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Developmental Monitoring and Referral for Low-Income Children Served by WIC: Program Development and Implementation Outcomes

Maternal and Child Health Journal volume 26, pages 230–241 (2022)Cite this article

Abstract

Objective

To develop, implement, and assess implementation outcomes for a developmental monitoring and referral program for children in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Methods

Based on Centers for Disease Control and Prevention’s Learn the Signs. Act Early. campaign, the program was developed and replicated in two phases at 20 demographically diverse WIC clinics in eastern Missouri. Parents were asked to complete developmental milestone checklists for their children, ages 2 months to 4 years, during WIC eligibility recertification visits; WIC staff referred children with potential concerns to their healthcare providers for developmental screening. WIC staff surveys and focus groups were used to assess initial implementation outcomes.

Results

In both phases, all surveyed staff (n = 46) agreed the program was easy to use. Most (≥ 80%) agreed that checklists fit easily into clinic workflow and required ≤ 5 min to complete. Staff (≥ 55%) indicated using checklists with ≥ 75% of their clients. 92% or more reported referring one or more children with potential developmental concerns. According to 80% of staff, parents indicated checklists helped them learn about development and planned to share them with healthcare providers. During the second phase, 18 of 20 staff surveyed indicated the program helped them learn when to refer children and how to support parents, and 19 felt the program promoted healthy development. Focus groups supported survey findings, and all clinics planned to sustain the program.

Conclusions

Initial implementation outcomes supported this approach to developmental monitoring and referral in WIC. The program has potential to help low-income parents identify possible concerns and access support.

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Fig. 1

Data Availability

Data and links to materials are available upon request.

Code Availability

Not applicable.

Notes

  1. Implementation manual available upon request from the first author. An updated online implementation manual is available at https://www.cdc.gov/ncbddd/actearly/wic-providers.html.

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Acknowledgements

Special thanks to Katie Dunne for contributions to initial program design and implementation, and to Missouri WIC leadership and Eastern District staff for their program contributions and dedication to children’s healthy development.

Funding

This study was supported by Health Resources and Services Administration (HRSA) Grant H6MMC1059-03-01 with supplement from the Centers for Disease Control and Prevention (CDC), 2010–2012; Disability Research and Dissemination Center (DRDC) through Cooperative Agreement Number 5U01DD001007 from CDC, 2014–2016. Contents of the publication are solely the responsibility of the authors and do not necessarily represent the official views of HRSA, DRDC or CDC.

Author information

Author notes

  1. Janet E. Farmer

    Present address: School of Health Professions, University of Missouri, 4323 E. Ravens Ridge Drive, Columbia, MO, 65211, USA

  2. Lee Walker Falk & Mary J. Clark

    Present address: School of Health Professions, University of Missouri, 401 Lewis Hall, Columbia, MO, 65211, USA

  3. Wayne A. Mayfield

    Present address: Institute for Public Policy, University of Missouri, 137 Middlebush, Columbia, MO, USA

Authors and Affiliations

  1. Department of Health Psychology, University of Missouri, Columbia, MO, 65211, USA

    Janet E. Farmer & Mary J. Clark

  2. Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, 65211, USA

    Lee Walker Falk

  3. Office of Social and Economic Data Analysis, University of Missouri, Columbia, MO, 65211, USA

    Wayne A. Mayfield

  4. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy, Mail Stop S106-4, Atlanta, GA, 30341, USA

    Katie K. Green

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Contributions

JF provided conceptualization and oversight for program development/evaluation, and wrote the manuscript with input from all authors. LF, MC, and KG contributed to program design. LF coordinated on-site program implementation and evaluation. MC and WM contributed to data collection and data analysis.

Corresponding author

Correspondence to Janet E. Farmer.

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Conflict of interest

The authors have no conflicts of interest.

Ethical Approval

All aspects of program evaluation in this project were reviewed and approved by the University of Missouri Health Sciences Institutional Review Board.

Informed Consent

Informed consent was waived since all assessments were voluntary and anonymous.

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Not applicable.

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Farmer, J.E., Falk, L.W., Clark, M.J. et al. Developmental Monitoring and Referral for Low-Income Children Served by WIC: Program Development and Implementation Outcomes. Matern Child Health J 26, 230–241 (2022). https://doi.org/10.1007/s10995-021-03319-9

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  • DOI: https://doi.org/10.1007/s10995-021-03319-9

Keywords

  • Developmental monitoring
  • Early identification
  • Developmental delay or disability
  • WIC
  • Health disparities