
have read, the group splits up to start
an imitation exercise.
Tapping resources
and building skills
According to Ronald Dabney, these
kinds of activities do more than simply
expose the children to the arts. They
give them valuable training.
"We're tapping resources often
considered frivolous and non-essen­tial
to our academic and social
development," he says. "Our efforts
encourage creativity and indepen­dence.
We rely on the kids to take a
great deal of responsibilitiy in what
they do and how they do it. They, in
turn, become committed to their work.
30
"They are fearful in the beginning,"
he qdds. "But by the time they leave,
they've developed a sense of owner­ship
so that, no matter how transient,
no matter where they are in the city,
they can return to that space and say,
"I've been here before, I know these
people, I know this work, I know this
building.'
"Ten weeks is not really long
enough, but a great deal happens in
that time. The kids become very
close to the teachers. They learn to
trust them. This bond is established
right away."
While a major goal is to instill an
appreciation for the arts, that's not the
only purpose. "The project is set up
to encourage and enhance the
children's reading and literacy skills,"
Rhonda Mclean-Nur explains, "and to
develop excitement about self­expression
and creativity.
"We also want to let the children
know their options are open. It's
important for them to know that being
homeless is a temporary situation and
there are opportunities beyond what
they can see or feel immediately."
The arts training also helps build
self-confidence and gives the children
an outlet to deal with the stress they
experience in their daily lives.
"Becoming homeless gives children
a sense of instability," Mclean-Nur
says. "Their self-esteem is lowered.
They have to deal with children at
school who know they are in a shelter
or a welfare hotel. Their attitudes
begin to change about themselves,
their families, and other people.
"Our program provides the children
with a sense of belonging. They learn
various disciplines through what they
are doing and develop a stronger
sense of who they are and what they
can accomplish.
"And if they have any behavioral or
learning problems, we try to direct
their energy through the arts so they
can deal with their situation a little
better. We try to give them coping
mechanisms."
On-stage stories
from their lives
Mclean-Nur feels that offering the
children opportunities to express
themselves about issues that are
important to them is the secret to
motivating them. "At Ollantay Center
for the Arts in Queens," she says, "the
Food and Nutrition
kids were doing playwriting and
theatre. At first, a lot of them were
wonderful actors, but in terms of
creating the written materials it was
touch and go.
"As soon as the hosts had them do
scenes relating to being homeless,
their behavior changed. Everyone
wanted to work."
In one scene, they acted out a
scene from school. "They had a
classroom set up and two little boys
walked in," Mclean-Nur explains.
"The child playing the teacher said,
'You're late again. Sit in the back of
the room.'
"A fight started when one of the
other children said something about
their being homeless. The teacher
blamed the children who lived in the
shelter and sent them to the principal,
who went into a tirade."
Once the children were able to
work on these scenes, they wanted to
write. "And the ones who couldn't
write got enough individual attention
to help them learn to write. They
began to say things that were just
phenomenal," Mclean-Nur says.
The children in that particular group
were from two different welfare hotels.
As a result, there was some tension
and competition among them, but that
changed. "That happens in other
groups, too," Mclean-Nur says.
"Once they 'grab on,' they have
respect and appreciation not only for
everyone else, but for themselves
as well."
Success is not
measured in stars
Finishing up this week's session
with the Shakespeare festival staff,
the children from the Harriet Tubman
Center are given a writing assignment.
Having been physically active for the
past 2 hours, they take to the assign­ment
quietly but intensely. When the
papers are collected, the teachers and
children say goodbye.
The children exit the building into
Greenwich Village. The evening is
dark but the streets are colorfully lit
and teeming with activity. As the
children board the waiting bus, they
say goodbye to Rhonda Mclean-Nur.
"We don't profess to be training
future professional artists, but there
are some who will be," Ronald Dab-
March 1992
"It's important for
them to know that
being homeless is a
temporary situation
and that there are
options beyond what
they can see or feel
immediately."
ney says. "They have the talent and if
given the support and assistance, I
believe they will excel."
That support and assistance have
been forthcoming. Several participat­ing
cultural institutions have offered
scholarships for those children who
demonstrate exceptional talent or
aptitude.
For example, two children received
scholarships to continue dance
Children look over their writing assignments
before reading them aloud. Each had been ask­ed
to describe his or her "magic kingdom."
classes at the New York Theatre of
Ballet. They performed with a profes­sional
company in "The Nutcracker"
after only 6 weeks of classes.
But no one is suggesting that the
project's success depends on pro­ducing
future stars. It is alreading
succeeding in integrating reading,
writing, math, and science into a
variety of interesting educational
experiences.
And it's giving children who are
victims of circumstances beyond their
control the opportunity to express
their concerns, frustrations, and
feelings in a forum of supportive and
empathetic adults and peers.
It's more than art for art's sake.
It's art for children 's sake. +
For more information, contact:
Ronald Dabney
Coordinator of Education Programs
Department of Cultural Affairs
2 Columbus Circle
New York, New York 10013-12237
Telephone: (212) 841-4117
article and photos by
Martin Boner
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