WIC Nutrition Education Needs Assessment Technical Assistance Tool

Transcription

1 Iowa WIC Program WIC Nutrition Education Needs Assessment Technical Assistance Tool January 2012 Iowa Department of Public Health Bureau of Nutrition & Health Promotion

2 Table of Contents Section I. WIC Nutrition Education Needs Assessment...3 Overview... 3 Background... 4 Purposes of the Needs Assessment Process... 5 Components of this Document... 6 Resources... 8 Nutrition Staff Nutrition Services and Materials Nutrition and Health Indicators Guidelines for Interpreting Data Participant Feedback and Perceived Needs Section II. WIC Action Planning...17 Overview Determining Nutrition Education and Health Priorities Developing Action Plans Creating an Action Plan Monitoring and Evaluation Completing a Year-End Report Reporting Section III. Worksheets...29 Overview Nutrition Staff Nutrition Services and Materials Data for Pregnant, Breastfeeding and Postpartum Women Prevalence of Nutrition Risk for Pregnant Women Prevalence of Nutrition Risk for Breastfeeding Women Prevalence of Nutrition Risk for Postpartum Women Observations and Summary Women Data for Infants and Children Prevalence of Nutrition Risk for Infants Prevalence of Nutrition Risk for Children (2 to 5 years) Observations and Summary Infants & Children Participant Feedback and Perceived Needs Determining Nutrition Education Priorities WIC Action Plan Iowa WIC Program Page 2

3 Section I. WIC Nutrition Education Needs Assessment Overview Introduction The WIC Nutrition Education Needs Assessment is a technical assistance document for reviewing data and identifying priorities for nutrition education, breastfeeding promotion and support, and outreach activities for the Iowa WIC Program. In this section This section contains the following topics. Topic See Page Background 4 Purposes of the Needs Assessment Process 5 Components of this Document 6 Resources 8 Nutrition Staff 10 Nutrition Services and Materials 11 Nutrition and Health Indicators 12 Guidelines for Interpreting Data 15 Participant Feedback and Perceived Needs 16 WIC Program planning model Communicate, Cooperate, Coordinate, Collaborate Nutrition Education Needs Assessment Prioritize, Goals & Objectives Year-End Report Action Plans, RFA/RFP Evaluate Implement Monitor & Maintain Iowa WIC Program Page 3

4 Background Purpose The purpose of this document is to assist with the analyses of several data sets describing the health status and nutrition education needs of WIC participants. The series of worksheets included in this document will help you compare and contrast similar pieces of data from several sources and then draw conclusions about that particular health indicator or health behavior. Healthy People 2020 In addition, the worksheets reference relevant goals and action steps from Healthy People These goals and objectives provide important benchmarks for measuring progress towards meeting national and state priorities. Staff involvement All WIC staff is encouraged to be involved with the WIC nutrition education needs assessment. In most instances, a dietitian and/or the WIC coordinator will assume the responsibility for gathering data and completing the tables. Worksheets This technical assistance tool also includes several worksheets for recording information about staffing patterns, the current delivery system for nutrition services and participant feedback. This information, in addition to the health and nutrition data, provides a framework for the WIC planning process. Nutrition education and breastfeeding promotion and support activities must fit with current staffing patterns and service delivery strategies in order to succeed. In some situations, the focus of an activity may require a change in staffing or service delivery. WIC program process For additional guidance in conducting your nutrition education needs assessment, refer to Moving to the Future: Tools for Planning Nutrition and Physical Activity Programs at These materials are only accessible on the website. The documents will lead you through the assessment phase and provide the necessary tools to accomplish each step in the process of developing nutrition services that will improve the health of the participants in your service area. Iowa WIC Program Page 4

5 Purposes of the Needs Assessment Process Monitoring and evaluation A nutrition education needs assessment assists WIC agencies in evaluating: Nutrition-related problems and high-risk groups within the WIC participant population and community; Nutritional status and health behavior trends of the WIC participant population and community; Effectiveness of the nutrition education currently provided; and Resources available to WIC staff and the participant population. Make decisions This needs assessment will help you identify areas that need work in order to improve or increase nutrition services. The worksheets will help WIC staff in the following processes: Analyze the data you have collected; Set priorities; Develop program action plans; Monitor program implementation; Evaluate program action plans; and Provide baseline measurements during evaluation. Iowa WIC Program Page 5

6 Components of this Document Nutrition staff This section summarizes information about WIC agency staffing patterns. Nutrition services and materials The tools collect information about the current system of providing nutrition services, including how nutrition education is provided (group or one-to-one setting), how no shows for nutrition education are followed up, and the need for materials in languages other than English. Health indicators and program participant data This section of the document includes a series of worksheets to guide the nutrition education needs assessment process for each WIC participant category. Each worksheet provides space to record data from existing data sets, including the Pediatric Nutrition Surveillance System (PedNSS), Pregnancy Nutrition Surveillance System (PNSS), Prevalence of Nutrition Risk by Local Report, Prevalence of Nutrition Risk by County Report, WIC data system, Iowa Newborn Metabolic Screening Profiles, Iowa Bureau of Health Statistics: and other program data systems available in the community (e.g., Child Health, Maternal Health, Family Planning, Iowa Vital Statistics, agency data, county health planning data, student projects or research). At the end of each worksheet, the nutrition problems of greatest concern for that participant category are noted. Participant feedback This section summarizes input from participants collected through local agency patient satisfaction surveys or other reporting methods. This information also is used in determining the nutrition education strategies for the following year. Summary of nutrition education priorities This worksheet summarizes the conclusions drawn from the health and nutrition indicators and feedback from WIC participants. The priorities identified will provide direction for developing appropriate action plans that are related to the Iowa WIC program priority areas. This information may also be compared to the priorities addressed in each county s Community Health Needs Assessment and Health Improvement Plan within their service delivery area. Iowa WIC Program Page 6

7 Components of this Document, Continued Action plans This technical assistance tool provides a sample framework for developing an action plan. This may not be the same form used in the WIC application; however, it is a sample template for creating action plans. Guidance for writing action plans is found later in this document. Nutrition education and breastfeeding action plans submitted as part of the grant application must be written by a licensed dietitian. WIC action plans submitted as part of the WIC grant application must be submitted using the form in the application. Year-end report Mid-year and year-end progress reports provide continual feedback on WIC activities to local agency staff, administration, stakeholders, and funders. Reports may also be provided to community partners and added to the community health assessment data set. When reporting on the progress of action plans submitted as part of the WIC application WIC agencies must use the year-end report form provided by the Department. Worksheets Worksheets for nutrition staff, nutrition services and materials, health indicators and program participant data, participant feedback, determining nutrition education priorities and action plan are found in Section III. WIC agencies can tailor these worksheets to include additional agency and/or community data. Iowa WIC Program Page 7

8 Resources Tools for assessment and action plans The following assessment tools can be used to guide the nutrition education assessment process and action plans: Moving to the Future: Tools for Planning Nutrition and Physical Activity Programs Association of and Territorial Public Health Nutrition Directors. Community Tool Box provides online resources for communities or agencies to plan and promote community health and development. Witkin, B. R., & Altschuld, J. W. (1995). Planning and Conducting Needs Assessments. A Practical Guide. Thousand Oaks, CA: Sage Publications. Friedman, M. (2005). Trying Hard Is Not Good Enough: How to Produce Measurable Improvements for Customers and Communities. Trafford Publications, Victoria, BD, Canada. The Results Accountability Implementation Guide; Questions and Answers about How to do the Work. Results Accountability; Fiscal Policy Studies Institute. IDPH resources The following resources can be obtained through the Iowa Department of Public Health web site ( Community Health Needs Assessment and Health Improvement Plans Iowa Barriers to Prenatal Care County Data Iowa Behavioral Risk Factor Surveillance System Survey (BRFSS) 2010 Annual Report on Iowa s Dental Home Initiative for Children 2010 WIC Oral Health Survey Report The Impact of Unaddressed Dental Disease: Emergency Room Utilization FY11 School-Based Sealant Program Report School Dental Screening Audit Report Iowa Health and Vital Statistics Iowa Health Data and Resources (Iowans Fit for Life) EPSDT Dental Services Report Iowa Access to Baby and Child Dentistry Folic Acid Center for Congenital and Inherited Disorders Minority Health Iowa Data Warehouse Iowa WIC Program Page 8

9 Resources, Continued Other data sources The following online resources have information about families with young children: Iowa Quickfacts from the US Census Bureau and county information through the US Census Bureau. of Iowa Library This is another resource for US Census data and trend information through the of Iowa Library. HealthInfo Iowa Health information database that combines local, regional, state and national data. Link to Data concerning Blood Lead Testing: Lead Prevention Program, Iowa Department of Public Health Iowa Health Fact Book - The University of Iowa and the Iowa Department of Public Health presents county health and behavior information. Iowa Kids Count - The Child and Family Policy Center provides county, state, and national trends in the well being of children between 2000 through Regional Capacity Analysis Program (ReCAP) The program helps communities address issues related to regional economic and demographic change. They are focused on applying research and data in support of community development efforts. Iowa Food Security, Insecurity & Hunger Provides profiles on food assistance program usage and food insecurity and hunger statistics. Iowa Early ACCESS Provides information on the Early ACCESS program which provides families with coordinated services to identify, coordinate, and provide needed services and resources that will help families assist their infant or toddler to grow and develop &Itemid=1270 Quick Health Data Online The Office on Women s Health provides state and county level data by gender, race and ethnicity from a variety of sources. Center for Public Health Statistics University of Iowa college of Public Health. Vital Statistics Iowa Department of Public Health. ats_2010.pdf Iowa WIC Program Page 9

10 Nutrition Staff Purpose This section summarizes information about the agency s staffing pattern. Directions List the names of all staff members (employee and contracted) who provide nutrition services. Put a check ( in the columns that describe the specific services each individual provides. If your agency employs more than ten individuals who provide nutrition services, make a copy of this worksheet to list all staff. Inquiry Ask the following questions upon completion of the table. What is the nutrition staff (FTEs) to participant ratio for your agency? Is it.50 FTE per 1000 assigned participants? To calculate the ratio, divide the total number of WIC assigned participants in your agency by the number of nutrition FTEs. This will determine the number of participants per nutrition FTE. Does the agency have adequate nutrition staff to meet assigned caseload? What is the average number of minutes spent providing nutrition education at certification visits and second nutrition education visits? Does the nutrition staff speak other languages? Are there non-wic nutrition services that your agency could offer to the community (e.g., Maternal Health enhanced services, Child Health nutrition assessments, Head Start assessments/menu planning, Medicaid reimbursement, services to school districts, child care providers, etc.). Iowa WIC Program Page 10

11 Nutrition Services and Materials Purpose The nutrition services tables collect information about the current system of providing nutrition services. This information may be helpful to review when writing action steps designed to make changes in the way WIC services are provided. Data system reports Participation Report - Use the participation reports of the past six months to track participation trends within the service delivery area. The participation report tracks all active participants who have received benefits within a specified time period. Enrollment Report - Use your most recent report completed after the last clinic in a month to complete this table. To calculate the percentage, divide the number of participants in a given category by the total number of participants. Enrolled is defined as having an active WIC status. Appointment Summary - Use data from two or three reports from the current fiscal year to complete this table. This will provide better trend data. Prevalence of Nutrition Risk by Local Report Use data from the last fiscal year to complete the agency percent for each indicator. Prevalence of Nutrition Risk by County Report Use data from the last fiscal year to complete the county percent for each indicator. Inquiry After completing the table, consider the following issues: Using participation and enrollment, what is the trend in WIC participation within the service delivery area and are you meeting the need? Describe how second nutrition education contacts are provided to participants who are not at high risk (i.e., one-to-one, group, or both). What is the approximate no show rate for nutrition appointments? Describe how you follow-up on no shows for nutrition education. Estimate the number of non-english speaking families served by your program (i.e., families with such limited English language skills that a translator is needed in order to provide program services). List the languages spoken and how you are serving those with no translator. Determine the average length of time WIC participants spend in clinic. How does this compare with past time studies? Are there clinic flow challenges and hours of service concerns that need to be addressed? Iowa WIC Program Page 11

12 Nutrition and Health Indicators Purpose This section includes worksheets for each WIC participant category. The worksheets will help you analyze all of the data for one group of WIC participants at a time. The worksheets use data from multiple WIC sources; however, additional data sources are encouraged. Directions Complete each worksheet by recording the data requested. Each worksheet has space to record data for up to nine counties. Relevant objectives, goal statements and action steps from Healthy People 2020 are listed on worksheets. This information will help you monitor progress towards meeting those objectives. If your proposed service area is different than the defined service area in a data set, you need to calculate your own agency prevalence rates or percentage rates or leave those columns blank. To calculate these rates, refer to a basic statistics text or someone in your agency with background and skills in statistics or math. Pregnancy Nutrition Surveillance System (PNSS) The Pregnancy Nutrition Surveillance System (PNSS), from the Centers for Disease Control and Prevention (CDC), tabulates and analyzes information on the nutritional status and behavioral risks of pregnant women and their association to birth outcomes or infant mortality and low birth weight. The surveillance system also helps measure infant feeding practices in the early weeks of life. In Iowa, this data represents only pregnant, breastfeeding and postpartum women participating in the WIC program. Some of the data provides information that will help monitor progress toward Healthy People 2020 objectives, goals and action steps. Iowa WIC Program Page 12

13 Nutrition and Health Indicators, Continued Pediatric Nutrition Surveillance System (PedNSS) The Pediatric Nutrition Surveillance System (PedNSS), from the CDC, tracks the prevalence of nutrition-related health conditions in pediatric populations. In Iowa, these data only represents the infants and children participating in the WIC Program. Some of the data also provides information that will help monitor progress toward Healthy People 2020 objectives. Less than 100 records The PNSS and PedNSS data sets do not calculate rates for variables with less than 100 records; they report that information with an *. Both surveillance systems do calculate a three-year average for some indicators that can be used in place of singleyear data. Prevalence of Nutrition Risk by Local and Prevalence of Nutrition Risk By County These reports show the number and percent of WIC certifications in which a given risk is assigned by and County in a fiscal year. All risks are determined in the specified period of time (fiscal year) and will be cumulative. Data from these reports are recorded on the worksheets. Data about specific goals and objectives in Healthy People The other risk factor data are recorded in tables called other WIC Risk Factor Data. Put a ( ) or a (X) in the column if a county s prevalence rate exceeds 5. These data are useful for monitoring the nutrition risks of eligible participants in a chosen fiscal year and also from year to year to determine trends in certain agencies and counties. Iowa WIC Program Page 13

14 Nutrition and Health Indicators, Continued Iowa Newborn Metabolic Screening Profiles (INMSP) The data collection form used for documenting newborn metabolic screening tests includes infant feeding information. This information is reported by hospital and by county. The data provides an estimate of breastfeeding incidence for all infants born at each hospital and in each county. Refer to the Iowa Newborn Metabolic Screening Profile trend data to assist you in analyzing infant feeding practice data over a period of time. To receive county specific information, contact the state WIC office at Other data sources Other data, including agency, community or program data (e.g., MH, CH, FP or Head Start), may provide insight or explanation for WIC trends. In this section, record any information from other sources that will be helpful in evaluating the health and program participation data. Agencies are encouraged to collect participant satisfaction information or may collect other data from participants that would be included as a component of the WIC needs assessment. Observations/ perceived needs Briefly describe observations or anecdotes regarding attitudes, practices or cultural patterns of WIC participants. Determine priorities Following the analyses of the objective and subjective data, identify the nutrition and health priorities for your service area. List the problems of greatest concern. Assessing community needs and resources The last major area of assessment is recording and analyzing the health and nutrition needs and services in your service area. Each county has a Community Health Needs Assessment and Health Improvement Plan on file with the Iowa Department of Public Health. Knowing both the quantity and quality of those services will help agencies design an intervention that will maximize a community s resources and improve the health of the citizens of the community. WIC agencies should regularly communicate WIC data to community-based health planning teams, local boards of health and their partners (CH, MH, FP, Head Start, public health nursing, etc.). Iowa WIC Program Page 14

15 Guidelines for Interpreting Data Review demographic data Review the sociodemographic characteristics of the WIC participant population and compare them to the state WIC population age, race, ethnic group, education level, etc. Some groups have markedly different rates of risk or outcomes than other groups. For example: Does your service area differ significantly from the state profile? How might these differences relate to other risks or behaviors? Has your service area recently experienced an influx of non-english speaking groups? Make comparisons Compare county and agency data to state data. For example: Is the rate higher or lower in your agency? Is the rate higher or lower in some counties? How does your agency data compare with the Healthy People 2020 objectives? Inquiry Consider explanations for unusual or unexpected rates. For example: Are training and quality assurance measures in place? Are there programmatic explanations for the data, such as restricted caseload, special outreach efforts, or other screening or program efforts in the community? Note: A few percentage points difference may not be worth an elaborate explanation. Year-to-year changes may be misleading because a one time phenomenon can result in differences that are not meaningful. As more years of data are accumulated, meaningful trends can be identified. Trend analysis Consider the size of the population when analyzing trends. Iowa WIC Program Page 15

16 Participant Feedback and Perceived Needs Overview This section summarizes input from participants. WIC program participants can provide valuable input in the development of the nutrition education work plan. In addition, participants may be more interested in nutrition services or activities if their opinions have been considered. Participant surveys A systematic survey of WIC participants can also identify their major health and/or nutrition problems. It is important to recognize that participant perceptions may not always reflect the needs indicated by the health and nutrition data; however, they are valuable in identifying program priorities. Iowa WIC Survey The Iowa WIC Survey provides some information about interests and attitudes about nutrition services. The survey is conducted by the state WIC office every three to five years. The WIC Program or local agency may also collect information on client satisfaction surveys. Occasionally, WIC agency staff may also receive unsolicited feedback from participants as well. Directions Gather a variety of local and state reports (Iowa WIC Survey, client satisfaction surveys, feedback from suggestion boxes, perceived needs surveys, etc.) and review the information for common themes. Inquiry After gathering the information, ask the following questions: What findings from these reports pertain to nutrition and health services? What findings or feedback has the agency obtained through other surveys or comment systems? What common themes are prevalent among these sources? Priorities Transfer this information to the Determining Nutrition Education Priorities worksheet. Iowa WIC Program Page 16

17 Section II. WIC Action Planning Overview Introduction This section provides guidance on determining priorities for nutrition education, breastfeeding promotion and support, and outreach activities for the Iowa WIC Program. In this section This section contains the following topics. Topic See Page Determining Nutrition Education and Health Priorities 18 Developing Action Plans 19 Creating an Action Plan 21 Monitoring and Evaluation 24 Completing a Year-End Report 26 Reporting 27 Iowa WIC Program Page 17

18 Determining Nutrition Education and Health Priorities Purpose A nutrition education needs assessment yields lots of data and may point to many health and/or nutrition problems among an agency s WIC population. However, to improve WIC participants health and nutritional status the action plans must be focused. Once nutrition education and health priorities have been determined, strategies and action plans are written to address the nutrition education-related priorities. Directions This form summarizes your assessment of nutrition education needs based on nutrition and health indicators, program participation, and participant feedback. The form is a summary of pertinent data on the nutrition education needs of each WIC participant category; pregnant women, breastfeeding women, postpartum women, infants, and children. Review this information and identify a minimum of two priorities for each WIC participant category that are related to the Iowa WIC program priority areas listed in the current FFY RFA or RFP. Inquiry Answer the following questions: What are the nutrition education priorities for pregnant women, breastfeeding women, postpartum women, infants, and children? What common themes emerge from participant feedback that relates to the nutrition education needs assessment? Given all these nutrition-related problems and nutrition education needs, which priorities will be addressed in an action plan? Are there other data available to support the priority or create a data indicator set? Determine nutrition problems Review all of the data for each WIC participant category and determine which nutrition problems are of greatest concern. List these problems on the Determining Nutrition Education Priorities worksheet. Compare these problems to the Iowa WIC program priority areas listed in the current FFY RFA or RFP. Iowa WIC Program Page 18

19 Developing Action Plans Purpose A proposed action plan requires careful preparation to make sure strategies are met efficiently and cost-effectively. A well-written plan is needed to keep the process focused and organized. The plan serves as a: Road map or blue print to communicate information to WIC staff, community partners and/or funders; Method of systematizing the planning process; Justification for proposed activities and budget; Description of activities to be undertaken; Description of proposed methodologies to be used in the interventions, assessments, and evaluations; and Schedule of completion dates for activities. Note: Nutrition education and breastfeeding action plans submitted as part of the WIC grant application must have a dietitian cited as author. Directions When the nutrition and health priorities have been identified for the coming year, action plans can be written. The components of an action plan may include: purpose area(s) selected, Local WIC agency focus area, Target population, Baseline measure(s), Current and target measures (baselines), Story behind the local WIC agency focus, What works Strategies and activities, Person responsible, personnel involved, Community partners involved, Plan for evaluating and reporting, Counties or clinics involved, Budget or anticipated expenses, and Other resources required. Iowa WIC Program Page 19

20 Developing Action Plans, Continued Suggested activities Activities encouraged by the WIC Office include: Forming a local/community breastfeeding steering committee. Developing a system for early contact with breastfeeding mothers prior to giving birth and 7-10 days after hospital discharge. Focusing on issues identified by a community coalition s needs assessment. Creating an outreach plan to increase WIC caseload. Strengthening the delivery of WIC nutrition education activities. Minimum requirements Each agency is limited to two action plans. Breastfeeding promotion and support and nutrition education action plans must be submitted as part of the WIC application. Agencies are responsible for making appropriate progress on both action plans that are submitted with their WIC application. Each Local WIC Focus Areas must correspond to an Iowa WIC Program Purpose Area listed on the current FFY RFA or RFP. Action plans submitted must utilize the Results Based Accountability guidelines. Iowa WIC Program Page 20

21 Creating an Action Plan Overview An action plan requires careful preparation to make sure focus areas are met as rapidly and cost-effectively as possible. A well-written plan is needed to keep the process focused and organized. Baseline measures and the story behind the baseline Baseline data provide the starting points from which progress can be measured. The story behind the baseline asks, Why are things happening the way they are? Baseline data can indicate the incidence or prevalence of a problem; they may indicate the availability of a resource; or it may measure attitudes about a problem. The baseline is made up of two parts; where the data has been and where it is headed if no actions are taken. Any success with the baseline is then measured by changing the curve of the baseline from where it was headed and into the direction of where you want it to be. Sometimes an agency may conclude that a problem is related to lack of services and the solution is to provide more services. The story behind the baseline challenges each agency to think deeper about causes and to consider both the service and non-service solutions that can affect any of the baseline measures being evaluated. What works Asking What works to improve the baseline or to make things better? is the first step in creating action plans. Each baseline measure and story will often point to a specific known action and community partners who should be involved in the action plans. Another component of identifying what works is to include low cost and/or no cost options because some of the best options may not require a lot of money. Focus area strategies Describe and list all major activities needed to achieve the identified focus area. The description may include proposed methodologies to be used in the interventions, assessments, and evaluations. A detailed description will allow anyone reading the plan to fully understand what is proposed. Each step should include a completion date for the task described in the statement. Other pertinent information such as staff responsible may also be included. Iowa WIC Program Page 21

22 Creating an Action Plan, Continued Timeline Include a timeline that identifies deadlines and estimated time to complete each activity, including evaluation and reporting. The timeline enables the intervention to remain focused and on track. Person responsible The WIC Coordinator, dietitian or a nurse should be identified as the person responsible for nutrition education and breastfeeding action plans. Any WIC staff can be charged with leading activities involving outreach, customer service, or team building activities. Personnel involved Identify all personnel involved with accomplishing the action plan. If your action plan includes collaborating with another agency or program, discuss your ideas with the appropriate agency staff to determine interest in a joint project, and clarify project roles and responsibilities. Community partners List the individuals or agencies that may assist you in achieving the action plan by completing action steps. A letter or statement of support from collaborating agencies and programs may improve the success of the action plan. Counties or clinics involved List the counties or clinics involved in each action plan. Financial or other resources required List all resources required to achieve the action plan. What new resources are necessary for the action plan? Do you need more staff, new equipment, or new print materials? Iowa WIC Program Page 22

23 Creating an Action Plan, Continued Evaluating the action plan The action plan should meet several criteria. Is the action plan: Complete? Does it list all the action steps or changes to be made by all relevant parts of the agency and/or community? Clear? Is it apparent who will do what by when? Current? Does the action plan reflect the current work? Does it anticipate newly emerging opportunities and barriers? To evaluate written action plans, apply the SMART+C formula: Element Inquiry Specific Is the action plan specific? What is to be achieved? Who/what is expected to change, by how much and by when? Measurable Can data be collected, detected, or easily obtained? What is the baseline indicator? What is the target? Achievable Can the action plan really be met? Is the action plan realistic? Relevant Is the action plan relevant to the Iowa WIC Program Purpose Areas? Does it show what will be accomplished and why? Timed/timely Does the action plan include a timeline by which it will be achieved? Challenging Does the action plan stretch WIC staff aims to significant improvement of importance to the agency, community and the Iowa WIC Program? Iowa WIC Program Page 23

24 Monitoring and Evaluation Rationale The purposes of monitoring and evaluation are to determine: Whether to change, eliminate, continue or expand a program or service; Effectiveness or cost benefit; Progress towards meeting action plans; Whether current and future programs are justified; and Accountability. Integrating monitoring and evaluation steps into the implementation plan is critical to ensuring that data collection systems are in place. Evaluation should take place during the intervention (monitoring), as well as at the end, so that problems can be identified in time to make mid-course corrections. Monitoring and evaluation strategies Depending on the type of actions, a variety of monitoring and evaluation strategies can be used. For many action plans, the first step is to identify baseline data. Monitoring and evaluation strategies may include: Data from chart reviews; Data from existing reports or data systems (e.g., PEDNSS, PNSS, WIC Data System, etc.); Questionnaires for participants targeted in the strategies (e.g., Infant Feeding Practices Questionnaire, internal agency survey); Manual data collection forms designed for use at specific points in the intervention (pre-test/post-test); and Cost effectiveness information (to indicate whether a program achieves the desired outcomes at a lower cost than another approach). Cost benefit analysis tells whether the dollars invested into the program produces a positive dollar return. Note: nutrition consultants may also be able to provide suggestions about streamlining the data collection process, incorporating the process into clinic procedures, and ensuring that data collected are not available from another source. Iowa WIC Program Page 24

25 Monitoring and Evaluation, Continued Inquiry To monitor and evaluate program progress, ask the following questions: How much did we do? How well did we do? Who is better off because of what we did? What data will be collected? When will data be collected? Who will be responsible for collecting the data? How will data be collected and documented? How do the results compare to the baseline data? Was there an increase/decrease in number or percentage from that stated in the baseline data? How will new or revised service systems be evaluated for effectiveness, efficiency, or other characteristics? What barriers were encountered? How will any barriers be resolved? How will the results be reported? To whom? Reduce barriers Frequently, barriers impede the completion of monitoring and evaluation steps. To reduce barriers: Work with individuals who are conducting the evaluation; Anticipate the nature of evidence needed; Develop a clear needs statement that tells what the intervention intends to solve; Write a measurable and time-specific action plan; List monitoring and evaluation as a component of the implementation plan and timeline; Include monitoring and evaluation expenses in the program budget; and Involve colleagues in the monitoring and evaluation process and keep them apprised of progress and results. Periodic evaluation Regardless of the evaluation techniques used, evaluation and monitoring should be done at regular intervals depending on the activity and data availability. At a minimum, a six-month evaluation should be conducted to determine if action plans need changes. Iowa WIC Program Page 25

26 Completing a Year-End Report Overview A year-end report documents progress that has been made toward achieving an action plan. Further guidance on completing year-end reports for action plans submitted as part of the WIC application can be found in WIC Policy and the most recent RFP or RFA. Purpose The purpose of the year-end report is to provide feedback for local agency staff and administration, Boards of Directors, Boards of Health, and to the Iowa Department of Public Health. Progress reports provide continuing feedback on WIC activities and assist in the establishment of future priorities. The report will also be valuable when the assessment process is repeated. Report components A year-end report may include the following: Names and titles of authors, Copies of community action plans as originally submitted, Narrative discussion of each action plan including relevant data to indicate progress made, and Any other pertinent stories or positive results. Suggested discussion questions The following questions may help guide the completion of the progress report: Are you monitoring or evaluating the action plan at the time of the report? What was the baseline measurement from the assessment? What are the current measurements and the source of the measurements? Are you on target (monitoring) or have you achieved the action plan (evaluation)? If yes, what were your successes and what data document your progress? How does this success help achieve the action plan? If no, were the action steps (intervention) inappropriate or incomplete? How can the intervention be changed to achieve the action plan? Is the action plan inappropriate, unrealistic, or not applicable? Were there any unexpected problems or barriers to achieving the action plan? Were any modifications made to the action plan? What were they? What is the next step toward achieving the goal? Iowa WIC Program Page 26

27 Reporting Communicating data The primary purpose of evaluation is to use the results to guide the WIC agency in improving your nutrition education, breastfeeding support, and outreach efforts. WIC agencies are encouraged to share WIC findings with various audiences to garner their support or raise their awareness. Sharing WIC data with the communities in which WIC services are provided may expose certain nutrition and health issues among the WIC population and encourage the community to take action. Informing the community Some of the reasons for sharing WIC information with the community are to: Inform community leaders and citizens of the needs of low-income families; Raise awareness about nutrition and health issues; Attract volunteers, funding, and in-kind resources from concerned citizens and agencies; Promote registration of the efforts of volunteers or collaborators; Lobby for local ordinances or program changes to address issues of concern; and Provide accountability to the community, trustees, and funders. Key audiences The following key audiences should be considered when sharing WIC data: WIC staff staff Board of Directors Community Area Education Agencies Child Health, Maternal Health and Family Planning Programs Churches Civic and business organizations Community Action Agencies Community Health Planning Groups County Public Health Nursing Agencies Empowerment Areas Government officials Hospitals and other health organizations Local Boards of Health Local press (editors, editorial boards, health reporters) Public/private school districts Iowa WIC Program Page 27

28 Reporting, Continued Types of reports There are many types of reports suitable to different types of audiences. Results should be shared with the WIC participants that you serve. WIC data can be communicated through a: Technical report; Executive summary; News release; Media appearance; Staff meeting, workshop or retreat; PowerPoint presentation; Brochure, poster, or newsletter; or Memo. Reference: Communicating Information about the Initiative to Gain Support from Key Audiences, Chapter 32, Section 3. Community Tool Box, Iowa WIC Program Page 28

29 Section III. Worksheets Overview Current data The data used in this section is the most current data available and was derived from the following reports: Data Source Report Period Number of Records PNSS (January 1-December 30) CY ,813 PedNSS (January1-December 30) CY ,424 Prevalence of Nutrition Risk Iowa Newborn Metabolic CY ,999 Screening Profile Iowa Vital Statistics Live Births ,514 In this section This section contains the following worksheets: Topic See Page Nutrition Staff 30 Nutrition Services and Materials 31 Data for Pregnant, Breastfeeding and Postpartum Women 33 Data for Infants and Children 57 Participant Feedback and Perceived Needs 69 Determining Nutrition Education Priorities 70 WIC Action Plan 72 Iowa WIC Program Page 29

30 Nutrition Staff Directions List the names of all personnel providing nutrition services (CPAs). Put a check ( in the columns that describe the specific services each individual provides. If your agency employs more than ten individuals who provide nutrition services, make a copy of this form. STAFF NAME ASSIGNED TASKS 1. Job Title Certifications High Risk Nutrition Appointments Other 1:1 Nutrition Appointments Group Nut. Education Breastfeeding Coordinator Other (administration, assessment, evaluation, etc.) Iowa WIC Program Page 30

31 Nutrition Services and Materials Directions Use the most current WIC participation, enrollment, and appointment summary reports to complete the following tables. Participation report Participation Clinic/County Month 1: Month 2: Month 3: Month 4: Month 5: Month 6: Month 12: Iowa WIC Program Page 31

32 Nutrition Services and Materials, Continued Enrollment report Month: Participants Pregnant women Number of Participants: PARTICIPANT TYPES Not breastfeeding women Breastfeeding women Infants Children Special children Number of participants Total number of participants age Appointment summary report kept for months of:: Month 1: Month 2: Month 3: Certification Health updates Nutrition appointments Total: Inquiry Is there a significant increase or decrease in participation and/or enrollment? Describe how second nutrition education contacts are provided to participants who are not at high risk (i.e., oneto-one, group, or both). What is the approximate no show rate for the different kinds of appointments? Describe how you follow-up on no shows for nutrition education. Estimate the number of non-english speaking families (i.e., families with such limited English language skills that a translator is needed in order to provide program services) served by your program and list the languages spoken. Iowa WIC Program Page 32

33 Data for Pregnant, Breastfeeding and Postpartum Women Directions Using 2009 PNSS complete the following worksheets using county and agency data. In this section The following tables are included in this section. Table See Page Ethnicity 34 Woman s Age 34 Education 35 Poverty Level 36 Program Participation 36 Migrant Status 37 Prepregnancy BMI 37 Maternal Weight Gain 38 Anemia 39 Parity 40 Interpregnancy Interval 40 Medical Care 42 WIC Enrollment 42 Smoking 43 Drinking 45 Birthweight/Birthoutcome 46 Infant Feeding 48 Prevalence of Nutrition Risk Pregnant Women 50 Prevalence of Nutrition Risk Breastfeeding Women 52 Prevalence of Nutrition Risk Postpartum Women 54 Observations and Summary - Women 56 Iowa WIC Program Page 33

34 Data for Pregnant, Breastfeeding and Postpartum Women, Continued Ethnicity Indicators PNSS All Women White, not Hispanic 71.4 Black, not Hispanic 8.2 Hispanic 16.3 American Indian/ 0.5 Alaskan Native Asian/Pacific Islander 2.1 Multiple Races 1.5 Unknown 0.1 Woman s age Indicators PNSS All Women < 15 years years years years years years 1.2 Unknown 0.1 Iowa WIC Program Page 34

35 Data for Pregnant, Breastfeeding and Postpartum Women, Continued Woman s age (continued) Indicators Prevalence of Nutrition Risk 331 Pregnancy at young age 6.56 pregnant 331 Pregnancy at young age 4.37 breastfeeding 331 Pregnancy at young agepostpartum 6.76 Education Indicators PNSS All Women < High School 28.3 High School 43.6 > High School 28.1 PNSS data not available for agency or county Iowa WIC Program Page 35

36 Data for Pregnant, Breastfeeding and Postpartum Women, Continued Poverty level Indicators PNSS All Women > Adjunctive eligibility 0.0 Unknown 0.3 PNSS data not available for agency or county Program participation Indicators PNSS All Women WIC 100 SNAP 26.0 Medicaid 68.0 TANF 4.5 Unknown 0.0 PNSS data not available for agency or county Iowa WIC Program Page 36

37 Data for Pregnant, Breastfeeding and Postpartum Women, Continued Migrant status Indicators PNSS All Women Yes 0.0 No 100 Unknown 0.2 Prevalence of Nutrition Risk by Class of Participation 802 Migrant statuspregnant Migrant statusbreastfeeding Migrant statuspostpartum 0.02 PNSS data not available for agency or county Prepregnancy BMI Indicators PNSS All Women Underweight (<19.8) 2.5 Normal weight ( ) Overweight( ) Obese (>29.0) 32.8 PNSS data not available for agency or county 1 PNSS data combines overweight and obese for agency and county Iowa WIC Program Page 37

38 Data for Pregnant, Breastfeeding and Postpartum Women, Continued Maternal weight gain Healthy People 2020 Objectives Maternal, Infant, and Child Health (MICH)-13.0: Increase the proportion of mothers who achieve a recommended weight gain during their pregnancies (developmental). Retained from 2010 Nutrition and Weight Status (NWS)-11.0: Prevent inappropriate weight gain in youth and adults. 11.5: Adults aged 20 years and older. (NHANES-Potential Data Source) Indicators PNSS-All Women Less than ideal 17.7 Ideal 31.4 PNSS data not available for agency or county Greater than ideal 50.7 Prevalence of Nutrition Risk 101 Pregnant 3.48 underweight (BMI 18.5) 111 Pregnant 54.7 overweight (BMI 25.0) 101 Breastfeeding 2.84 underweight (BMI <18.5) 111 Breastfeeding overweight (BMI >25.5) 101 Postpartum 3.27 underweight (BMI ) 111 Postpartum overweight (BMI 25) Iowa WIC Program Page 38

39 Data for Pregnant, Breastfeeding and Postpartum Women, Continued Anemia Healthy People 2020 Objectives NWS-21.0: Reduce iron deficiency among young children and females of childbearing age. NWS-21.3: Females aged 12 to 49 years-target: ( improvement) Baseline: 10.4 of females aged 12 to 49 years old were iron deficient in NWS-22.0: Reduce iron deficiency among pregnant females- (Target: improvement) Baseline: 16.1 of pregnant females were iron deficient in Indicators PNSS-All Women 1 st trimester 4.4 PNSS data not available for agency or county 2 nd trimester rd trimester 28.3 Postpartum 21.2 Prevalence of Nutrition Risk 201 Low HCT/Hgbpregnant Low HCT/Hgbbreastfeeding Low HCT/Hgb - postpartum Iowa WIC Program Page 39

40 Data for Pregnant, Breastfeeding and Postpartum Women, Continued Parity (# births >20 weeks) Indicators PNSS All Women PNSS data not available for agency or county Interpregnancy interval Indicators PNSS All Women < 6 months months 28.7 months 55.3 PNSS data not available for agency or county Iowa WIC Program Page 40

41 Data for Pregnant, Breastfeeding and Postpartum Women, Continued Interpregnancy interval (continued) Indicators Prevalence of Nutrition Risk 332 Closely-spaced pregnanciespregnant 332 Closely-spaced pregnanciesbreastfeeding 332 Closely-spaced pregnanciespostpartum Iowa WIC Program Page 41

42 Data for Pregnant, Breastfeeding and Postpartum Women, Continued Medical care Healthy People 2020 Maternal, Infant and Child Health (MICH) MICH-10.0: Increase the proportion of pregnant women who receive early and adequate prenatal care. (Target: improvement). Baseline:70.8 of females delivering a live birth received prenatal care beginning in the first trimester in Indicators PNSS-All Women Medical care 44.6* 1st trimester No medical care 49.7* Prevalence of Nutrition Risk 334 Lack of adequate prenatal care-all women 4.1 *Questionable Data WIC enrollment Indicators PNSS All Women 1 st trimester nd trimester rd trimester 15.2 Postpartum 9.2 PNSS data not available for agency or county Iowa WIC Program Page 42