WIC & Community Health Center Integration Mary Sammer MS, RD VP Nutrition Services North County Health Services

Goal 1: Align WIC, Nutrition and Breastfeeding Messages To increase the knowledge of WIC benefits, services and eligibility requirements among select NCHS support staff Increase knowledge of infant and child nutrition among select NCHS Pediatric staff. Method: Develop 4 Training Modules 1: All About WIC (Call Center, Pt. Resource Specialists, MA’s, Receptionists, etc.) 2: Basic Nutrition (Pediatric, Women’s Health and Adult MA’s and Health Partners) 3: Infant Nutrition (Pediatric, Women’s MA’s and Health Partners) 4: Child Nutrition (Pediatric, Women’s MA’s and Health Partners) Objective: 100% of MA’s & Health Partners will show improvement in posttest scores for modules 2, 3 & 4

Results: Goal 1 Module 1 All About WIC Module 2 Basic Nutrition Staff Count Pre-test Score Post-Test Score Percent Change Module 1 All About WIC >200 N/A Module 2 Basic Nutrition 5 Cohorts 55 43-67 71-91 22-65 % Modules 3&4 Pediatric Nutrition 4 Cohorts 27 52-69 89-97 28-86 %

Goal 2: Improve Child Retention To improve the participation of certified infants and children who identify NCHS as their health care provider in the San Marcos (pilot) clinic through Recruitment, Retention and & Re-engagement activities. Methods: Hire a WIC Coordinator (an existing, highly-skilled WNA) Train to match appts (Peds EHR and WIC MIS) Screen matched patients/ppts for WIC status and encounter need Huddle with HC staff in morning to ID kids Maintain a detailed spreadsheet of RETENTION ENCOUNTER and RETENTION ACTIVITIES: number of encounters, infant enrollments, GA education, Mailed vouchers, etc.

Sample Encounter Spreadsheet Date Parent Child WIC ID Retn Cat Provider Last WIC Next WIC Next Labs Due Notes/barriers Outcomes Out come code 8/2/18 XXXXX XXX 1 Moser 8/1/18 9/5/18 6/3/19 A+ ppt, baby is already E, enc her to cont EBF. 8/3/18 XXXX 2.1 Zachry 7/2/18 10/16/18 3/1/19 Prob w/transport, Seen by clinic LC for latch 4.1 Morris Goes to other WIC Agency 4.2 Russo Never been on WIC, Revd benefits/location

Goal 2: Objectives WIC Coordinator will have at least 10 face-to-face encounters per day with WIC ppts (guardian) during Pediatric visits. WIC participation will increase by 5% above baseline among the infants and children that are also patients of NCHS San Marcos Health Center – the pilot site. Identify opportunities & provide streamlined WIC services

Streamlined Pediatric Activities Provide WIC education and issue benefits Provide retention messages and re-engage back on to WIC Recruit new ppts, screen for eligibility and start enrollment process/appt Start NB enrollment using Maternal Infant Assessment from LC in Peds Utilizing EHR information (Hgb, Ht/Wt) to remove holds, issue benefits Assist with Therapeutic Formula process ELIMINATE ANY BARRIERS TO PARTICPATION New Utilize Nutrition Fast Passes and EHR for processing OB pts

Retention Encounters: Jan 2017-Sept 2018 RETENTION CONTACTS 1 A+ (keeps all appts) 1727 49% 2 A+, and needs to E newborn 443 12% 3 B user (misses some appts) 125 4% 4 B user, and needs to E newborn 43 1% 5 Active past/now gone * 339 10% 6 Goes to another WIC 435 7 Never on WIC * 441 TOTAL ENCOUNTERS 3553 100%

Sample Encounter Spreadsheet with Outcomes Date Parent Child WIC ID Retn Cat Provider Last WIC Next WIC Next Labs Due Notes/barriers Outcomes Out come code 8/2/18 XXXXX XXX 1 Moser 8/1/18 9/5/18 6/3/19 A+ ppt, baby is already E, enc her to cont EBF. Ppt went in on the 1st. 8/3/18 XXXX 2.1 Zachry 7/2/18 10/16/18 3/1/19 Prob w/transport, Seen by clinic LC for latch Inf enrolled WIC same day 2 4.1 Morris Goes to other WIC Agency Gave locations 5 4.2 Russo Never been on WIC, Revd benefits/location   E same day

73% of ALL Encounters = WIC Benefits OUTCOMES 1 A+ continues 1692 48% 2 Went to WIC same day 274 8% 3 Went to WIC later date 537 15% 4 FI’s mailed 55 2% 5 Other WIC agency 370 10% 6 Not interested 187 5% 7 Over income 78 8 No response yet 360 TOTAL ENCOUNTERS 3553 100%

42% of “One-Time/Active in Past Users” Re-engaged OUTCOME 2 Went to WIC same day 37 11% 3 Went to WIC later date 105 31% 6 Not interested 75 22% 7 Over income 18 5% 8 No response yet 104 339 100% RE-ENGAGED

20% of “Never on WIC” = New Recruits OUTCOME 2 Went to WIC same day 23 5% 3 Went to WIC later date 68 15% 6 Not interested 96 22% 7 Over income 57 13% 8 No response yet 197 45% 441 100% New Recruits

Percent of WIC Infants & Children w/NCHS Provider

PEDIATRIC CONTACTS 2018-Present Had contact then mailed Date E GA EA80 SA20 SA SR Mail SD Mail w/o Contact Had contact then mailed SUM Peds Contacts Oct   23 17 1 12 2 55 Nov 19 13 4 14 50 Dec 20 6 10 Jan 5 11 18 52 Feb 27 Mar 41 16 3 29 92 Apr 91

Thank you! Any questions?