SECTION I: SD WIC Goals and Objectives FFY 2018-2021 Guiding Principles Department of Health Vision Healthy People Healthy Communities Healthy South Dakota Office of Child and Family Services Serve with integrity and respect Eliminate health disparities Demonstrate leadership and accountability Focus on prevention outcomes Leverage partnerships Promote innovation WIC s Mission South Dakota WIC aims to safeguard the health of limited income women infants and children up to age five at nutritional risk by providing personalized nutrition information, breastfeeding education and support, referral to healthcare and social services, and nutritious foods to supplement diets. 1
VENDOR and FOOD FUNDS MANAGEMENT GOAL 1: Implement new practices with the EWIC Implementation to assure Program Integrity and management of food funds. A. Indicator 1 - Evaluate peer grouping systems based on redemptions and additional federal guidance to determine appropriateness of current peer groups. B. Indicator 1, 6 - Evaluate whether food pricing surveys are needed following the first year of ewic implementation. C. Indicators 2, 4 - Enhance the SDWIC-IT System within the vendor and external vendor modules to improve overall monitoring of the vendor management section. D. Indicator 3 - Utilize Reports within WIC Direct and Data Direct to determine appropriate food costs and expenditures through redemption data for cost per participant, projections, and for monitoring caseload management set forth in federal requirements. E. Indicator 3 - Gather food redemption data for more accurate review and analyze0 statewide food availability for review of acceptable foods. Explore options for CDP canned reports from other States. F. Indicators 4, 5 - Develop materials for WIC Vendors to improve customer services to WIC participants. G. Indicator 7 - Evaluate Independent Farmers and possible authorization as WIC vendors. H. Indicator 7 - Evaluate Farmers Markets and possible application for South Dakota. I. Indicator 8 - Determine if South Dakota should implement vendor selection criteria and develop policy and procedure to reflect it. J. Evaluate ways to incorporate clinic staff as liaisons on behalf of the Central Office for the Vendor community for participant services. Key Performance Indicators: 1. Once peer groupings are evaluated assure updates are recorded in the system accurately and reported via the TIP report appropriately to Regional Office. 2. Vendor Module Screen meets testing criteria and provides accurate data collection for management and TIP reporting requirements. 3. Reports developed provide the intended information to accurately evaluate redemption values and types of foods purchased to improve price monitoring and determination of most appropriate foods to make available to WIC participants. 4. Complete education and compliance buys of at least 5% of the authorized vendors and confirm documentation in SDWIC-IT. 5. Materials developed and implemented within the vendor community to reduce the number of technical assistance calls taken by the State Office, help desk and local agencies. Establish baseline in the first year of goals. Monitor use of mobile application to determine benefits and set baseline for future use. 2
6. Compare 10% of the stores in each peer group to ensure proper reporting of food price lists on the external vendor module with actual redemption amounts. 7. Evaluate if combination mobile devices would support SNAP and ewic purchases with independent farmers and farmers markets. 8. Survey new vendors locations each year to determine if vendors are in rural or urban areas. 3
NUTRITION AND OUTREACH SERVICES GOAL 1: Improve the quality, accessibility and effective use of healthcare for WIC Participants. A. Indicator 4, 6 - Promote the right care at the right time in the right setting. a. Maximize the use of electronic technology to improve the quality of care (Tele Health, Peer Counselor Tracker, wichealth.org, social media) b. Support innovative ways to deliver WIC services (Collaboration with other providers at the state and local levels. Ex. Healthcare Providers, Birth-to-3; Head Start, ENFEP SNAP-Ed; providing Harvest of the Month group classes) B. Indicator 1, 3, 8 - Improve South Dakota s breastfeeding rates compared to national targets and rates using the following sources: a) Healthy People 2020 Goals and Objectives; b) CDC Breastfeeding Report Card; c) PNSS and PedNSS data; d)prams Survey C. Indicator 1, 3 - Provide staff education to increase competency of breastfeeding, breastfeeding support and promotion, and use of/referrals to the Breastfeeding peer counselor program and support staff in obtaining Certified Lactation Counselor training. D. Indicator 1, 6, 8 Promote usage of breastfeeding toolkits for businesses and Mom s to educate employers and WIC participants on the benefits of breastfeeding. Goal 2: Emphasize the relationship between nutrition, physical activity and health with special emphasis on the nutritional needs of pregnant, postpartum and breastfeeding women, infants and children under five years of age, and raise the awareness about the dangers of using drugs and other harmful substances during pregnancy and while breastfeeding. A. Indicator 1, 3 - Encourage use of breastfeeding support groups and post-partum phone calls to provide anticipatory guidance, realistic information, shared experience, and personalized support. a. Update breastfeeding peer counseling policy to address the online component B. Indicator 4 - Promote WIC as a nutrition program to help increase the value of nutrition education appointments for participants by: a. Providing ongoing nutrition training b. Updating the paraprofessional Nurse Nutrition Educator training materials c. Updating language used in policy and procedures to reflect nutrition education as the priority and a main benefit of the WIC program d. Updating breastfeeding materials to include current, evidence-based breastfeeding information C. Indicator 4 - Work with other nutrition assistance programs to submit a grant application to assist in the development of strategies to improve coordination among USDA FNS Child Nutrition and other Nutrition Assistance Programs focusing on identified poor rural counties with low income with the expected result of improved participation rates. D. Indicator 11 - Focus on providing education to children and developing materials for clinic staff to utilize with children. Harvest of the Month lesson developed in Sioux Falls. Waiting for clinic to provide information on the number of participants that may be served and the amount of food needed. Research ways to provide children nutrition education within the Head Start environment with and count as nutrition contact. 4
E. Indicator 10 Decrease alcohol and illegal drug use in women through nutrition education and materials. Goal 3: Develop and strengthen partnerships to improve public health A. Indicator 6, 7, 8 - Coordinate services with Maternal Child Health, the Office of Chronic Disease Prevention and Health Promotion, the South Dakota Breastfeeding Coalition, and other dedicated groups throughout South Dakota to increase awareness of breastfeeding benefits. B. Indicator 1, 6, 8 Collaborate with the Office of Chronic Disease Prevention and Health Promotion and healthcare providers throughout South Dakota within the Breastfeeding and Healthcare Professionals Workgroup to gather information around successful healthcare outreach surrounding breastfeeding promotion. Define the need Develop materials to support breastfeeding C. Indicator 6 Increase the use of referrals to participants through enhanced public and provider awareness and education through use of social media. D. Indicator 3 Utilize the Statewide BFPC program through Growing Up Together to increase breastfeeding initiation and duration. E. Indicator 1, 2, 9 Participate on the HealthySD Stakeholders group to coordinate efforts throughout the state to work toward their goals of: a. Promote, support, and implement the adoption of food service guidelines/nutrition standards in priority settings Early Care and Education (ECE), Local Education Agencies (LEA), worksites, communities b. Increase access to healthy foods and beverages c. Increase access to breastfeeding friendly environments F. Indicator 5 Coordinate tobacco prevention and cessation training and promotion with the DOH tobacco program and other programs in the Department. G. Indicator 7 Work to improve and coordinate services between the Tribal Indian WIC Agencies, the six bordering states, and the SD WIC program. Continue collaborative efforts sharing data information to detect and prevent dual participation. H. Indicator 7 Partner with Headstart to complete certifications on site for 3 and 4 year old children. I. Indicator 6, 8 Develop relationships with hospital OB/Delivery and Pediatric specialties to increase referrals to the WIC Program Goal 4: Assist the individual who is at nutritional risk in improving health status and achieving a positive change in dietary and physical activity habits, and in the prevention of nutrition-related problems through optimal use of the supplemental foods and other nutrition foods. This is to be taught in the context of the ethnic, cultural and geographic preferences of the participants and with consideration for educational and environmental limitations experience by the participants. A. Indicator 1,2,3,5 - Use the Pregnancy Nutrition Survey Surveillance (PNSS) report and Pediatric Nutrition Surveillance System (PEDNSS) to evaluate the health of South Dakota WIC participants. B. Evaluate the needs for various cultures within South Dakota including, but not limited to migrant farm workers and their families, Native Americans, and homeless persons in the development of education materials, trainings and counseling techniques. (Participant Survey, Needs Assessment Survey, Training Needs Assessment Survey) 5
Key Performance Indicators: 1. Increase the percentage of breastfeeding initiation from 75.3% to 80%, breastfeeding at 6 months from 39.1% to 45%, breastfeeding at 12 months from 32.5% to 40%. (PedNSS Data) Breastfeeding Initiation 80% by 2020 o 2015 75.3% o 2016-74% o 2017 74.8% Breastfed at 6 Months 45% by 2020 o 2015 39.1% o 2016 42.2% o 2017 41.5% Breastfed at 12 Months 40% by 2020 o 2015 32.5% o 2016 38.7% 2017 37.7% 2. Decrease the number of children receiving risk codes related to overweight and obesity from 36.5% to 30%. (NEMP Needs Assessment Report 2016) - data for average of children 2-4 with overweight or at risk of overweight and obese codes) NEMP Assessment Report 2017 shows 39.5% having codes related to overweight and obesity 3. Increase the number of BF participants receiving BFPC services from 106 to 247 per month. (Growing Up Together Annual Report) 2017/2018 increased to serving an average of 570 participants per month 4. Increase participation rates statewide. 5. Decrease the number of women enrolled in WIC who smoked while pregnant from 48% in 2016 to 45%; and decrease the average percent of infants and children who live in households where someone smokes from 7% in 2016 to 6%, (Baseline Data from: NEMP Needs Assessment Report 2016 Percentage of PG clients with Maternal Smoking risk code; Average percentage of Infants and Children with Exposure to Environmental Tobacco Smoke code) NEMP Assessment Report 2017 shows 47.6% having codes related to smoking while pregnant and 7.4% infants and children who live in households where someone smokes. 6. Utilize newly developed Facebook page and blogs to reach more clients by providing nutrition information. A social media group has been developed to review Facebook posts and blogs. Goal is to have at least one Facebook post weekly and one blog per month on sdwic.org website. 7. MOU with Headstart and ITOs will be developed to improve child retention rates for 3-4 year olds with Headstart. MOU has been developed and is in the process of being signed by all parties 8. MOU with OB/Delivery and pediatric specialists in larger facilities. Increase the number of hospitals that WIC has MOU s in place with from 2 to 5 and include additional OB/Delivery and pediatric specialists in larger facilities. 9. Increase the redemption percentage of ewic cash value benefit for fresh fruits/vegetables. Redemptions for FFV: Based on FFV Redemption percentages from October 2017 to May 2018 baseline rate determined at 74.88%. Increase the overall rate to 80% redemption of our FFV benefits being redeemed each month by WIC families. 6
10. Decrease the number of women enrolled in WIC who were assigned the risk code alcohol or illegal drug use 372.01 from 30.8% in 2017 to 25%. 2 2017 NEMP Needs Assessment Report - PG 45.7%, BE 27.2%, BP 19.5%. 11. Increase to number of children who remain on WIC from 43% to 46%. (2018 Potential Eligible 43%, 2017 Potential Eligible 44%, 2016 Potential Eligible 45%) 12. Increase 2018 statewide rate of 82.5% to 85%. (CY2017 Closeout and Priority Enrollment Year to Date Average 2017 Total Ave Rec Ben (16,216/19,648 = 82.5%)) 7
WIC Technology GOAL 1: Maximize the effectiveness and strengthen infrastructure of the SDWIC-IT system for collection and reporting of data and program operations to satisfy federal reporting requirements. A. Indicator 1: Continue to monitor, track, and complete all bugs and fixes identified within the system 136 known bugs will be assigned by prioritization. B. Indicator 1, 2: Complete major enhancements and federal required changes. a. Develop interface for dual participation data sharing between ITO s and SD WIC Program. b. Develop dual participation files for transfer in and out for surrounding States. c. Review schedulers from other states and review non-wic appointment types/removal. d. Update Nutrition Education screens in SDWIC-IT and policy with a step-by-step of how to complete each appointment type in SDWIC-IT to improve delivery of nutrition education services. e. By September 30, 2021, manual ewic adjustments will be able to be tracked within the SDWIC-IT System and within WIC Direct system. f. Implement a running note function within the application to allow notes to be captured from the opening of a client record throughout the time the record is open. g. Update SDWIC-IT UPC Database to increase efficiencies (reduce the number of items that must be completed and screens reviewed when entering new food items). C. Indicator 2: Utilize the SDWIC-IT FOCUS group to assist in determining and prioritizing future enhancements, and assist with testing and verifying functionality of the program once the fixes are in place prior to moving to the production database. a. This group will promote and provide consistent messages to all field staff regarding SDWIC-IT. b. Individuals in the group will relay information to all staff within their own regions c. The group will test all changes and give a go/no go determination for releases d. FOCUS group will train on changes for staff within their regions and based on feedback from the training will assist in making adjustments to the training e. To be a voice at regional meetings to keep staff apprised of changes to the system. D. Indicator 3: Update all training materials as needed for new staff based on above enhancements and bug fixes. E. Re-vamp the current new employee orientation process for SDWIC-IT. New training should include both SDWIC-IT training and policy/procedure. a. Utilize a committee of both Central Office and Local Clinic staff to review survey information and provide recommendations. b. Determine how training should be provided, how, when and where. c. Provide new employee training working to develop an individualized training process to allow for more flexibility as new staff come into the WIC Program. d. Develop an administration training manual for Central Office staff. F. Develop and provide refresher course training each year for seasoned staff based on Help Desk reports and concerns/issues identified. G. Develop state policy and procedure to assist in assuring program integrity for vendor management. 8
a. Work with CDP to determine canned reports already developed that may be utilized to detect fraudulent activity. H. Review and determine how the ewic shopping experience can be improved on for the participant. a. Review the mobil application use and monitor satisfaction of participants. b. Develop committee of participants to assist in the review of the shopping experience and provide recommendations for improvement. GOAL 2: Improve the quality and accessibility of WIC services through the use of social media, SD WIC Website and Knowledgebase A. Continue to develop and add information to the existing SDWIC.org website to improve overall services to WIC participants a. Develop an electronic enrollment process b. Develop an online application c. Electronic scheduling capabilities for WIC participants. B. Keep knowledge database updated and easily accessible to WIC staff for easy access to policy and procedures and guidance to assure appropriate services for WIC participants. a. Continue to add to the central office tab specific guidance needed to implement the WIC Program. (798 procedures, MIS administrative manual, working desk manuals) b. Add other OCFS program policy and procedure. Key Performance Indicators: 1. Complete 3 major releases and fix remaining bugs not addressed in 2018 releases and new bugs as identified. 2. SDWIC-IT FOCUS Group will meet at a minimum 4 times per year, in addition to a minimum of 6 conference calls to stay on task with the completion of testing and implementing enhancements and bug fixes. 3. All new employees will receive SDWIC-IT Training prior to providing WIC services within the clinic environment. 9
STAFFING AND ORGANIZATION and CASELOAD MAINTENANCE GOAL 1: Maximize the effectiveness and strengthen infrastructure of the department of health by assuring adequate resources to carry out program operations and deliver quality services to the WIC population. A. Improve and increase effective communication throughout the Office of Child and Family Services. B. Promote a culture of organizational excellence through timely and effective training practices. C. Leverage data from the SDWIC-IT system, participant surveys and management evaluations to determine need of participants, training need of staff and share best practices. 1) Work closely with Regional Managers and the Assistant Office Administrator to meet multiple programs needs to deliver WIC services and meet staffing standards with involvement of nutrition staff in all aspects of WIC. 2) Monitor clinic caseload information and time spent providing services recorded in the 100% time study requirement to participants and adjust time as needed to complete quality WIC services. 3) Utilize the staffing ratio system based on appointment times to determine appropriate staffing needs to cover WIC services. 4) Expand Tele-Nutrition into other areas such as certification processes and Breastfeeding Feeding Peer Counseling Services, Group Nutrition Counseling, etc. D. Complete annual training needs assessment to determine the needs for training of all staff. E. Staff participating in state-level committees will provide education for staff in their regions on topics including, but not limited to, breastfeeding support and promotion, nutrition education, and MIS updates. These staff members will also review educational materials used in statewide delivery of WIC services. (NEMP, Breastfeeding Coordinators, SDWIC-IT FOCUS minutes) F. Provide annual training for staff on formula, breastfeeding, acceptable foods, vendor training, MIS, nutrition counseling and evidence-based practices, and food packages. G. Update orientation materials for WIC staff to reflect current training processes. H. Implement mentoring program for Participant Centered Services (PCS) to improve effectiveness and appreciation of nutrition appointments and involve WIC participants as partners in WIC assessment and care plan development. I. Continue to research educational materials specific to use of opioids and heroin. J. Evaluate the needs for various cultures within South Dakota including, but not limited to migrant farm workers and their families, Native Americans, and homeless persons in the development of education materials, trainings and counseling techniques. K. Coordination of nutrition and vendor activities to improve participant shopping experience. L. Improve the ability of clinic staff to teach in the context of the ethnic, cultural and geographic preferences of the participants and with consideration for educational and environmental limitations experienced by the participants. GOAL 2: Ensure program benefits are provided to all eligible persons 10
A. Enhance outreach in an attempt to reach all eligible participants, with the main focus on children ages 1-4, and pregnant women. B. Market WIC at the Clinic level, utilizing the SDWIC-IT NEMP Needs Assessment report developed annually for the Nutrition Education and Marketing Plans. Meet the statewide marketing goal. Utilize caseload priority closeout reports and, average annual participation rate by category. C. Review and evaluate participant survey responses to assist in developing methods to increase participation. Review questions regarding participant satisfaction/customer service and develop statewide goals for use in clinic environments. D. Participate in the National WIC Association Social Media Campaign for Child Retention and increase program participation. E. Utilize press releases quarterly to market the WIC Program a. Reaching out to pregnant women b. Targeting dads of WIC eligible children c. Announcing new income guidelines d. Child Retention focus (reach them, teach them, keep them) e. Develop outreach and marketing tools specific to grandparents. F. Continue to utilize data collected from SDWIC-IT, Management Evaluations and Nutrition Education and Marketing Plans to determine individual county needs for outreach and for more efficient and effective case management practices. G. Assure Program Integrity a. Summarize the frequency and types of misuse being reported to look for patterns of misuse and train staff on specific misuse problems. b. Educate clients, staff & vendors regarding requirements of the program to deter fraud & abuse. c. Update policy and procedure for dealing with fraudulent activity to the State Office to assure follow-up happens in a timely manner. d. Develop policy and procedure to allow for in-kind services in lieu of monetary fines e. Assure corrective action responses resulting from ME reviews are implemented by clinic staff and monitored by Regional Managers to assure continued compliance. f. Utilize Regional Managers to conduct Quality Assurance reviews on all CPA staff once a year in conjunction with their ACES. g. Monitor the separation of duties report to ensure single user certifications are not happening. In the event they do happen, charts will be audited to ensure there are not fraudulent activities. h. Develop a system to allow participants to participate in in-kind services in lieu of monetary payments. Key Performance Indicators: 1. By September 30, 2019, establish baseline for the number of re-occurring findings for Management Evaluations from previous findings recorded. 2. Develop and Utilize the MIS System to effectively meet the requirements for monitoring separation of duties. 3. By September 30, 2018, develop staff survey of training received at 3 months and 5 months. 4. Increase the number of pregnant women enrolled in WIC at (less than 8 weeks from 17% in 2016 to 19%. Increase the number of pregnant women enrolled in WIC (between 8 and 20 weeks from 29.5% to 31%. a. 16% in 2017 less than 8 weeks 11
b. 30% in 2017 between 8 and 20 weeks 5. Maintain or increase the current percentage of potential eligible participants. a. 92% of women b. 98% of infants 6. Increase the retention of children 1-4 participating in the WIC program. Using 2017 data as a baseline. a. Infant to C1: 34% b. C1 to C2: 15% c. C2 to C3: 9% d. C3 to C4: 12% 7. Increase participant satisfaction for specific populations, including but not limited to migrant farmworkers, homeless, and Native Americans. (Participant Survey) 8. Increase overall participant satisfaction. (Participant Survey) 12