Dec 28, 2015
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
Barriers to retention, NYS WICBarriers to retention, NYS WIC
Objectives
Identify barriers to retention among WIC infants and children
Identify barriers specific to check redemption patterns
Present barriers by race/ethnicity
Barriers to retention, NYS WICBarriers to retention, NYS WIC
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
Barriers to retention, NYS WICBarriers to retention, NYS WIC
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
Barriers to retention, NYS WICBarriers to retention, NYS WIC
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
Barriers to retention, NYS WICBarriers to retention, NYS WIC
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.
Barriers to retention, NYS WICBarriers to retention, NYS WIC
The most important benefit of WIC participation from participant’s perspective
In Upstate: Good nutrition and formula
In NYC: Formula and milk
Barriers to retention, NYS WICBarriers to retention, NYS WIC
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