Abstract
Objective
Referral to social and health services is a core process of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). We evaluate the feasibility and acceptability of a referral innovation implemented at two New York City WIC sites. This program aimed to improve retention by increasing WIC’s perceived value by addressing unmet needs of WIC families. The two main components were needs assessment via conversation and a closed-loop referral process for WIC families with children aged 6–9 months and 18–21 months.
Design
Referral outcomes from Unite Us and program data were tracked and assessed using descriptive univariate analyses. We conducted 29 in-depth interviews with caregivers and six focus groups with WIC and CBO staff. Qualitative data were analyzed using thematic framework analysis.
Results
From February 2020 through January 2021, 1,675 WIC caregivers participated in a conversation about their family’s needs. Four hundred sixty-one caregivers were referred to at least one service. 95 received services or benefits. In interviews, caregivers viewed referrals to other services positively but were not aware WIC could address needs holistically. In focus groups, WIC staff liked the conversation script but highlighted barriers to making referrals. CBO partners valued network participation as it increased their reach to new families.
Conclusions and Implications
Our approach facilitated targeted referrals for WIC participants. It is an acceptable enhancement of the WIC referral process with potential to strengthen WIC as a community provider.
Significance
The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides nutrition education, nutrition supplementation, breastfeeding support, and referrals, and is associated with improved health outcomes for participating families.
AbstractSection What does this Study Add?This manuscript describes the approach of and stakeholder perspectives on a novel approach to referral-making at one WIC agency. This innovation aimed to improve the existing process with closed-loop coordination through an online referral platform. The study adds to the limited research on WIC referral processes in general.
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Data Availability
Not applicable.
Code Availability
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References
Abdelhamid, M., Gaia, J., & Sanders, G. L. (2017). Putting the Focus Back on the patient: How privacy concerns affect Personal Health Information sharing intentions. Journal of Medical Internet Research, 19(9), e6877. https://doi.org/10.2196/jmir.6877
Barry, M. J., & Edgman-Levitan, S. (2012). Shared decision making—the Pinnacle of patient-centered care. New England Journal of Medicine, 366(9), 780–781. https://doi.org/10.1056/NEJMp1109283
Bull, J., & Fichera, D. (2021, February 9). Supporting WIC Enrollment: Using Technology to Improve Certification Experience for WIC Participants and WIC Agencies. WIC Research, Policy and Practice Hub. https://thewichub.org/supporting-wic-enrollment-using-technology-to-improve-certification-experience-for-wic-participants-and-wic-agencies/
Byhoff, E., De Marchis, E. H., Hessler, D., Fichtenberg, C., Adler, N., Cohen, A. J., Doran, K. M., de Cuba, S. E., Fleegler, E. W., Gavin, N., Huebschmann, A. G., Lindau, S. T., Tung, E. L., Raven, M., Jepson, S., Johnson, W., Olson, A. L., Sandel, M., Sheward, R. S., & Gottlieb, L. M. (2019). Part II: A qualitative study of Social Risk Screening acceptability in patients and caregivers. American Journal of Preventive Medicine, 57(6 Suppl 1), S38–S46. https://doi.org/10.1016/j.amepre.2019.07.016
Caulfield, L. E., Bennett, W. L., Gross, S. M., Hurley, K. M., Ogunwole, S. M., Venkataramani, M., Lerman, J. L., Zhang, A., Sharma, R., & Bass, E. B. (2022). Maternal and child outcomes Associated with the Special Supplemental Nutrition Program for women, infants, and children (WIC). Agency for Healthcare Research and Quality (US. https://doi.org/10.23970/AHRQEPCCER253
Davis, R. A., Leavitt, H. B., & Chau, M. (2022). A review of interventions to increase WIC enrollment and participation. Journal of Community Health, 47(6), 990–1000. https://doi.org/10.1007/s10900-022-01131-2
Gale, N. K., Heath, G., Cameron, E., Rashid, S., & Redwood, S. (2013). Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology, 13(1), 117. https://doi.org/10.1186/1471-2288-13-117
High, A., Dvoral, J., & Denny, E. (2011). Final Report to U.S. Department of Agriculture Food and Nutrition Service, 2011 MA WIC Special Project Grant (Massachusetts WIC Enhanced Referral and Family Support Project). Massachusetts Department of Public Health WIC Nutrition Program. https://wicworks.fns.usda.gov/sites/default/files/media/document/MA_report2011.pdf
Kline, N., Thorn, B., Bellows, D., Wroblewska, K., & Wilcox-Cook, E. (2020). WIC Participant and Program Characteristics 2018 U.S. Department of Agriculture, Food and Nutrition Service. https://www.fns.usda.gov/wic/participant-and-program-characteristics-2018-charts
Liu, C. H., & Liu, H. (2016). Concerns and Structural Barriers Associated with WIC participation among WIC-Eligible women. Public Health Nursing, 33(5), 395–402. https://doi.org/10.1111/phn.12259
Magness, A., Williams, K., Gordon, E., Morrissey, N., Papa, F., Garza, A., Okyere, D., Nisar, H., Bajowski, F., & Singer, B. (2021). Appendix F Local Agency Survey Tables (Table 8B) (Third National Survey of WIC Participants (NSWP-III)). Prepared by Capital Consulting Services and 2 M Research Services. Contract No. AG-3198-K-15-0077. U. S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support, Project Officer: Karen Castellanos-Brown. https://www.fns.usda.gov/wic/third-national-survey-wic-participants
Penumalee, L., Lambert, J. O., Gonzalez, M., Gray, M., Partani, E., Wilson, C., Etz, R., & Nelson, B. (2023). Why do they want to know? A Qualitative Assessment of Caregiver Perspectives on Social Drivers of Health Screening in Pediatric Primary Care. Academic Pediatrics, 23(2), 329–335. https://doi.org/10.1016/j.acap.2022.07.002
Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, Measurement challenges, and Research Agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65–76. https://doi.org/10.1007/s10488-010-0319-7
Tiehen, L., & Jacknowitz, A. (2010). WIC Participation Patterns: An Investigation of Delayed Entry & Early Exit (No. (ERR-109); Economic Research Report). USDA Economic Research Service. http://www.ers.usda.gov/publications/pub-details/?pubid=44783
Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042
USDA Food and Nutrition Service. (2022). WIC data tables | National level annual summary FY 1974–2021. WIC data tables. https://www.fns.usda.gov/pd/wic-program. Retrieved January 25.
US Department of Agriculture (USDA) Food and Nutrition Service (2013). Standard 11. Participant Referrals. WIC Nutrition Service Standards. https://wicworks.fns.usda.gov/wic-nutrition-services-standards-self-assessment/standard-11-participant-referrals
Weber, S. J., Dawson, D., Greene, H., & Hull, P. C. (2018). Mobile Phone Apps for Low-Income Participants in a Public Health Nutrition Program for Women, infants, and children (WIC): Review and analysis of features. JMIR MHealth and UHealth, 6(11), e12261. https://doi.org/10.2196/12261
Weber, S. J., Wichelecki, J., Chavez, N., Bess, S., Reese, L., & Odoms-Young, A. (2019). Understanding the factors influencing low-income caregivers’ perceived value of a federal nutrition programme, the Special Supplemental Nutrition Program for women, infants and children (WIC). Public Health Nutrition, 22(6), 1056–1065. https://doi.org/10.1017/S1368980018003336
Williams, V., McManus, B., Brooks-Russell, A., Yost, E., Olds, D., & Tung, G. (2020). Associations between Cross-sector collaboration and family outcomes in evidence-based nurse home visiting. Health Services Research, 55(S1), 31–31. https://doi.org/10.1111/1475-6773.13367
Acknowledgements
This work was supported by a sub-award from the Hopkins/USDA Participant Research Innovation Laboratory for Enhancing WIC Services (HPRIL), a cooperative agreement between the United States Department of Agriculture Food and Nutrition Service and the Johns Hopkins Bloomberg School of Public Health, Cooperative Agreement Number #OPS-WIC-PRIL-JH-2018. The findings and conclusions in this publication are those of the author(s) and should not be construed to represent any official USDA or U.S. Government determination or policy. The authors thank the WIC staff, community partners, and especially WIC caregivers for their time and participation in this project. The authors also acknowledge Laura Caulfield, Susan Gross, and David Paige for their assistance and feedback throughout this work.
Funding
This work was supported by a sub-award from the Hopkins/USDA Participant Research Innovation Laboratory for Enhancing WIC Services (HPRIL), a cooperative agreement between the United States Department of Agriculture Food and Nutrition Service and the Johns Hopkins Bloomberg School of Public Health, Cooperative Agreement Number #OPS-WIC-PRIL-JH-2018.
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LH, SF, MA, MM, and ZH contributed to the design of the study. LH and SF participated in data collection and analysis. CC drafted the manuscript. LH, MA, EE, MM, and ZH provided critical input to the paper. The final draft was approved by all authors.
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Haynes, L.A., Casareno, C., Fatema, S. et al. “What Matters to You?”: A Participant-Centered Approach to Needs Identification and Referral to Community Resources. Matern Child Health J 28, 905–914 (2024). https://doi.org/10.1007/s10995-023-03865-4
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DOI: https://doi.org/10.1007/s10995-023-03865-4