Barriers to Retention Children on WIC, NYS, 1999

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NYS DOH, Division of NutritionEvaluation and
Analysis Unit

• Barriers to Retention
• NYS WIC Infants and Children
• Presented by Mary Lou Woelfel
• Authors 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.

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Barriers to retention, NYS WIC

• 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

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Barriers 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

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Barriers 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

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Barriers 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

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Barriers 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

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Barriers 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

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Figure 1. Barriers by organization category
Scheduling
Facility
Getting there
Waiting
GeneralBureaucracy
Agency staff
Certifi-cation
NutritionEducation
Food procurement
Food package
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Specific barrier items 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
  childrens activities.
• Waiting - Too long, gt 1 hr for checks gt 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)

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Table 1. Demographic/economic characteristics of
study participants

• ()
• lt 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
• lt 50 pov 28
• lt 100 pov 64
• HS or less 64
• Food insecure 10

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Table 2. Public assistance

• ()
• 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

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Table 3. Number and participant type on WIC

• ()
• 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

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

• W B H () () ()
• Rent 69 85 91
• Single 54 79 72
• lt 50 poverty 22 32 28
• lt 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

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Barriers to retention, NYS WIC

• Results GO LA STAFF!
• In upstate and NYC, across all
• organization categories, local
• WIC agency staff received the
• highest ratings.

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Barriers to retention, NYS WIC

• The most important benefit of WIC
  participation from participants
  perspective
• In Upstate Good nutrition and formula
• In NYC Formula and milk

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Table 5. Barriers to retention

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

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Table 6. Most frequently cited barriers to
retention by Race

• Barrier White Black Hisp. Other
• Waiting too long 47 50 46 51
• Waiting area lacking childrens 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 2
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• Too little juice 24 29 26 30
• Waiting more than one hour to re-certify 25 27 3
  4 29
• Nutrition education boring 26 29 25 22
• Matching check amount to food container 24 24 17
  26

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

• W() B() H()
• Language barrier 0 0 7
• Inconsistent w/culture diet 3 6 10
• Too little milk 13 10 18
• Too little dry beans 4 10 9
• Getting off work 12 19 15
• Transportation 7 11 14
• Safety 4 3 8

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Figure 1. Barriers by organization category
Wait too long
Overcrowded, noisy nothing for kids to do
Schedule
Facility
Getting there
Waiting
Boring, repetitive
Agency staff
Certifi-cation
NutritionEducation
GeneralBureaucracy
Cereal box size
Too little food
Food procurement
Food package
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Table 8. Barriers and check patterns

• Failure to pick-up or cash checks reported by
• 46 of parent/caretakers
• Variables asso. w/failure to pick-up/cash chks
• Childs age
• As childs ages, failure to pick-up/cash checks
  increases
• Parents age
• Younger parents more likely to fail to pick
  up/cash checks.
• Problems getting checks replaced
• Problems rescheduling
• Too much milk

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Highlights

• Barriers to retention - participants 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

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Highlights

• 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
• Childrens food package
• Young mothers

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Thank you