WIC PLANS for Better Health

Executive Summary of theCalifornia WIC Program Strategic Plan to:

Improve Customer Service • Reinvent Nutrition Education • Expand WIC Linkages

2001-2004

California WIC Association in Partnership with Department of Health Services WIC Supplemental Nutrition BranchSeptember 2001

California WIC Association1010 11th Street, Suite 205Sacramento, CA 95814916/448-2280916/448-7826email: ltrue@calwic.orgwww.calwic.org

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California Department of Health ServicesWoman, Infants, and Children (WIC)Supplemental Nutrition Branch3901 Lennane DriveBox 942732Sacramento, CA 94234916/928-8500www.wicworks.dhs.ca.gov

WIC, the Supplemental Nutrition Program for Women, Infants and Children, is a nutrition program that helps pregnant women, new mothers, and young children eat well and stay healthy.

For information about applying for WIC, or to find the nearest local WIC program in your city or zip code,call toll free 1-888-WIC-WORKS (942-9675) or go to the search page at www.wicworks.ca.gov.

WIC Programs in California

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Summary and Introduction 2

California WIC: Diversity and Dedication

Basic Facts & Figures 5

A Hard Look at WIC Frontline Realities

The Strategic Audit 8Customer Service Challenges 8Nutrition Education on the Run 9Getting to WIC “Plus” 10

The Strategic Plan

The Planning Process 12The Logic Models and Common Themes 12Part I: Improving Customer Service 13Part II: Reinventing Nutrition Education 14Part III: Getting to WIC Plus 15What Results Have Been Achieved So Far? 16

Stakeholder Group inside back cover

Outside Experts inside back cover

A C K N O W L E D G E M E N T S

CWA wishes to thank The California Endowment and The California Wellness Foundation for financialsupport, and the Department of Health Services WICSupplemental Nutrition Branch for partnering with us in this effort. Phyllis Bramson-Paul, Linnea Sallack,Michele van Eyken, Karen Tabor, and Claudia Burnettprovided valuable comments. Public Media Center pre-pared the document for publication, with photographsby Jennifer Sauer and map by GreenInfo Network.

Report compiled by Laurie TrueSeptember, 2001

California WIC Association1010 11th Street, Suite 205Sacramento, CA 95814916/448-2280916/448-7826email: ltrue@calwic.orgwww.calwic.org

Table of ContentsA B O U T T H I S D O C U M E N T

Along with a general overview of the California WIC Program, this report contains a summary version of a very detailed four-year Strategic Plan for improving WIC customer service, nutrition education, andenhanced services. The Plan, based on detailed “Logic Models,” was the result of a year-long process theCalifornia WIC community completed during 1999 and 2000. The complete plan and accompanying documents can be found at www.calwic.org.

State and local WIC providers are already working on implementation of the Plan. They have requested asimpler, more accessible version, for use in staff education and training, internal planning, public educationand other activities. We hope this report will serve those purposes well.

Source documents used to prepare this summary:

California WIC Voices: A Hard Look at Realities on the Front Lines, Stefan Harvey, June 2000.

California WIC Strategic Planning 2000: Strategic Plan Report, Samuels & Associates, November 2000.

Data provided by the WIC Supplemental Nutrition Branch

California WIC is a statewide nutrition program providing services at clinic sites throughout California. (See detailed service map, back cover.)

In September 1999,the California StateWIC Branch andCalifornia WIC localagencies (via theCalifornia WIC

Association) formed an innovative partnership todevelop a new Strategic Plan for California WIC.Using blended public and private funding, aStakeholder Group, assisted by consultants, spenta year working on the four-year Strategic Plan.

Previous planning efforts havedealt with management reform,automation and growth, breastfeeding and retail grocerreforms. This community-wideeffort responded to a long-expressed need for focus onbasic WIC issues of front-endcustomer service, revitalizednutrition services, and WIC enhancements to improve public health. California WIC’s commitment to overhauling and renewing coreWIC services stems from the belief that WICparticipants’ lives are changing rapidly and WIC must overhaul serviceapproaches inorder to continueto meet theirneeds.

Both the State WIC Branch and the CaliforniaWIC Association needed to formulate new organizational strategic plans to bring CaliforniaWIC into the new century. The decision toblend public and privatefunds and join two parallelprocesses will result in a more coordinatedapproach to programplanning, training, andtechnical assistance to local WIC programs

that will be mutually beneficialduring the next four years.

A Strategic Field Audit conductedby Stefan Harvey of the Centeron Budget and Policy Prioritiesallowed the Group to take a hardlook at important local serviceissues, particularly customer

service and nutrition education. The StakeholderGroup then worked collaboratively over a year to develop and implement a joint outcome-basedStrategic Plan to (1) improve customer service,(2) revitalize nutrition education, and (3) expandcapacity to provide WIC enhancements withadditional funding (WIC Plus).

Implementation of the three-part plan is nowbeing carried out by State WIC in cooperationwith Local Agencies, and the California WIC Association.

“Everywhere I went I encountered dedicated individuals working tirelessly to give mothers bettertools with which to nurture and raise their children…Every day, I met someone, or experiencedsomething which made me realize that Senator Humphrey’s dream of achieving a better Americafor all women and children was being pursued earnestly by WIC staff at programs across California.”

— Stefan Harvey, California WIC Voices, June 20002 WIC PLANS for Better Health

Summary and Introduction

What is WIC?

WIC, theSupplementalNutrition Programfor Women, Infantsand Children, is afood and nutritioneducation programfor low-incomepregnant, breast-feeding, and postpartum women, infants and childrenunder the age of five who are low income (up to 185%of poverty) and at nutritional risk.

WIC is unique among federally administered food assistance programs in that it provides specific nutritiousfood prescriptions—WIC checks, redeemable at grocerystores—to a target population as an adjunct to ongoinghealth care.

Basic nutrition education, particularly breastfeedingpromotion and support, are core WIC services. WhileWIC does not provide direct health care to participants,a primary goal of the program is to encourage and facilitate access to preventive health and social services.

WIC is “user friendly,” providing nutritious food, social support, and anticipatory guidance to women at a vulnerable time in their lives, without cumbersomepaperwork or harassing verification requirements.

Who are California WIC Participants?

California WIC beganserving participants in1974, with a caseload of80,000. Today, it is secondin size only to Medi-Calin the Department ofHealth Services, and byfar the largest WIC

program in the nation. With a food budget of $700million and a Nutrition Services and Administrationbudget of $185 million, the program serves 1.25 million

participants. According to state estimates, 250,000 participants are eligible for WIC but are not beingserved due to capped funding.

About 23% of WIC participants (320,000) are pregnant,post-partum and breastfeeding women, 23% (314,000)are infants and 54% (733,000) are children ages 1-5.The WIC caseload reflects California’s diversity. Themajority of participants (72%) are Latino, followed byWhite (13%), African American (8%), and Asian (6%).

While 50% of WIC participants state that they areenrolled in Medi-Cal, only about 25% are usingCalWORKs and 17% are on Food Stamps. It appearsthat many more are eligible but not enrolled in Medi-Cal, Healthy Families or Food Stamps.

Most California WIC participants struggle with poverty(1.2 million live at or below 130% of poverty line), andmost WIC families work at one or more low-wage jobs.Many young WIC families are immigrants, migrant orseasonal farmworkers, or from special populations livingin Indian rancherias, refugee enclaves, and inner-cityneighborhoods. Some (44,700) are teen parents; otherWIC participants are in foster care, or are homeless.

Key Health Challenges Facing WIC Families

Some sources estimatethat as many as one-third of the 1.3million low-incomeuninsured childrenin California are inWIC families, yetonly half of WICparticipants report that they are currently enrolled inMedi-Cal. Welfare reform and immigration law changehave taken their toll, and the process of applying forMedi-Cal or Healthy Families continues to confuse,frighten and frustrate many WIC participants.

Almost 28% of WIC participants are overweight orobese. The obesity rate has risen sharply in the past

Basic Facts and Figures

California WIC: Diversity and Dedication

“WIC has enormous responsibilities because it works with young families during the very yearsthat children are in their most vulnerable period of development.”

—Veteran WIC Program Director 5WIC PLANS for Better Health

decade, and rates of obesity-related illness, such as Type II diabetes and heart disease, are also increasingeven among young children.

Despite the steady decline in the anemia rate, 7.2% ofparticipants have iron-deficiency anemia, an unacceptablyhigh rate. Other nutrition-related problems experiencedby WIC participants include low intakes of fruits andvegetables (27% of caseload); low intake of breads andcereals (26%); low Vitamin A intake (25%) and lowprotein intake (18%).

Despite WIC’s emphasis on breastfeeding promotion,community and family support for breastfeeding remainsa challenge, and breastfeeding rates among WIC womenare low. While 84% of WIC moms initiate breastfeeding,only 33% are exclusively breastfeeding by the time theirbabies are two months old.

One in four of California’s two-year-olds are not up-to-date on their vaccinations, and thus are not protectedfrom preventable infectious diseases. Many Californialocal WIC programs are engaged in intensive efforts toinsure that all WIC kids are fully immunized beforekindergarten.

Who are WIC Providers?

In California,the Departmentof HealthServices contracts with81 local agenciesto serve 1.25million partici-pants at 650

local sites, and employs over 200 state staff and 2,500state and local staff.

A local WIC site — whether a permanent clinic, a smallstorefront, or a folding table in a firehouse or churchbasement — is a fixture of nearly every small town, low-income neighborhood, and reservation inCalifornia. (See back cover for map.)

Local WIC agencies in the state are evenly dividedbetween those based in 39 county or city public healthprograms and 42 non-profit providers, some of which

operate programs in more than one county. However,non-profit contractors now serve the majority of WICparticipants.

Local programs range in size from those serving lessthan 1,000 to large urban programs, such as one with a caseload of over 300,000 participants, dwarfing moststate WIC programs. However, about half (38) ofCalifornia WIC agencies are small rural or neighborhoodprograms serving caseloads under 6,000.

Who are WIC Partners?

WIC is big business inCalifornia. WIC con-tracts with over 4,000local grocery stores asredemption sites forWIC checks, with anaverage monthly valueof over $64 million.About half of WICparticipants shop atlarge chains, 27% shopat “WIC Only” specialty stores, whichstock only WIC foods; and 23% patronize independentor neighborhood stores. WIC purchases account for a substantial portion of the total retail sales of dairy and cereal products, infant formula, juices, and otherbasic staples.

Medi-Cal, HMO, and Child Health and DisabilityPrevention (CHDP) medical providers, whether they be based in community health centers or private clinics,help WIC participants get the required blood tests andheights and weights they need to apply for WIC. Theyalso work with WIC staff, who refer high-risk cases tothem for additional follow-up.

Non-profit voluntary associations and advocates, such as the American Academy of Pediatrics, March of Dimes,United Food and Commercial Workers, California WICAssociation, the County Health Executives Associationof California, and California Food Policy Advocates,take a strong interest in policy and funding changes and challenges impacting WIC.

“We are not as customer friendly as we can be…we keep people waiting…we need more staff.”—Small agency WIC Director, north central California6 WIC PLANS for Better Health

On a “good day” a WIC appointment should take 45minutes to an hour. But on “bad days,” staffing shortagesor absences can turn WIC appointments into frustrat-ingly long waits with fussy infants and restless toddlers.The report found that few agencies communicate respectfor a participant’s time by informing them of the estimatedwait on a given day. Moreover, quite a few clinics did notseem to be finding creative ways to fill wait time withadditional support or education, relevant videos, etc.

Access to WIC

With more WIC participants workingthan ever before, the audit stronglyrecommended moreevening and weekendhours to accommodateworking families; at a

minimum, the report recommended that all clinics beopen during lunch.

Larger and better-staffed agencies operate telephonebanks and autodialing systems, which allow participantsto get reminders, information and scheduled appointmentseasily. However, the audit still found phone access problems in California WIC, with persistent difficultiesin reaching staff at some local agencies.

WIC Shopping

How easily a participant can shop for WIC foods is a critical factor in WIC customer service. AcrossCalifornia, the audit found that a spate of changes

to the WIC food package, instituted shortly before thetime of the audit, were causing serious confusion andconflict at grocery check-out counters.

Even withoutchanges, ringingup a WIC foodorder is time-consuming andcomplex. WICparticipantsrepeatedlymentioned how embarrassing the process can be. Thepotential for error is a source of real tension for groceryclerks, who can be fired for repeated WIC mistakes.

The audit emphasized that any effort to improve overallWIC customer service must include major efforts toreform the food package rules and streamline the check-out transaction.

WIC-only stores offer an alternative to grocery stores,offering only WIC foods in locations close to local WICsites. Many participants spoke very positively abouttheir shopping experience at WIC-only stores. However,WIC-only prices are significantly higher than those atcommercial grocery stores, which negatively impacts theprogram’s ability to serve all participants.

The replacement of WIC checks with an ElectronicBenefit Transfer (EBT) card could be a solution to thecustomer service problems created by the WIC grocerystore transaction, and the report urges California tomake WIC EBT a top priority.

Nutrition Education on the Run

WIC’s mandate to provide nutrition education — viapersonal counseling or classes — means that a very large number of extremely diverse individuals must bereached in a limited time with limited space and staff.Despite these obvious constraints, the audit found thatparticipants repeatedly expressed deep appreciation forthe information, support, even the simple personalattention, they get from WIC counselors.

WIC counseling sessions often take place in small cubicles,with numerous young children in tow. WIC classes

on complex andoften-changingtopics rangingfrom WIC foodsto car seat safetyto immuniza-tions, are oftenconducted byparaprofessionals

with limited training in adult education or groupdynamics.

Stefan Harvey, a long-time WIC advocate and trustedfriend of California WIC, conducted a “strategic audit”of the realities, challenges and opportunities facing localWIC programs as they enter the new century. Since1981, Ms. Harvey has been the WIC Project Director at the Center on Budget and Policy Priorities inWashington, DC.

Not to be confused with a comprehensive needs assessment,the audit was intended to be a “fact-finding mission”that could provide an initial reality check and feedbackto local providers, and a set of recommendations to jump-start the planning process.

From November 1999 through mid-February 2000, Ms. Harvey traveled 4,000 miles and visited a representativelist of 42 out of 81 agencies. She also reviewed data anddocuments, conducted surveys, and held a series of keyinformant interviews with WIC stakeholders. Her full

report, WIC VOICES: A Hard Look at Realities on the Front Lines is available from CWA.

Listening to WIC Staff and Participants

At each agency,Ms. Harveyinterviewed staff,held informaldiscussionswith participantsin waitingrooms, and

observed dozens of individual counseling sessions andclasses. She also conducted key informant interviewswith federal and state WIC administrators and childadvocates, county health directors, and other stakeholders.

Customer Service Challenges

Site Appearance

The audit allowed a trusted outsider to closely observefrontline operations,and provide rapidfeedback to stateand local WICproviders. A key

finding was that, while many WIC sites were modern,roomy, and attractive, others were dilapidated, over-crowded, and just plain bleak.

These findings raised awareness among WIC staff, used to working in less-than-ideal conditions, about theimportance of clinic appearance. Newcomers to the program, in particular, will absorb a negative messagefrom a site’s lack of clear and welcoming signage, aplethora of directives prohibiting “this and that,” tired bulletin boards, and uncomfortable chairs.

Waiting Room Experiences

Most WIC participants interviewed during the auditreported satisfaction with WIC and appreciation of theeducation and food benefits (in that order) that WICprovides. Many had stories about the helpfulness ofindividual staff members. However, the audit urgedimprovements on several fronts before the CaliforniaWIC program can claim it is providing excellent customer service.

A few brusque or down-right rude frontline staffwere vividly rememberedby some participants.The audit found thecommon practice ofyelling, or “barking,”the names of participants for counseling or voucherpick-ups impersonal and off-putting. Front-desk staff,whose critical job it is to welcome and orient participantswhen they first arrive, were often distracted by multi-tasking on phones or computers, or just plain absent.

The Strategic Audit

A Hard Look at WIC Frontline Realities

8 WIC PLANS for Better Health 9WIC PLANS for Better Health

Many California WIC staff and managers are nutritionistswho are passionate about the importance of WIC’snutrition education mission. They expressed frustrationwith the “short shrift” nutrition education seems to getfrom federal and state officials. WIC staff are pressuredwith additional rules and procedures and repeated callsto increase or maintain caseload, not to mention non-WIC health and safety messages that various playerswant them to impart to the WIC population at no cost,ranging from voter registration to tooth brushing.

Inadequate staffing levels and lack of culturally competentand diverse nutrition staff hamper the provision of quality WIC nutrition education. Particularly in smalleragencies, the WIC program director must wear manyhats—supervisor, high-risk counselor, budget director,and facility manager—leaving no time for updating

or upgradingnutrition educationmessages andmaterials. This is arecipe for burnoutand poor service.

The audit foundhuge variety, interms of both content and quality of nutrition educationapproaches, topics, and teaching methods in local programs.Aside from minimum federal standards, there are nostatewide standards for quality, and few attempts toestablish ongoing participant feedback or impact evaluation for WIC nutrition education.

Getting to WIC Plus

“California WIC is a perfect match for many different kinds of Prop 10 interventions. With creative collaboration and blended funding, local commissions can work with WIC providers toinclude innovative and effective early childhood and parenting screening, referrals, and directinterventions as part of the existing WIC service delivery infrastructure.”

— CWA Director Laurie True

Given thelarge numberscomingthrough WICclinic doors,local programshave thecapacity to actas a key point

of entry linking families to a variety of health and socialprograms they may need. The WIC Plus concept is simple: provide enhanced or additional health or socialservices to WIC families, using sources of funding otherthan the 100% federal WIC dollars currently available.Popular shorthand accurately describes WIC Plus as“doing more with other people’s money.”

Enhanced services provided by California WIC agenciesare funded by foundations as well as federal, state andlocal government sources, and include health care outreach and enrollment efforts, immunization and leadscreening and referrals, breastfeeding peer counseling,ESL and teen support, gardening, car seat safety, oralhealth and many other activities.

In 2000, CWA commissioned Children’s Partnership to develop strategies for strengthening the WIC andMedi-Cal/Healthy Families connection, particularly forWIC kids (50% of the caseload). Their report, WIC: A Door to Health Care for California’s Children can bedownloaded from www.childrenspartnership.org.

In April 2000, UCLA Center for Healthier Children,Families and Communities published California WICand Proposition 10: Made for Each Other ; a detailedanalysis of the many ways WIC and local Prop 10Commissions can collaborate to provide additional services to WIC families. This report is available atwww.healthychild.ucla.edu.

WIC Plus Not for Everyone

Some WIC programs take a pass on WIC Plus, and prefer to stay focused on providing top quality WIC services and nutrition support to families. The auditpointed out the need to carefully define the differencebetween core services and enhancement services andemphasized that WIC Plus should be optional.

10 WIC PLANS for Better Health

Roll out changes with improved staff training and professional support:

• Train WIC Staff to Support New Programs and Standards

• Support WIC Staff and Address Registered Dietitian (RD) Shortage

Improve feedback loops, mid-course corrections, and accountability:

• Establish On-Going Monitoring and Evaluation System

• Establish timeframes for all products and deliverables.

The Plan-Part IImproving Customer Service

The main focus of the Customer Service Logic Model is to develop and implement a multi-year Campaign toimprove customer service within the local WIC agencies,with state-level guidance and support. The desire is to increase WIC participants’ perceived access to andsatisfaction with WIC services, staff, and facilities.

The stated goals and selected objectives to appropriatelyand successfully implement this campaign are:

1. Assess all levels of WIC policies for CustomerService impact, and advocate for necessary policychanges to improve and streamline services.

• Modify protocol for reviewing all levels of WIC policies and procedures, in order to insure all of them are evaluated for customer service impact.

• Advocate for policy changes identified by an established Customer Service Impact review process.

2. Develop an infrastructure to collect continuousinput from participants on their needs, opinions, perspectives, and changing demographics. This needsto happen on multiple levels. Increase voice amongWIC participants on Customer Service standards,training, policy, and food service delivery systems.

• Conduct annual survey, focus groups, etc, with WIC participants to continually assess their needs and experience with WIC.

• Engage participants in state and local task forces and advisory bodies.

3. Develop and implement a comprehensive, universal CA WIC customer service campaign.

• Develop internal and external customer service mission and vision statements.

• Develop and implement new state-wide customer service standards.

4. Develop and implement a CA WIC staff customerservice training program to support the implementationof the new Customer Service campaign.

• Assess CA WIC staff internal and external customer service needs.

• Assess available training methodologies for customerservice, cultural competency, management, and team building.

• Assess available CA WIC training resources, apportion, and/or apply for more as necessary.

5. Improve the convenience of the food delivery system,as well as the real and perceived value of the food.

• Identify strategies to streamline existing fooddelivery systems, including the implementation of Any Authorized Grocer and Peer Group Pricing.

• Develop a process for designing a food package to provide improved flexibility, cultural acceptance, and perceived value by WIC participants.

• Secure federal approval for regulations to allow for modification of food packages.

• Improve education and training around food delivery.

6. Improve WIC employee effectiveness and efficiency.

• Improve staff development opportunities and develop a career ladder for all WIC employees.

• Increase employee participation in local agency program planning and operations.

• Improve staff-to-participant ratio.

• Modify use of paraprofessionals, non-RD professionals and RDs, to maintain appropriate staff balance to meet participants’ needs.

A joint strategic planning process was begun in early2000 to allow the California WIC community to take ahard look at state and local philosophies and approachesin regards to its core services, and come to consensusabout developing and implementing new and morecohesive directions for the program. Members of theStrategic Planning Stakeholder Group included the fullmembership of the WIC Task Force, the CWA Board(which includes WIC paraprofessionals), State WICBranch Executive Staff and federal representatives, additional local WIC agency staff, and communitypartners including medical providers and county publichealth officers.

Informed by the Strategic Audit, as well as by additionaldata from a number of focus group surveys conductedby media consultants and others, information andinsights from experts in nutrition education, customerservice and other topics, the Group’s goal was to developa strategic plan which lays out what needs to happen at all levels to insure that every local WIC program is providing the best possible customer service and state-of-the-art nutrition education, and that every local WIC program has the opportunity to enhance WIC services with additional funding.

The Planning Stakeholder Group divided into threeworkgroups: Customer Service, Nutrition Education,and WIC Plus. Each of these workgroups then beganthe Logic Modeling process, in order to build groupconsensus around their proposed plans for the next fouryears. The Logic Model process provides a systematicway for members of the workgroup to state their ownwishes for the strategic planning process, so that thegroup as a whole can make decisions and set prioritiesaround proposed goals and program components. Thefinal models represent a realistic and achievable “roadmap” for future activities, including additional needsassessment and planning, as well as activities and deliverable products.

The Logic Models and Common Themes

More about the logic modeling process can be found,along with the complete— and very detailed — logicmodels themselves, along with timelines and cross-cuttingthemes, in the Full Report, available from CWA or theCWA website at www.calwic.org. State and local WICproviders are already working on implementation of thePlan. They have requested a simpler, more accessibleversion, for use in internal planning, staff training,etc. — hence this report. Careful readers and members of the Stakeholder Group will find that many ideas andsections of both the Strategic Audit and Logic modelshave been abbreviated, combined, and re-arranged foreasier comprehension. Please refer to the full set of LogicModels for the complete and detailed action plans.

Each of the three Logic Models repeatedly emphasizedthemes that cut across the three topics, which havehelped frame the implementation of this large plan in the WIC community. Thus, for Customer Service,Reinventing Nutrition Education, and WIC Plus, thePlan contains common steps or themes, which areroughly sequential:

More needs assessment and listening:• Assess Current Practices and Policies• Establish Data Collection Infrastructure for

On-Going Participant Input

Creating or changing WIC standards, policies, and programs:

• Develop and Implement New Programs and Standards

• Identify and Create Policy Change to Support New Programs and Standards

The Strategic Plan

The Planning Process

12 WIC PLANS for Better Health 13WIC PLANS for Better Health

6. Increase the quantity, quality, and diversity of nutrition educators in each WIC site:

• Revise and update standards for staffing nutrition educators to support participant-centered focus.

• Integrate the use of non-RD health professionals to help meet nutrition education staffing needs.

• Promote access to a larger pool of culturally diverse RDs.

• Establish WIC nutrition educators as state and community leaders in the field of nutrition education.

The Plan-Part III:Getting to WIC Plus

The main focus of the Plus Logic Model is to providesupport and build skills for local WIC agencies thatconsider themselves ready to enhance their core WICservices through WIC Plus. This includes implementingmechanisms to secure funding for enhancing servicesthat could effectively address the variety of needs at thelocal level.

The stated goals to appropriately and successfully implement this campaign are:

1. Assess local agencies’ readiness for WIC Plus and provide technical assistance where needed.

• Develop a tool to assess local agency readiness for WIC Plus.

• Survey local agencies on areas of interest and abilities, in order to create an inventory of local WIC and WIC Plus activities and priorities.

• Reassess WIC Plus activities annually to identify local agencies’ updated WIC Plus projects. Provide technical assistance, where needed, to local agenciesundertaking WIC Plus activities.

2. Build skills, capacity, and training opportunities for WIC staff to do WIC Plus activities (RD’s,Nutritionists and paraprofessionals-WNAs ).

• Develop a leadership training institute to include: management skills, public health concepts, community development and leadership development.

• Develop opportunities for WIC staff to increase skills in program planning, assessment, evaluation, and advocacy.

• Provide language training as necessary for WIC Plus activities.

3. Accomplish voluntary WIC Plus activities with outside funding through internal and external collaborations and partnerships.

• Identify existing partnerships and develop new partnerships that promote the WIC mission.

• Establish a network to share successful WIC Plus model programs, and ways to develop successful partnerships.

• Gain the support of DHS and DSS, and have department directors send targeted letters to countiesin support of accomplishing WIC Plus activities.

• Develop WIC Plus model programs: planning grants, and interventions, which are participant-centered and contain evaluation components.

• Develop “What is WIC?” report and presentation for County Health Officers, foundations, Welfare Directors, and others.

4. Secure funding for promotion of healthy practicesthrough participation in community-based programs,such as: women’s health services, family planning, parenting, school readiness, etc.

• Develop and implement a marketing campaign regarding health care and related services.

• Assess current community partnerships.

• Ensure that linkages occur through a WIC “ombudswoman,” who will advocate and follow-up on linkages with WIC families.

5. Secure funding to increase access, participation, andutilization among WIC recipients eligible for existingpublic/private health care, food, housing, employment,and/or other empowerment programs. Screen and referWIC participants to Medi-Cal, Healthy Families, andFood Stamp programs.

The Plan-Part II:Reinventing Nutrition Education

The main focus of the Nutrition Education LogicModel is to “reinvent” and revitalize nutrition educationin the WIC community, and to implement an overhaulof our nutrition education program and program stan-dards statewide. The desire is for WIC participants to be involved in cutting-edge adult learning that isparticipant-centered, and thus relevant to their needs.

The stated goals to appropriately and successfully overhaul California WIC nutrition education are:

1. Assess resources and evidence of what works innutrition education, and build consensus on philosophyand approaches.

• Identify what currently works in support of nutritioneducation, through: a critical review of publications;an investigation of nutrition education models, philosophies and approaches; and an exploration of the input/content from experts in the field.

• Develop a philosophy statement regarding nutritioneducation that can be used for internal and externalmarketing of the CA WIC nutrition education program.

• Build consensus among the CA WIC community regarding responsive participant-centered model/philosophy, and specific approaches for implementation.

2. Create an inventory of current nutrition educationassets and facilitate the use of existing resources whichsupport the participant-centered model.

• Create online the CA WIC Lesson Plan Compendium to reflect the participant-centered model, approaches and standards. Make available online to all local agencies.

• Create a resource list online of nutrition education and training materials for local agency use, which reflects the participant-centered model, approaches and standards.

• Encourage a visiting/mentorship program between local agencies and staff. Continue to offer local agency sharing, Best Classes sessions, and nutrition education content and skills sessions at CWAAnnual Meeting. Offer funding/support for more WIC staff to attend.

• Sponsor regional nutrition consortia that will provide support for existing consortia, help build new ones, and facilitate exchange between consortia.

• Develop and build skills and competencies of all WIC staff, especially paraprofessionals on an on-going basis, and provide necessary support, resources and funding.

3. Establish quality, participant-centered, minimumstandards for Nutrition Education in CA WIC.

• Review federal and state regulations to determine how California WIC can implement nutrition minimum standards.

• Develop participant-centered nutrition education minimum standards for California WIC.

• Revise California WIC policies as needed, to implement standards statewide.

• Adopt and establish an Evaluation Plan and a Quality Assessment Plan (or Continuous Quality Improvement System) for California WIC’s Nutrition Education program.

4. Identify state and local agency needs/costs and allocate resources accordingly to support minimumstandards for participant-centered nutrition education.

• Assist local agencies in conducting program self-assessments in order to move towards participant-centered model.

• Provide ongoing support for local agencies as they create and implement action plans that reflect new model.

• Commission cost analysis for implementing new model standards.

• Develop and implement staffing pattern that support participant-centered model.

5. Develop an infrastructure to collect continuousinput from participants on their needs, opinions, perspectives, and changing demographics. This needsto happen on multiple levels. Increase voice amongWIC participants.

• Conduct annual survey, focus groups, etc, with WIC participants to continually assess their needs and experience with WIC.

• Engage participants in state and local nutrition education task forces and advisory bodies.

14 WIC PLANS for Better Health 15WIC PLANS for Better Health

The Stakeholder Group

Department of Health Services WIC Branch Staff

Phyllis Bramson-Paul, DirectorWIC Supplemental Nutrition Branch

Linnea Sallack, ChiefAutomated Management Section, WIC Branch

Carol Chase, ChiefTraining, Breastfeeding, and Education Services Section, WIC Branch

Michele van Eyken, ChiefNutrition Policy and Operations Section, WIC Branch

California WIC Association Board Representatives

Lynne Frazier, MPH, RD, PresidentPublic Health Foundation Enterprises WIC, Los Angeles

Anne Patterson, MPH, RD, Past PresidentSanta Barbara County Public Health WIC

Heidi Kent, MPH, RD, President-ElectHarbor-UCLA REI WIC, Los Angeles

David Thiessen, TreasurerOrange County Health Care Agency WIC

Beverly Clark, MPH, RD, SecretaryContra Costa County Public Health WIC

Sheilah Altomare, RDTiburcio Vasquez Health Center WIC, Union City

Eloy Navarro, Paraprofessional RepresentativeSacramento County Health Department WIC

Caroline Chantry, MDUC Davis Medi-Cal Center/Academy of Pediatrics

Laurie True, MPHExecutive Director, CWA

California WIC Task Force

Eloise Jenks, M.Ed., RDPublic Health Foundation Enterprises WIC, Los Angeles

Marshia Duncan, MS, RDShasta County Public Health WIC

Lorrie Hinkleman, RD, PhDSan Bernardino County Health Department WIC

Julie Wetmore, RDButte County Department of Public Health WIC, Chico

Elaine Emery, RDStanislaus County Health Services Agency WIC, Modesto

Anne Williams, RDKern County Economic Opportunity Council WIC, Bakersfield

Nancy Flynn, RDUnited Indian Health Services WIC Program, Trinidad

Gayle SchachneNortheast Valley Health Corporation WIC, San Fernando

Debra KeyesWatts Health Foundation WIC, Los Angeles

Steve BaranovHarbor-UCLA WIC, Los Angeles

Delinda HortonWest Oakland Health Council WIC, Oakland

Teri Ellison, MPH, RDSacramento County Health Department WIC

Jim Sousa, RD, MPHHumboldt County Department of Public Health WIC

Claudia Martinez-Concha, MPHCalifornia Food Policy Advocates

Leah Carter, MPH, RDClinica Sierra Vista WIC, Lamont

Art Lizer, MPH, RDRiverside-San Bernardino County Indian Health Services

Betty Touchon, RDMendocino County Health Department WIC

Shama Johnson, MPH, RDUrban Indian Health Board, Oakland

Marta MacKenzie, MPH, RDDirector, Shasta County Health Department

Outside Experts ConsultedDuring Planning Process

Stefan HarveyWIC Project DirectorCenter on Budget and Policy PrioritiesWashington, DC

Sarah Samuels, DrPHPrincipalSamuels & Associates, Oakland

Leslie Mikkelsen, MPH, RDPrevention Institute, Berkeley

Susan Miller, MPHAuthor, “Reinventing Nutrition Education in WIC”Nutrition Consultant

The Strategic Plan

What Results Have Been Achieved So Far?

Newly constituted and reconstituted State WIC Task Forces, along with the CWA Board, have begunimmediate implementation of this comprehensive andambitious plan. Below is only a sampling of first-yearimplementation activities.

Customer Service

California WIC has made a multi-year commitment toplan, implement, and evaluate a statewide CustomerService Campaign. First year activities include the formation of a Customer Service Committee, which hasalready begun meeting, with the charge to (among others)develop an internal and external customer service missionand vision; and to implement new state-wide customerservice standards, accompanied by a comprehensive staff training program and a commitment to buildingan infrastructure to collect continuous input from participants on their needs, opinions, perspectives, and changing realities.

Additional activities in Customer Service are in the goal area of improving WIC employee effectiveness andefficiency. The California WIC Association recentlyreceived funding from the University of California, San Francisco to implement “WIC Workforce Renewal.”This initiative includes four key components including1) Growing Your Own RD, 2) Feasibility Study for aVirtual Internship Plan, 3) Workforce DevelopmentSupport including scholarships, and 4) LeadershipDevelopment. The 2000 Strategic Plan was especiallycritical in underscoring the need for this initiative andtherefore securing the funding.

Nutrition Education

In the first year, a contract was awarded to Samuels & Associates to assess resources and conduct a criticalreview of the published and available literature in orderto identify what currently works in support of WICnutrition education. The report is now available on the CWA website.

The Nutrition Education Committee will then buildconsensus among CA WIC community practitionersregarding responsive participant-centered models/philosophies, and pursue specific approaches for imple-mentation, along with the necessary support, resources,and funding.

WIC Plus

The California WIC Association has been funded tobuild capacity among local agencies desiring to under-take WIC Plus activities to meet WIC participants’needs. Specifically, CWA is working with six largeSouthern California agencies to increase access amongWIC recipients eligible but not participating in Medi-Caland Healthy Families, with multi-year funding fromThe California Endowment. The California WellnessFoundation has funded CWA to use a Small GrantsPool to build capacity among small agencies to provideenhanced services to meet local public health needs.

The WIC Branch has compiled the results of a localagency survey in order to create an inventory of localWIC Plus activities and priorities. The inventory, whichwill be annually updated, includes a wide variety ofWIC Plus activities, ranging from federally fundedimmunization activities; to partnerships with theCalifornia Nutrition Network and Project Lean; tonewly funded Proposition 10 efforts to expand orenhance WIC services to children aged 0-5; to privatelyfunded efforts to increase WIC participants access tohealth or dental care. This inventory will soon be available at www.wicworks.gov.

Listening to WIC Participants

One of the principal themes and implementation activitiesbuilt into the Strategic Plan is the institutionalization of ongoing efforts, at both state and local levels, to gainparticipant input, in the form of focus groups, interviews,surveys, and other forms of feedback. This input willallow California WIC to redesign nutrition educationapproaches to be participant and family-centered. It will also inform the design of an effective customerservice campaign.

16 WIC PLANS for Better Health