Barriers to Retention NYS WIC Infants and Children* Presented by: Mary Lou Woelfel Authors: Mary L. Woelfel, Howard Stratton, Robert Pruzek, Donald

Barriers to Retention NYS WIC Infants and Children*Presented by: Mary Lou WoelfelAuthors: Mary L. Woelfel, Howard Stratton, Robert Pruzek, Donald Hernandez, Gene

Shackman, ShuGuang Chen

* A USDA WIC Special Project Grant. Awarded to the NYS DOH DON by the U.S. Department of Agriculture, Food and Nutrition Service, Office of Analysis and Evaluation, under grant 59-3198-7-525. Study results are sole responsibility of authors and may not reflect the view of the funding agency.

NYS DOH, Division of NutritionEvaluation and Analysis Unit

NYS DOH, Division of NutritionEvaluation and Analysis Unit

Introduction

In U.S. and NYS WIC caseload declining slightly In NY, older the child, lower the retention Many eligible children do not receive WIC services

Barriers to retention, NYS WICBarriers to retention, NYS WIC

Background NY 999: WIC provided services to

469,000 clients on average each month

Approximately 290,000 are infants or

children

NYS provider network: 99 agencies

with oversight of 570 sites


Objectives

Identify barriers to retention among WIC infants and children

Identify barriers specific to check redemption patterns

Present barriers by race/ethnicity


Methods Focus groups with WIC participants, guidance

team, lit. review used to identify potential barriers Identified barriers used to design 20-minute

survey Survey administered one-on-one at WIC sites Outsourced to ensure candid response From perspective of WIC participant 11 volunteer agencies; 41 sites 3167 parents/caretakers of WIC infants/children


Data collection and data analysis Response rate 80%; completion rate; 94% Data collected March through Dec 1999 Informed consent obtained Representative of 11 agencies Chi-square, logistic regression


Measured variables Demographic and economic Public assistance programs Fast food consumption Food insecurity Employed due to welfare reform Benefits of WIC 68 individual level barriers

Dependent variables Cashing or picking up checks


SchedulingScheduling

Agencystaff

Agencystaff

GeneralBureaucracy

GeneralBureaucracy

Food procurement Food procurement

FacilityFacilityGetting

thereGetting

there

Food package Food package

WaitingWaiting

Certifi-cation

Certifi-cation

NutritionEducationNutritionEducation

Figure 1. Barriers by organization categoryFigure 1. Barriers by organization category

Scheduling. Inconvenient times, work problems, rescheduling, no specific appointment time, separate family appointments.

Getting there. Parking, neighborhood safety, transportation

Facility. Overcrowding, noisy, lack of children’s activities.

Waiting - Too long, > 1 hr for checks; > 1 hr to recert.

Bureaucracy. Rules unclear, rigid, changing food package, bringing child, paperwork, replacing checks, blood work, proxy.

Nutrition Education. Long, boring, repetitive, useful

Agency staff. Negative treatment, customer friendly, speaking your language, insensitive to culture, not listening, giving conflicting info.

Food procurement. Store policy diff. than WIC policy, negative treatment by store staff; food availability-finding food, food not in stock, not getting all WIC food. Food package size-matching check to container in store, cereal box size, milk size.

Food package. Variety, quantity (too little, too much of each item)

Specific barrier items by organization category Specific barrier items by organization category

(%)

< 1 year 26

1 year old 22

2 year olds 19

3 year olds 18

4 year olds 15

White non-H 46

Black non-H 34

Hispanic 15

(%)Rent 78

Single 65

Employed 45

< 50% pov 28

< 100% pov 64

HS or less 64

Food insecure 10

Table 1. Demographic/economic characteristics of study participants

Table 1. Demographic/economic characteristics of study participants

(%)Medicaid 57

TANF 30

Food stamps* 40

Head Start* 8

Free/Reduced lunch* 18

WIC and other food programs

WIC only 51

WIC plus 1 35

WIC plus 2 11

WIC plus 3 3

Table 2. Public assistance Table 2. Public assistance

(%)Number in household on WIC

1 on WIC 56

2 on WIC 33

3 on WIC 9

4 or more 2

WIC composition

Infant only 24

Child only 60

Infant & child 16

Missed pickup/cash checks 46

Table 3. Number and participant type on WIC Table 3. Number and participant type on WIC

W B H(%) (%) (%)

Rent 69 85 91

Single 54 79 72

< 50% poverty 22 32 28

< 100% poverty 58 67 72

Employed 45 50 34

HS or less 63 61 71

Medicaid 52 61 63

TANF 19 39 46

Food stamps 31 49 51

Free/Red lunch 17 21 15

Food insecurity 8 8 18

Missed pickup/cash checks 44 50 41

Table 4. Socio-demographics by race/ethnicity. NYS WIC

Table 4. Socio-demographics by race/ethnicity. NYS WIC

Results GO LA STAFF!

In upstate and NYC, across all

organization categories, local

WIC agency staff received the

highest ratings.


The most important benefit of WIC participation from participant’s perspective

In Upstate: Good nutrition and formula

In NYC: Formula and milk


Barrier Percent reporting barrier

Waiting too long 48Waiting area/no child activities 42 Waiting area/overcrowded/noisy 36Waiting more than 1 hr to recertify 27Cereal box size 41Matching check to foods 23Too little WIC formula 38Too little WIC juice 27Nutrition education repetitive 33Nutrition education boring 27Different policies WIC/Vendor 29

Table 5. Barriers to retentionTable 5. Barriers to retention

Table 6. Most frequently cited barriers to retention by Race

Table 6. Most frequently cited barriers to retention by Race

Barrier White Black Hisp. OtherWaiting too long 47% 50% 46% 51%

Waiting area lacking children’s activities 38% 50% 39% 41%

Not getting right cereal box size 43% 41% 35% 41%

Too little formula 36% 40% 43% 40%

Waiting room overcrowded and noisy 31% 40% 41% 35%

Nutrition education repetitive 34% 35% 29% 23%

Stores having different WIC policies 26% 35% 25% 28%

Too little juice 24% 29% 26% 30%

Waiting more than one hour to re-certify 25% 27% 34% 29%

Nutrition education boring 26% 29% 25% 22%

Matching check amount to food container 24% 24% 17% 26%

W(%) B(%) H(%)

Language barrier 0 0 7

Inconsistent w/culture diet 3 6 10Too little milk 13 10 18Too little dry beans 4 10 9

Getting off work 12 19 15 Transportation 7 11 14Safety 4 3 8

Table 7. Barriers by race/ethnicityStatistically significant differences among less cited

barriers

Table 7. Barriers by race/ethnicityStatistically significant differences among less cited

barriers

Schedule

Agencystaff

GeneralBureaucracy

Food procurement

FacilityGetting

there

Food package

Waiting

Certifi-cation

NutritionEducation

Figure 1. Barriers by organization category

Wait too long

Cereal box size Too little food

Boring, repetitive

Overcrowded, noisynothing for kids

to do

Failure to pick-up or cash checks reported by 46% of parent/caretakers

Variables asso. w/failure to pick-up/cash chks Child’s age

As child’s ages, failure to pick-up/cash checks increases

Parent’s age Younger parents more likely to fail to pick up/cash

checks.

Problems getting checks replaced Problems rescheduling Too much milk

Table 8. Barriers and check patternsTable 8. Barriers and check patterns

Barriers to retention - participant’s perspective Long waits, overcrowded, noisy facilities

with nothing for kids to do Nutrition education boring and repetitive Cereal box size; problems matching

voucher to cereal box size (Cost containment effort)

Too little formula Too little juice

HighlightsHighlights

Race/ethnic similarities Whites, Blacks, Hispanics cite same top barriers Race/ethnic differences Inconvenient hrs for employed Blacks

More Blacks work than whites and Hispanics.

Language and food barriers for Hispanics

Failure to pick up/cash checks Children’s food package Young mothers

HighlightsHighlights

Thank you

Documents

Barriers to Retention NYS WIC Infants and Children* Presented by: Mary Lou Woelfel Authors: Mary L. Woelfel, Howard Stratton, Robert Pruzek, Donald