Women Infants and Children program overview and implementation

WIC Program Evaluation

Evaluation Plan for the Women, Infants and Children Program (WIC)

The Women, Infants, and Children (WIC) program is a federally funded initiative to assure that women who are pregnant or nursing have adequate nutritious food to remain healthy (USDA, 2008a). The program also helps to supply food to children under 5 who are considered to be at risk for poor nutrition during their early developmental years (USDA, 2008a). The program was established in 1974. Individual states administer the program and make certain that the women who need assistance and their children have access to the program. The program has changed little since its inception. The following will outline a plan to evaluate the WIC program to ascertain whether it still fulfills its mission, or whether it is in need of changes in order to continue to serve its clientele.

Introduction

WIC was established in 1972 as part of an initiative to help improve the nutrition of low income women and children (USDA, 2008a). The program was formerly known as the Special Supplemental Food Program for Women, Infants, and Children. The name was changed in 1994 under the Healthy Meals for Healthy Americans Act (USDA, 2008a). Only the name changes and the program was essentially the same as it was in the past.

Under this program, the state provides vouchers for participants to use at authorized food stores (USDA, 2008a). Vouchers can only use them for foods that are considered nutritionally sound for the mother and child. The program plays an essential part in helping to lower Medicaid costs for women and children in the program. Since its beginning, the program has helped to lower Medicaid costs, and has been linked to longer gestation periods, higher birth weights, and lower infant mortality (USDA, 2008b). These outcomes help save costs associated with medical treatments in pregnant women and their children. The program is a necessity in helping to improve the lives of women and children from low income sectors of the population.

The program objectives center on reducing Medicaid costs for pregnant women and their children by focusing on the root of the problem. By providing women and children access to healthy food and nutritional information, WIC improves health outcomes for the population that it serves. The objectives of the program focus on reduction of costs, but attack the problem at the root.

The theoretical basis for the program stems from the importance of good nutrition in maintaining a healthy state. Good nutrition is the foundation of good health. Low income families may not have the resources to obtain plenty of nutritious food. This is where WIC steps in. WIC is based on the theory that providing women and children with access to nutritionally sound food will improve their health and reduce health costs.

Funding for state WIC programs is provided through Federal grants. Funding levels differ from year to year, according to need. An examination of funding from the FY 2008 demonstrates that the program funded $6,369,672,455 in grants to all of the states and territories combined (USDA, 2008c). For the past five years, program participation has hovered at around 8,000,000 participants (USDA, 2008c).

Stakeholders and Expected Outcomes

The WIC program has primary and secondary stakeholders. Participants in the program itself could be considered primary stakeholders, as they are the ones that receive the direct benefits of the program. The state and local level program administrators would also be considered primary stakeholders. Administrators on the state and local level are affected by the success of the program in that they will continue to gain funding only if the program produces positive results.

Federal funding agencies could be considered secondary stakeholders. They have a direct impact on the continued finding of the program, based on need. Their decision regarding funding levels is affected by the proven and perceived success of the program. However, unless the program is a complete failure, they will continue to fund the program on some level. Their funding decisions have an affect on their budget, but they will not suffer loss of services from the program. The Medicaid program could also be considered a secondary stakeholder, but only because they receive the benefits of lowered costs due to the WIC program. The decisions of federal funding agencies have a direct impact on state and local administrators, but it is the impoverished women and children that have the greatest stake in the program.

The primary activities of the WIC program focus on providing low income women and children with access to the nutrition necessary to maintain health. They provide education and training for women and children regarding the most nutritional food choices (USDA, 2008d). They also help to assess and revise nutritional standards for women and children. They work to promote and encourage partnerships on the federal, state, and local level. WIC provides immunization screening and referrals (USDA, 2008d). They provide breastfeeding promotion and support (USDA, 2008d). Perhaps the most recognized service that WIC provides is their food voucher program. This program provides vouchers for low income women and children that can be used to purchase nutritious foods for recipients from approved suppliers (USDA, 2008d).

The intended outcomes of the program are improvements in the health of women and children. The specific intended outcomes of the program are longer pregnancies resulting in fewer premature births (USDA, 2008d). The program is also expected to reduce incidences of low birth weight babies and increase the chances that the woman will receive proper prenatal care (USDA, 2008d). It is also expected to improve infant feeding practices through education. The program is expected to improve immunization rates and provide a regular source of medical care (USDA, 2008d). Another expected outcome of the program is improved cognitive development of the child due to better nutrition (USDA, 2008d). All of these goals are stated expected outcomes according to their website.

Rationale for the Study

Not much has changed in the WIC program since its inception over 30 years ago. They have increased and improved some of their services, but the main objectives and operation of the program have not changed. They continue to serve an increasing number of clients and receive appropriate levels of funding accordingly.

When one searches for past evaluations of the WIC program, it is difficult to find sources more recent than the mid-1980s to the mid-1990s. The last comprehensive program evaluation was conducted in 1988 by the American Society for Clinical Nutrition (Rush, Horvitz, & Seaver et al., 1988). This study estimated changed in birth outcomes that could be directly attributed to WIC from 1972-1980 across several states. It measured dietary intake, weight gain, anthropometry, duration of gestation, birth weight, and infant length and head circumference of women and their babies (Rush, Horvitz, & Seaver et al., 1988). It established causality through comparison of these factors among women and their babies who participated in the program and between groups of cohorts of similar income that did not participate in the program (Rush, Horvitz, & Seaver et al., 1988). This study found that women and children that participated in the program had greater positive outcomes, as compared to their cohorts.

This was the last major comprehensive evaluation of the WIC program. Although, it demonstrates that the WIC program has positive outcomes for the women and children under its care, it is not known whether these findings are still valid. This lack of recent studies is the key reason for undertaking the following research endeavor. It is necessary to determine if the program continues to improve the lives of the women and children under its care. It will also help to recognize any changes that may help the program to serve its clients.

II. Purpose of the Evaluation

The purpose of this evaluation is to provide current information regarding the efficiency and effectiveness of the WIC program. The aims of the evaluation are:

To provide an assessment of the effectiveness of the WIC program in reducing Medicaid costs related to issues with low income women and children

To assess the impact of the program from the perspective of the women and children that it is meant to serve

To assess the current program in its ability to provide needed services to the target population

The evaluation model will be both summative and formative. A majority of the model will focus on the summative portion of the evaluation, providing a more recent analysis of the program than is currently available. The summative portion of the model will be the primary focus of the research. However, research of this nature cannot be undertaken without some form of recommendation being made as a result. Therefore, some formative assessment and recommendations will be presented in the final report. The formative portion will focus on strengths, weaknesses, and deficiencies that need to be addressed for program improvement.

Project Organization

The evaluation team will be a collaboration between university colleagues and administrators on all levels of the program. It will also include members of the medical profession and persons associated with the Medicaid program. Other than the university researchers, many of these participants will be needed to provide statistics regarding various inputs, outputs, and outcomes of the programs.

The evaluation will consist of two distinct data collection and analysis devices. The first will be statistical data that is provided by various service programs and agencies. This data will be aggregated in the program evaluation. The second type of data will be collected from WIC recipients via a questionnaire administered by research staff. These two types of data collection will be analyzed separately and in terms of their impact on each other.

This evaluation will be divided into several phases requiring varying levels of staff, time, and resources. The following summarizes the resources, timeline and budget needed for each stage of the evaluation. Budgeted amounts on the table reflect estimated hours and salary costs for staff, as well as materials needed to complete the phase.

Phase and Task

Staff Needed

Amount Budgeted

Date of Completion

Phase I: Initial Consultation and Planning

Key WIC Personnel

Phase II: Questionnaire Design and Research

Phase III: Gathering of Statistical Impact Information

Various Entities for phone consultation and gathering statistical information from the various agencies

Phase IV: Questionnaire Administration

25 part time field personnel

Phase V: Statistical Analysis of Raw Data

Phase VI: Draft Report writing and presentation

Phase VII: Fact Checking, Editing and Revision of Draft Report

Phase VIII: Final Presentation of Report to State and Local WIC agencies

January 7, 2010

Audience

The audience who will initially receive the final presentation of this report will be state and local WIC offices. In addition to these agencies, the federal funding agencies will receive a copy. These agencies will have full legal ownership of the information contained in the report and will be able to disseminate the information as desired by them. They may use a portion of the report and the information in making funding or other determinations. They may release all of part of the report to the press or the American public. However, this is at their discretion and the evaluation will be written with WIC agents and funding agencies in mind.

III. Methodology

The evaluation will answer questions that can be broken into single data points and that require definitive answers. Much of the final evaluation report will rely on presentation of data as graphs or tables. Therefore, the research will use quantitative research methods as the primary data collection tools. The researcher may expand on the analysis in a narrative form, but the primary research methods will involve statistical data collection and analysis to answer the research questions and achieve program objectives.

Evaluation Questions

The purpose of the evaluation is to determine the appropriateness and effectiveness of the WIC program in improving outcomes for low income women, infants, and children. In order to achieve these goals, the research will focus on answering the following research questions.

Have the desired outcomes of the WIC program changed since its inception?

Does the program still produce the desired outcomes?

What is the impact, in numerical terms, of the program in reducing Medicaid costs?

How has the program affected individual recipients of the program?

What is the outcome of the program for prenatal care in pregnant women?

What is the outcome of the program in terms of reducing low birth weight and other birth defects?

What is the outcome of the program in terms of increasing rates of immunizations?

What is the outcome of the program in terms of reducing medical costs related to poor nutrition in women, infants, and children under the age of 5?

What is the outcome of the program in terms of increased cognitive functioning and school-readiness in small children?

These questions will provide interested stakeholders with an overall understanding of the situation that exists within the WIC program. It will also provide interested parties with specific information into area that need improvement. In order to measure the outcomes of the research and to assess program effectiveness, specific benchmarks and goals will be set. These benchmarks and goals will be set in cooperation with state and local WIC administrators so that they reflect realistic expectations of the agency and the federal government. Setting these specific goals and benchmarks will be part of the planning process for this evaluation.

Data Sources

Data for the project will stem from a host of sources, many of which include primary and secondary stakeholders. In many cases, stakeholders will be a source of information and data. In this study, stakeholders will be directly involved in planning, execution, and will serve as sources of data and statistics. The following table summarizes data sources for various phases of the study.

Data Type

Data Source

Data Collection Instrument

Number of Participants, Demographic information

State and local WIC office

Phone and mail requests for needed information

Impact on Medicaid costs for WIC participants, statistics on number of medical problems in women and children who are participants

Medicaid office

Phone and mail requests for needed information

Impact of WIC on the individual

Surveys administered to WIC recipients

WIC Recipient Questionnaire

Information on immunization rates

State and Local Health Departments, Hospitals, Insurance companies

Phone and mail requests for needed information

Research personnel will collect the data in the manner summarized above. Sampling techniques will vary according to the type and source of data being collected, in some cases, the agencies already track the type of data needed. A questionnaire will be administered to WIC recipients to evaluate their perceptions of the program and the services that they receive. The questionnaire will use Likert scale type questions, asking the client to rate certain types of services that they receive.

This research will involve collection of demographic information. This raises questions concerning privacy and individual rights regarding their personal information. Information will be used in aggregate and will not reflect any identifying personal information. Data collected from agencies will involve aggregate statistics that are routinely kept by these agencies. It will not be possible to identify individuals using this type of data collection method. In the case of the questionnaire, clients will be asked some demographic information, but they will be asked no information that can be used to identify them as individuals. All surveys will be identified by number only. The researcher will be responsible for making certain that there are no duplicates.

IV: Data Analysis

Data will be analyzed using descriptive statistical analyses. Likert type responses from the survey will be analyzed using frequency distribution. Results will be presented using graphs and tables that are appropriate to the data gathered. The five key university personnel will be responsible for analyzing the data and presenting it in a manner that is easy to understand for the reader.

In some cases, agencies may provide researchers with raw data. In this case, the data will have to be analyzed in order to determine the most appropriate method. In other cases, the researcher will be provided aggregate statistics from the various agencies. In these cases, the researcher will have to collect enough information from the agency to determine validity and how to interpret the data as it relates to the present evaluation.

V: Findings and Conclusions

The five key university personnel selected to participate in this research study will be the primary individuals responsible for interpretation of the results. They will work as a committee to make certain that the evaluation meets specified research goals. The study will be presented in draft form to a delegation of key stakeholders for commentary. The final report will reflect the results of that commentary. The main purpose of this process is to make certain that the final recipients of the report find it to be useful. The researchers want to make certain that evaluation answers a majority of the questions that stakeholders might have about the program.