Altarum Institute Partners with NWA for CPHMC Evaluation

By: Loren Bell, Altarum Institute Fellow

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The WIC program has traditionally been focused on the mission of improving the health of vulnerable populations by delivering nutrition services directly to low-income pregnant and breastfeeding women, infants, and children.  The clinical approach used by WIC combines nutrition assessment, nutrition education, supplemental foods, and referrals to health and social services for individual clients and their families.  These services are designed to promote healthy eating and physical activity behaviors and healthcare during a critical time period in a woman and child’s life.  However, to create opportunities for program participants to make healthy behavior changes and access healthcare services, changes to policies, systems, and the environment are often necessary.

Through a grant from the Centers for Disease Control and Prevention, the National WIC Association (NWA) funded 32 local WIC agencies in 18 states to plan and implement policy, systems, and environmental (PSE) change in their local communities. Through the Community Partnerships for Healthy Mothers and Children (CPHMC) project, agencies implemented several interventions to promote linkages to chronic disease prevention services and improve the local food environment.  Agencies had a wide menu of choices in interventions they could implement, and they were required to build or join community coalitions, conduct a community needs assessment and work with partners to implement the interventions.

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Altarum Institute conducted an evaluation of the CPHMC project using information gathered from all of the local agencies and many of their partners. There were a number of findings directly related to the implementation of interventions and success of the program, but some of the more exciting results were related to how WIC expanded its role and changed the community’s understanding and perception of the WIC program. The project built capacity for WIC agencies to lead and facilitate PSE efforts and the transformation of WIC from a direct service provider to a change agent within the community had some dramatic results. A few of the key findings from the evaluation include:

1.     Creating or engaging with existing coalitions was a challenge for some WIC agencies, since they were not viewed in their community as leaders in PSE change and engaging in collaborative activities was new for many of them.  However, while some agencies found it initially difficult to find appropriate partners to create or integrate into local coalitions, nearly all were eventually successful in engaging meaningful, working coalitions in the project.  Coalition members included such organizations as SNAP-Ed programs, YMCAs, hospitals, Head Start Programs, food banks and pantries, and community clinics. Three-quarters of the local agencies were confident that they had found the right partners for implementing their interventions. Further, at the end of the project, the majority of them indicated that they would continue working with their coalitions.

2.     In order to implement the project objectives, local agencies needed to develop partnerships with organizations and businesses where the interventions took place, such as restaurants, grocery stores, farmers’ markets, food pantries, physician’s offices and other types of partners.  For many of the projects, this involved WIC for the first time in efforts to develop relationships beyond making referrals.  Working with these partners changed both the role that WIC played in the community and how WIC was viewed by these entities. Project partners reported they gained a much better understanding of the WIC program and many indicated that the partnership established for the project would inspire future collaboration.

3.     One of the challenges for both WIC and their coalition members and partners was that most local WIC agency staff involved in the project had limited or no experience with implementing PSE changes.  However, after experience in forming partnerships to develop and implement their project interventions, and with technical assistance from NWA, most felt that they gained significant experience in PSE implementation, which would help their agencies to sustain efforts in their community after funding ended.   

4.     About half of the local agency project coordinators felt that they were extremely successful in implementing their project objectives, and the other half felt they were somewhat successful.  Some of the factors that contributed to their success included engagement and collaboration from coalition members, strong leadership and support from their local agencies, and cooperation from partners in organizations and businesses to implement project interventions.

Overall, the conclusion from the evaluation is that WIC can play an important role in creating partnerships to implement PSE changes for improving the food environment and increasing linkages for chronic disease prevention and treatment services. The CPHMC project clearly demonstrates that WIC agencies can successfully lead or participate in community-based initiatives to implement PSE change.   While WIC agencies may not have as much experience in PSE changes as some other organizations, they learn quickly and have access to community partners, such as grocery stores, farmers’ markets, hospitals and healthcare providers, and health departments that can play a critical role in achieving PSE changes.

Healthy Partnerships: Farm Fresh Foods for Clinton County Residents

By: Kelsey Barnes, Public Health Nutrition Educator

Clinton County is a rural county in upstate New York with 81,000 residents.  Low income is the County’s most obvious disparity. Approximately 1/3 of the total population lives in households with income levels below 200% of the Federal Poverty Level and about 1 in 5 local children live in a low income household.  Nearly a quarter of the County’s total population is categorized as having “low food access.”  Regardless of income, 75% of Clinton County residents do not consume adequate amounts of fruits and vegetables.   In a recent community survey, one out of every four respondents reported access to healthy foods as a concern for themselves or their family.  With a high proportion of low income families and many obstacles to accessing opportunities for health, it isn’t surprising the County also experiences higher rates of common chronic diseases compared to state and national averages. Due to these findings, Clinton County identified healthy food access as a priority for its community health improvement plan. 

A shy, but awesome, Clinton County Farmer helps promote  Farm Fresh Cash . 

A shy, but awesome, Clinton County Farmer helps promote Farm Fresh Cash

Although there are a number of farms in the region, it was discovered only a handful were offering direct to consumer sales.  In addition, many of these farmers were not participating in state and national nutrition incentive programs.  In 2016, multiple partners teamed up to change this.

As part of the local Community Partnerships for Healthy Mothers and Children (CPHMC) initiative, project staff assisted a local farmers’ market program in recruiting farmers to become authorized to accept state and national nutrition incentive vouchers, such as WIC Farmers Market Checks, WIC Fruit and Vegetable vouchers and SNAP.  The team educated farmers about the different programs, coordinated trainings for them and even provided guidance throughout the authorization process. 

Farm Fresh Cash can be used 7 days a week!

Farm Fresh Cash can be used 7 days a week!

To help household food dollars stretch even further for local families, farmers were also encouraged to participate in a local nutrition incentive program called Farm Fresh Cash (FFC).  CPHMC project staff helped spread the word to local WIC families by creating and maintaining a listing of all farmers with direct to consumer sales, including location, hours of operation and the nutrition incentive programs they participated in. 

Farm Fresh Cash was launched in the summer of the 2016.  In its first year, 21 local farmers and markets stepped up to participate in the program and nearly 800 residents received FFC vouchers (the program is on track to triple that number in 2017).  In addition, five new farmers completed the authorization process to accept state or national nutrition incentive benefits.   As a result, more residents are visiting local farm stands and markets and hundreds of local families have easier access to locally grown fruits and vegetables.

Truman Medical Centers: Engaging Mobile Markets to Improve Access to Healthy Foods in the Urban Core

By: Emily Meissen-Sebellius, Project Coordinator, Weighing In

Jackson County is ranked 75 out of 115 Missouri counties for health outcomes. One of the biggest burdens in the county is the high rates of obesity and diabetes.  The Partners 4 Health project sought to focus on two particular zip codes within Jackson County (referred to as the Linwood Corridor) that face significant challenges, particularly in key drivers of health. The area is considered a “food desert” and the rate of WIC authorized stores is significantly lower than Missouri state rates.

Increased access to healthy foods through mobile markets

TMC Healthy Harvest Mobile Market delivers low-cost, high-quality fruits and vegetables to underserved communities. Through this project, a new stop was added across from the Linwood YMCA, a key community partner.

TMC Healthy Harvest Mobile Market delivers low-cost, high-quality fruits and vegetables to underserved communities. Through this project, a new stop was added across from the Linwood YMCA, a key community partner.

The project began with receiving feedback from WIC participants that access to high-quality, low cost fruits and vegetables was a challenge. While several convenience stores and a few smaller grocery stores serve the area, the availability of fresh produce is at times limited, low quality and/or high in price. Because of a lack of full-service grocery stores in the targeted area, we focused efforts on access through two existing mobile markets. The Truman Medical Center Healthy Harvest Mobile Market (HHMM) sells fruits and vegetables to underserved communities. Rollin Grocer is a full service mobile market that brings a variety of groceries, including fruits and vegetables, to the urban core.

A key coalition partner, the Linwood YMCA, serves as a community hub for physical activity, community involvement, healthy cooking classes, and will soon be opening a healthcare clinic co-located at the newly renovated location. Through the coalition and leadership team, the HHMM added a new stop to its schedule to include the Linwood YMCA!  This new stop provided increased access to high quality, low costs fruits and vegetables in the targeted area.  The new stop was added at the beginning of the 2017 market season and has since steadily grown in attendance. Coalition members have worked together to promote the new HHMM stop and support our HHMM and YMCA partners. The leadership team is committed to continuing this work, and we will still meet monthly to brainstorm ideas and tweak our approaches for promoting and connecting community members to the HHMM, as well as other resources for healthy living.

 A full array of groceries, including fresh fruits and vegetables, are available inside Rollin Grocer, a full-service mobile grocery store serving food deserts and underserved neighborhoods in Kansas City. Rollin Grocer operates 6 days/week, year-round

 A full array of groceries, including fresh fruits and vegetables, are available inside Rollin Grocer, a full-service mobile grocery store serving food deserts and underserved neighborhoods in Kansas City. Rollin Grocer operates 6 days/week, year-round

Rollin Grocer has partnered with WIC team members to help adjust their inventory  to meet requirements to be a WIC-authorized vendor. Rollin Grocer has submitted a pilot proposal to the state of Missouri to become WIC authorized and participated in a positive site visit with the state WIC director and vendor coordinator this year! While approval has not yet been granted from USDA, the coalition and leadership team are hopeful that pilot status will be granted for Rollin Grocer’s innovative model. The leadership team and coalition partners will continue to advocate for approval and will work with Rollin Grocer to promote healthy items that they carry.  If Rollin Grocer is approved, we will utilize our coalition partners to spread awareness of this new resources for WIC participants.

Both markets have been engaged in sharing the coalition’s message about health- 12345 Fit-Tastic!- through print materials, grocery bags, t-shirts and new resources with healthy recipes, storage and prep tips for fruits and vegetables and chronic disease prevention information. We look forward to opportunities for the coalition to provide healthy lifestyles messaging and information to the mobile markets and for the coalition members to continue to promote the mobile markets to the families they serve, into the future.

Increased access to healthy foods through fruit and vegetable prescriptions

The Linwood Family YMCA staff sport their 12345 Fit-Tastic! t-shirts on Wednesdays to promote the new TMC Healthy Harvest Mobile Market stop at the Linwood YMCA. The coalition’s 12345 Fit-Tastic! message helps create a buzz around healthy eating and physical activity in connection with the project activities.   

The Linwood Family YMCA staff sport their 12345 Fit-Tastic! t-shirts on Wednesdays to promote the new TMC Healthy Harvest Mobile Market stop at the Linwood YMCA. The coalition’s 12345 Fit-Tastic! message helps create a buzz around healthy eating and physical activity in connection with the project activities.   

The Partners 4 Health leadership team has been able to align the work of this project with other interest in the community around food “prescriptions”. By leveraging other funds, we have been able to provide coupons to WIC participants in the targeted zip codes which can be used to purchase fresh fruits and vegetables at the HHMM. The coupons are provided by WIC staff at WIC visits along with a fruit and vegetable “prescription.”  By the end of June, more than 80 coupons will have been provided to WIC participants, along with information about the HHMM, to increase access to fresh fruits and vegetables and awareness of the new stop at the Linwood YMCA.  In addition, healthcare providers from Children’s Mercy Primary Care Clinics have delivered about 300 food prescriptions to families who have been identified as food insecure. These prescriptions also include a $5 coupon to the family and information about the HHMM.  In addition, the Linwood YMCA has been able to leverage grant funds to provide an additional 500 coupons to the HHMM for community members. We are excited to continue to move forward with these opportunities throughout the market season. Our next steps are to begin a qualitative evaluation to understand facilitators and barriers to using the coupon at the mobile market by working with researchers at Children’s Mercy’s Center for Children’s Healthy Lifestyles and Nutrition.  Our leadership team will continue to meet to inform these efforts, and we are looking for future opportunities to utilize technology for food prescriptions and/or to promote mobile markets, as well as continuing to explore the intersections of healthy lifestyles and food insecurity.

The momentum and focus created by this project has allowed us to align with existing efforts effectively.  We look forward to continuing the efforts above through our coalition with support of the leadership team, which plans to continue meeting monthly. In addition, we are excited about furthering the relationship between Children’s Mercy and TMC-WIC with a new WIC clinic opening at the Children’s Mercy Primary Care Clinic in July.  In May, WIC staff delivered training on the WIC program to healthcare providers in the Primary Care Clinic, which provides nearly 17,000 well-child checks annually. The leadership team looks forward to ongoing opportunities to connect and carry forward the project objectives through this new co-location. The leadership team is also looking forward to future opportunities through the new onsite clinic at the Linwood YMCA for community clinical linkages.

Racine Kenosha’s Fruit and Veggie of the Month!

By: Anna-Maria Roaché, Program Manager, ACOG

The Kenosha Health Improvement Project (K-HIP) implemented many innovative ideas regarding healthy food promotion. Racine Kenosha Community Action Agency’s (RKCAA) WIC clinic in Kenosha, Wisconsin facilitated the activities of the Community Partnership for Healthy Mothers and Children project. The initiative aims to reduce the impact of chronic diseases in Kenosha County through policy, systems, and environmental strategies that improve access to healthy foods and strengthen community and clinical linkages.

The Fruit and Veggie of the Month initiative encouraged healthy food choices at grocery stores through enhanced food promotions. Each month, Kenosha WIC families have the opportunity to prepare a healthy recipe in RKCAA’s teaching kitchen. The recipe is featured at several grocery stores the following month through a partnership that developed among WIC dietitians and store managers. Bright signage is displayed in the produce section with recipe cards so shoppers can easily purchase the ingredients to prepare the recipe at home.  

With this in place, families will not only sample the recipes in the teaching kitchen, but they will also have exposure to healthy foods, and see the same recipe at their local grocery stores. Families have been extremely receptive to the program, and are excited to purchase the ingredients and recreate the specific dish in their own home.

The Kenosha Health Improvement Project has succeeded in creating awareness of healthy food choices to many families in their community. Racine Kenosha Community Action Agency will continue this initiative to create a culture of health in their region.

RKCAA Engages Providers with the Eat. Move. Thrive. Prescription Pad & Video Campaign

By: Pam Halbach, WIC Director, Racine Kenosha Community Action Agency

Kenosha County ranks 64th out of 72 in the County Health rankings. However, much is being done in the community to alter these statistics. The Kenosha Health Improvement Project (K-HIP) is one such group that sought to reduce the impact of chronic diseases in Kenosha, WI, through policy, systems, and environmental strategies that improve access to healthy foods and beverages and strengthen community and clinical linkages.  

Eat. Move. Thrive. is a non-pharmaceutical prescription pad being used by Kenosha providers to “write a prescription” for increasing fruit and vegetable consumption, participating in a local cooking class on healthy eating, attending a fitness class to increase physical activity, or participating in a mental wellness activity. These innovative prescriptions will engage patients in improving their health and the health of their families.

According to the providers and patients who piloted the project, it was fun, easy to use, and helped in making healthy changes. As a result, one family started exercising together, several parents inquired about parenting classes, one patient cut tobacco use by half, and several patients stated they looked at the pad a few times a day which helped keep them on track with their goals. The Eat. Move. Thrive. prescription is accompanied by a brochure that directs patients or clients to resources that can help them accomplish their goals, which may range from eating more vegetables to increasing daily steps to engaging in self-care such as tobacco reduction or cessation.

Providers who participated were impressed with the results. One noted, “The concept is important to continue long-term. Whatever can give patients [as] a reminder to complete a self-evaluation of their health is worth it. It is another positive tool that the patient can use to visually see their progress and report back on.”

A series of videos were created as a tool to discuss the initiative with local providers, promote in their WIC office waiting room, and use for outreach and for presenting about programming. However, the overall goal of this particular video was to engage providers. The Racine WIC office’s intentions were to showcase the diverse ways in which the Eat. Move. Thrive. initiative could be implemented by including narrative from a physician, a therapist, and a bilingual WIC dietitian. So far, the response has been impressive with two to three new providers signing on to use the non-prescription pads each week. In particular, the Department Head of Kenosha United Hospital System is currently working with ten nurses in the Medical/Surgical Unit to implement the non-pharmaceutical approaches when discharging patients to improve their health and recovery.

Additionally, RKCAA is showcasing the video when they go out and discuss the project with physicians and other providers. Not only does the video facilitate discussion on how to create behavior change, but also reminds physicians and providers of the WIC Program and reminds them to encourage families to use their farmer’s market checks. To see more of the videos they created you can go to their YouTube page here.

K-HIP was funded by the Community Partners for Healthy Mothers and Children grant through the National WIC Association and U.S. Centers for Disease Control (CDC) and administered by the Racine/Kenosha Community Action Agency’s Women Infants and Children clinic. K-HIP is a collaboration of multiple stakeholders in the community. Dr. Junith Thompson, a local OB/GYN of Kenosha, RKCAA - WIC staff, Kenosha County Division of Health, Kenosha Community Health Center, Kenosha YMCA, and UW-Extension designed and developed the prescription pad.

Doctors in Northern Idaho Individualize Healthy Lifestyle Rx 

By: Nanci Jenkins, Panhandle Health District CPHMC Grant Manager

Dr. Dean Ornish, world renowned heart surgeon and cardiologist, once described surgical interventions to treat heart disease in the absence of healthy lifestyle changes as if the sink is overflowing with water and you grab a mop to start cleaning up without first turning off the faucet. Doesn’t make much sense, does it?  If the cause of the overflowing sink isn’t addressed, then you will be continually frustrated while mopping as hard as you can. What if every time a physician was asked to treat a patient they not only treated the problem but they also treated the cause of the problem? Effectively turning off the faucet. In Bonner County, Idaho an attempt to do just that is underway.

Smoking is one cause of illness that most people are aware of.  The American Heart Association has led the way in studying techniques to aid in smoking cessation population wide. One of the techniques identified involves an intervention by physicians.  In some cases, this may mean writing a prescription for a medication to help ease the craving or to counter the effects of nicotine. But an equally powerful technique necessitates a physician looking directly at a patient and stating in no uncertain terms, “You must stop smoking now!”  It is surprising how many patients state that they have never been told this by their own doctor and once they were told, they found the strength to stop. Others discovered that when told to quit, their desire to do so increased yet they still struggled with knowing the means to success.

            The Bonner County Coalition for Health (BCCH) has created a tool to help physicians tell their patients that they must make a lifestyle change now (like stop smoking or eat more vegetables for example) and to help them find the means to do so. The tool is called “Healthy Lifestyle Rx”. These are non-pharmaceutical prescription pads individualized to each health care organization. A physician may write a prescription and hand it to the patient just as they would a prescription for a medication. A cardiology practice might be most interested in stopping smoking and blood pressure management with a low sodium diet.  An OB/GYN practice might be most interested in having their patient enroll in the WIC program or engage in a walking program. These specific recommendations will appear on their individualized prescription pad.

            Unique to this program in Bonner County is the addition of a website link. Each pad has the newly created BCCH website address printed on it. Since physicians are over burdened with paperwork these days, the idea of adding one more task was not well received. By adding a website to the pads, we have allowed the patients to go to a place to get clarification after they have left the physician office. The website offers a button that mimics the logo on the Healthy Lifestyle Pads for each organization. A patient simply finds the logo that matches the prescription they were given, clicks on it and is taken to the page that describes exactly what their physician would like for them to do.

            In the process of creating this tool, we discovered another excellent website resource in our county.  It is The Sandpoint Community Resource Center (SCRC).  They too have a website and are now linked to the BCCH website. A patient can look up health resources on the SCRC site and be taken directly to the BCCH site. Additionally, the Healthy Lifestyle Rx links are readily available on the SCCR website. This has been a wonderful collaboration that helps all residents of Bonner County and beyond. For more information please visit and

Southeast Health District's Breastfeeding Billboards

By: Denise Thompson, Southeast Health District WIC Nutritionist

This advertisement is also featured at the Sweet Onion Cinema. Prior to the start of each movie this banner is displayed with a voice-over (listen below). 

This advertisement is also featured at the Sweet Onion Cinema. Prior to the start of each movie this banner is displayed with a voice-over (listen below). 

As a coalition, Southeast Health District's Mommy & Me, As Healthy As Can Be, explored effective ways to provide education and normalize breastfeeding in the rural south. Located in the southeast pocket of Georgia, Tattnall County has a staggering rate of breastfeeding. In 2014, only 22% of Tattnall Mothers breastfed compared to 49% nationally. Many barriers contribute to these low rates including poverty, the need to return to work post-labor, lack of work-place policies, and the social stigma of breastfeeding. Advertising was a must, and we chose billboards because they reach a large and diverse market with a high frequency of customers being repeatedly exposed to the promotion.

As a coalition, we cannot continually stand outside with signs that applaud those who are currently or planning to breastfeed. Neither can we stand at festivals in a booth daily to handout education or speak to every employer on the benefits of supporting breastfeeding for their employees and customers. However, a billboard can give education and encouragement constantly. Honestly, if a billboard is designed right, it can reach a vast amount of different groups of people that a coalition may not be able to reach.

We have a total of four billboards located in the surrounding area of Tattnall County. The four locations are Hwy 280, east of Vidalia, Hwy 280 at Brinson Road, US 301, north of Glennville, and US 341, 1 mile south of Baxley. One prime rule of real-estate is location, location, location. We felt this rule applied to promotional material as well and wanted those traveling in and out of Tattnall County to be able to see the billboards. We are anticipating that the one year of time that these billboards have, will reap benefits in our community for years to come.

During our coalition meeting, our team discussed different design options. We reminisced about previous billboards that were memorable and what were current trends that would be appealing not only to Moms, but their families as well. There were two designs created to help with our mission. An ”Eat Local” theme and “I breastfeed” super hero theme.  We choose a super hero character because it’s colorful, eye catching, and we hoped that it would grab the attention of Dads and kids to open up the conversation on breastfeeding.

The response has been astonishing at this point because our WIC clients were coming into the local health department excited about the “new billboards” they had been seeing and we were not even aware they were out yet. Word traveled fast! We hope to encourage our superheroes and their families to continue to save the day. The definition of a superhero consists of an exceptionally skillful or successful person that has extraordinary powers -which we feel Moms do. Although Moms may not wear the cape or mask, they are still real life superheroes that fly in to save the day. They work all hours of the night, and just a drop of their breastmilk contains around one million white blood cells. A Mom’s nourishment can provide benefits for their child for years to come. Seems pretty heroic right? If the shoe fits they say to wear it, so we are encouraging our Moms to lace up and put on those shoes!

Great Dialogue, Best Practices and Inspiration Abound at CDC Year 3 Meeting in Denver

By: Erin Sanders, CPHMC Operations Management Consultant

Karen McNeil-Miller welcomes NIDCDP teams to Denver, CO

Karen McNeil-Miller welcomes NIDCDP teams to Denver, CO

On Monday, April 17th awardees from CDC’s National Implementation and Dissemination for Chronic Disease Prevention program convened in Denver, Colorado for their Year 3 meeting. Coalition members from across the country participated in the four-day conference. As Cohort #2 grantees approach the final weeks of their funding period, this conference was a great opportunity to connect both with Cohort #1 agencies, as well as other grantees of the American Heart Association and American Planning Association.  

Bhagya Kolli and Amy Funk with Jay Walljasper

Bhagya Kolli and Amy Funk with Jay Walljasper

Monday began with a welcome session featuring an overview of initiatives and accomplishments from project leaders at AHA, APA, and NWA. This was followed by a Welcome to Colorado from Karen McNeil-Miller, CEO of the Colorado Health Foundation and a networking reception with stunning views of the Rocky Mountains. Tuesday and Wednesday were filled with a mix of general sessions, facilitated dialogues, open networking opportunities, and a poster session. The general sessions shared accomplishments, partnerships, sustainability work, and innovative approaches; while facilitated dialogue sessions offered grantees space to discuss cross-cutting objectives and topical initiatives; and open networking sessions allowed for awardees to connect with other funders, agencies and coalitions.

NWA was extremely proud to have multiple representatives from the CPHMC project highlight their work during general sessions. On Tuesday morning, Anna-Maria Roaché and Jeanne Mahoney from ACOG participated in the Power of Partnerships Panel, which focused on how collaboration can broaden reach and lead to greater successes when carrying out long-term place-based work. During the Health Equity session, Mary Schultheis and José Rivera from Crescent City WIC identified key challenges and conditions to consider when addressing health disparities at the local level. And on Wednesday, Bhagya Kolli and Amy Funk from the East St. Louis, Illinois project reflected on core initiatives that have been sustained after their funding period and how they maintained key strategies.

Anna-Maria Roaché (left) and Jeanne Mahoney (second from left) during Partnerships Panel

Anna-Maria Roaché (left) and Jeanne Mahoney (second from left) during Partnerships Panel

Faciltator David Gibbs with José Rivera and Mary Schultheis (L-R) during Health Equity Session

Faciltator David Gibbs with José Rivera and Mary Schultheis (L-R) during Health Equity Session

Amy Funk (center-right) and Bhagya Kolli (right) during Sustainability Session

Amy Funk (center-right) and Bhagya Kolli (right) during Sustainability Session

CPHMC National Team with Mary Schultheis

CPHMC National Team with Mary Schultheis

Thursday morning featured eight unique options for mobile tours, which allowed sub-recipients from across the country to interact with successful local project staff and inspired new ideas, and approaches that can be proposed or adapted in their own communities. Attendees took to foot, bus or bike to experience mobile tours highlighting projects focused on such broad topics as WIC referrals, the concept of a built environment, overcoming health barriers, improving street and roadway access, downtown bikeability, healthy food procurement and local food hubs/urban farms. Following the tours, attendees gathered one final time for an invigorating closing session with Eduardo Sanchez from AHA.

Community Partnerships Project Shines at NWA Annual Conference

The National WIC Association (NWA) recently held its Annual Education and Networking Conference in Philadelphia, Pennsylvania. While the conference officially kicked off on Sunday, April 2nd, the Community Partnerships for Healthy Mothers and Children (CPHMC) project team members met for an exciting pre-conference meeting on Saturday, April 1st. The pre-conference started out with a fascinating presentation from Karen Shore at the Food Trust, one of NWA’s national partners on the CPHMC project. Karen spoke about all of the work The Food Trust does to improve the healthy food offerings at a variety of retail markets. Her insights were helpful for the CPHMC local agency representatives who are working on healthy retail in their home communities.

The remainder of the day on Saturday was spent in informal discussions between CPHMC local agency team members about a variety of topics. The Altarum Institute, NWA’s evaluation partner on the CPHMC project, helped to introduce and facilitate one of the networking sessions, and spent some time highlighting some of the remarkable achievements of the CPHMC agencies in attendance. As there are only about six weeks left in the project, this meeting was an opportune time for local agency team members to discuss successes, challenges, and best practices from their projects.

Here is the CPHMC group at Sunday’s poster session!

Here is the CPHMC group at Sunday’s poster session!

CPHMC team members came together again on Sunday morning for a poster session in which each agency presented a poster highlighting one outstanding aspect of their project. This was an information-packed session in which local agency representatives from around the country (who are not being funded through the CPHMC project) had the opportunity to walk around, read about CPHMC interventions, and interact with the CPHMC local representatives to ask questions and learn more. CPHMC representatives also prepared one-pagers for this event, which summarized all of their selected interventions, so that session attendees could learn about aspects of the projects that weren’t captured in the posters themselves.

Jill Bonczysnki

Jill Bonczysnki

During NWA’s Annual Conference, which kicked off Sunday afternoon, the CPHMC had a strong presence. On Sunday afternoon, following the opening general session, Jill Bonczynski, WIC Director for the Tri-County Health Department in Colorado, participated in a concurrent session in which she touched on Tri-County’s efforts to increase WIC participation. Tri-County Health Department is a CPHMC agency, and funds from the CPHMC project have helped to bolster their WIC recruitment and retention efforts. During the same time slot, Sloan Gingg, Grant Coordinator for the San Juan Basin Health Department in Colorado (another CPHMC agency), presented on San Juan Basin’s partnership with Head Start, one of the central efforts of their CPHMC project.

Sloan also made an appearance on Tuesday morning during a general session that highlighted the power of partnerships in the CPHMC project. Amber France from Wood County Health Department in Wisconsin, Susan Gross from Johns Hopkins School of Public Health in Maryland, and Nanci Jenkins from Panhandle Health District in Idaho joined Sloan for a panel discussion about how each agency leveraged local partnerships to accomplish their project goals. In addition to the panel discussion, Quinney Harris, Senior Program Manager at the National WIC Association, introduced the overall project and touched on major accomplishments, and Linnea Sallack and Loren Bell of the Altarum Institute wrapped up the session by presenting on highlights from their evaluation of the first cohort of local WIC agencies involved in the CPHMC project. This general session was truly outstanding and gave all conference attendees the opportunity to learn about the CPHMC project and understand ways that their agencies can engage in this sort of policy, systems, and environmental (PSE) work.

Jill receiving her award

Jill receiving her award

Later that morning, Glencora Gudger, Community Partnership Coordinator for the Richmond City Health District, participated in a panel in which she discussed how the Richmond City Health District, a Cohort 1 CPHMC agency, has worked to improve breastfeeding rates in Richmond. In order to improve community partner knowledge of WIC breastfeeding services, increase referrals to WIC for breastfeeding support and develop unified breastfeeding messaging, Richmond City WIC developed a three-prong approach which entailed 1) delivering WIC 101 presentations to over 50 community partners 2) cohosting a citywide breastfeeding symposium to implement a singular, train-the-trainer breastfeeding curriculum and 3) implementing this curriculum at a number of community organizations.

During the same time slot, Sina Gallo, Assistant Professor in the Department of Nutrition and Food Studies at George Mason University, gave a presentation about infant Vitamin D supplementation based on a study being conducted that aims to describe the Vitamin D supplementation practices of local mothers participating in WIC. Dr. Gallo has been a partner in Loudoun County Health Department’s CPHMC project, particularly on their breastfeeding interventions. Another Loudoun County partner, Amara Channell Doig, also of George Mason University, presented earlier in the conference about addressing breastfeeding disparities.

Gordie Moeller receiving his award

Gordie Moeller receiving his award

To wrap up the day on Tuesday, NWA presented its NWA Leadership Awards to six individuals who have shown outstanding WIC leadership within the last year. Three of the six award recipients are connected with the CPHMC project! First, Jill Bonczynski, who was mentioned earlier, was presented with a WIC Leadership Award for her innovative and dedicated leadership at the Tri-County Health Department in Colorado. Jill was deserving of this award for a number of reasons: She successfully oversees 10 grants and manages two other funding sources which provide evidence-based education and resources to focus on obesity prevention, access to healthy foods, care coordination linkages and co-location of services; she has worked to integrate and co-locate the WIC program into primary care provider offices; and she instituted a yearly WIC Educator Planning Day, among other accomplishments.

Kate Noon receiving her award

Kate Noon receiving her award

Second, Gordie Moeller, a food security advocate in West Michigan, was presented with the Friend of WIC Award. Gordie has recently volunteered and served as a coalition member with District Health Department #10, a CPHMC agency, in their efforts to improve access to healthy foods in Lake and Oceana Counties. Since retiring in 2006, after 40 years of working as a social worker, Gordie has voluntarily worked on food security issues all over west Michigan. His work has included connecting people to WIC and other food benefits through a Community Resource Guide in West Michigan and connecting farmers and markets to business and grant opportunities, including WIC, DOUBLE UP, and Project Fresh.

Third and finally, Kate Noon, Founder, Virginia Alliance for Breastfeeding Laws, was presented with an NWA Advocacy Award for her efforts to help pass the 2015 Virginia Right to Breastfeed law. Kate has collaborated with CPHMC project staff at the Richmond City Health District to help make breastfeeding more accessible in the city of Richmond.

Overall, the Annual Conference was a resounding success, and the national CPHMC staff at NWA are thrilled that the Community Partnerships project had such a strong presence at the conference. More and more WIC state and local staff are learning about the power of partnerships and the need for WIC to step outside of the clinic walls to improve community health!

ACOG Presents at the SOPHE 68th Annual Meeting!

By: Anna-Maria Roaché, Senior Program Manager  

On March 31st 2017, ACOG had the great privilege of presenting at the SOPHE 68th Annual Meeting! ACOG submitted an abstract entitled: Building Community Clinical Linkages: WIC Strengthens Provider Relationships. ACOG, along with other national partners which included: The American Heart Association, and the American Planning Association presented at the session entitled: Partnering4Health: The Power of A National Collaborative In Reducing Chronic Disease. Presentations highlighted project successes for sub recipients as well as how WIC and ACOG have effectively strengthened provider relationships through our community based project. We highlighted specific project successes, which included the successful inclusion of the CPHMC Project in the American Board of Obstetrics and Gynecology’s (ABOG), Maintenance of Certification process (MOC), as well as Breastfeeding Bootcamps, lactation rooms and support programs, non-pharmaceutical prescriptions and WIC 101 trainings.

After the presentations, there was time built in for questions and answers, our presentation received a lot of interest, as many participants did not know what community clinical linkages were or what the WIC program entailed. This was a great opportunity to connect with other organizations and share best practices with others who are working to implement similar initiatives. The conference overall highlighted various areas of public health and included sessions regarding minority health, health equity, health promotion, and chronic disease prevention. There were also several round table sessions which touched on health literacy, health insurance, faith based interventions, food access and nutrition, and global health. We are looking forward to many more opportunities to share our work and the great work of our sub-recipients!

Here’s to Your Health: A Healthy Eating and Living Television Show

By: Rachael Black, MICA Community Partners Coordinator

With the year’s involvement in CPHMC starting to come to an end, Mid-Iowa Community Action’s coalition started to look for new ways it could expand on its efforts to increase the promotion of healthy lifestyles. Having received support from the local radio station, it seemed like a reasonable step to reach out to the local educational television channel, Marshalltown Community Television (McTV). McTV’s Production and Programming Manager was thrilled with the idea. A task force was assembled to consider the feasibility and scope of the project.

The McTV Production and Programming Manager, along with WIC Dietitians and MICA staff, quickly realized that the task force wanted the show to be inspiring, but realistic. The show shifted from a healthy food and eating show, to a healthy eating and living show, which would consist of 3 main segments: a guest of the week who would talk about health related topics, a cooking segment, and a question and answer session with a dietitian. With the show’s format finalized, there was still work that needed to be done, including finding on screen talent, a location to film and—most importantly—funding.

McTV was able to cover the filming and editing expenses, and Hy-Vee agreed to supply food items for the cooking segment. When one task force member, a WIC dietitian, volunteered to be the host of the show, it looked like the funding issue was solved. Finding a location for the cooking segment was the real challenge, but the show eventually found a location to film and a volunteer willing to cook on camera. The first recipe was a mango chicken stir-fry over a bed of brown rice.

Mango chicken was selected as our first cooking segment a tie-in to our first guest of the week, Pick a Better Snack. The Pick a Better Snack program visits local elementary schools and offers education on fruits and vegetables that can be used as healthy snacks. Mango just happened to be the fruit the students were sampling that week, and the lesson was filmed for the show. The last step was to film the show’s intro and Q&A with a Dietitian.

While finalizing the video, staff decided on the name “Here’s to Your Health.” The first installment premiered on March 4th at 3pm, and is also available on YouTube. The next episode airs March 18th at 3pm. MICA, McTV, Hy-Vee, local WIC Dietitians, and chef Russ are all excited to continue in collaboration even after the CPHMC program at MICA comes to an end. The show plans to release an episode every other week, with topics including gardening, healthy food changes in the schools, importance of getting immunization, and more. We hope to showcase the PSE changes being made around our community and keep people more aware of what our community has to offer in regards to their health. We hope you tune in. Until then, Here’s to Your Health!

Its Water Time at Sully Elementary!

By: Anna-Maria Roaché, Senior Program Manager, ACOG

On February 15 2017, I had the privilege of being a guest reader for Loudoun County’s “Its Water Time!” Initiative. On this day, the program was being held at Sully Elementary, located in Sterling, Virginia for two classes of children in the STEP program. This initiative was developed through intensive research by this agency for best practices in drinking water promotion campaigns and increased drinking water access in school systems. Based off of this research, Loudoun County developed a toolkit entitled, “Summary of Best Practices in Drinking Water Access in Schools.” This toolkit was presented to the Director of School Nutrition Services by this local agency. Discussions were held regarding options for increasing water access in the K-12 school system. The toolkit was shared with other stakeholders in the community, including the Head Start Advisory Committee, which led to a partnership with Head Start and STEP as they worked to eliminate juice from their classrooms.  A collaboration was created between the Head Start and STEP Program Director and Supervisors, and the “It’s Water Time!” program, a curriculum for preschool and elementary aged children to promote drinking water, was developed. This program has been performed for all 400 children enrolled in the Head Start and STEP programs throughout Loudoun County, and has helped teachers make the switch from serving milk, juice, and water to only serving milk and water in their classrooms. Reusable water bottles are also provided to every student and teacher to encourage children to drink more water.  

I joined Jennifer Brady, WIC Project Coordinator, and Michelle Apple, partner from George Mason University at the elementary school, and they proceeded to explain the order of the program. The “It’s Water Time!” program includes a water mascot, a storybook, a song and dance routine, a coloring page, and a parent educational flier. We began the first class with Jennifer introducing the program, she discussed the importance of water and asked the children if they drank water. The kids were so happy to see new faces in their classroom! They were also excited and engaged in the first part of the program. Jennifer then introduced the “It’s Water Time” mascot, Captain Hydro, and I proceeded read the story. The children loved the mascot and were interactive with me as I read the book. We then went on to sing a song and do a dance routine; the kids loved it so much we did it twice in both classes!

After we conducted the activity, we passed out Captain Hydro coloring pages and walked around the room talking to them about the lesson and Captain Hydro. Each child has their own reusable water bottle so they can have their own “Water Time” during their class periods. The bottles either had the child’s name on it, or were assigned based on shapes that corresponded to a specific child. This was such a great experience to see the children in both class periods be so enthusiastic and ready to learn about such an important topic. Loudoun County has made great strides with this initiative and continues to see success. Jennifer shared an anecdote with me pertaining to the success of this program: at one of the schools, one of the bus drivers, requested that teachers require their children use the restroom before they got on the bus, as a result of the increased water consumption!  They currently have classes scheduled to the end of February. NWA and ACOG are very excited to see the continued success of this initiative and this agency through the duration of the project period.              

Eat Fit NW Michigan Kicks Off in Lake County

By: Colleen Unsal, District Health Department #10

On Thursday, February 16, 2017, a little bit of the bayou arrived in Lake County!  We welcomed Molly Kimball, RD, CSSD, creator of the Oschner “Eat Fit NOLA” program, and Julie Nieto, RD to kick off our “Eat Fit NW Michigan” program.  Twenty people attended this fun training, including registered dieticians, health educators, food council members, restaurant owners, food bank coordinators, and more.  Fueled by “King Cake” flavored coffee that Molly and Julie shared, this high energy group was ready to jump right in.  

The Oschner “Eat Fit” program is where “nutritious meets delicious.” By working with grocery stores, restaurants, cafeterias, etc., Eat it NW Michigan is a healthy eating initiative that aims to promote and encourage healthier menu choices in the community, and is a free program for its partners.  Our team of dieticians and nutrition ambassadors have developed specific criteria for meals that are lower in calories, sodium, animal-based fats, and added sugars.  All Eat Fit menu and food items, as well as our partners, can be identified by our Eat Fit circle logo, for easy recognition.  The people in the room were full of ideas in our brainstorming sessions where possible community partners were identified, and ambassadors volunteered to contact the partners and initiate the program.  Our first participating restaurant is Marquette Trails Golf Course’s “The View” restaurant, and we have already started reviewing their menu and identifying Eat Fit choices.

Eating Healthy isn’t just lettuce and celery sticks.  It can be delicious, satisfying, and pleasing to the eye as well as the taste buds. As part of our chronic disease-prevention grant through the National WIC Association’s Community Partnerships for Healthy Mothers and Children (CPHMC) Project, we want to provide improved access to environments with healthy food and beverage choices.  Eat Fit NW Michigan highlights the better-for-you items right on the menu or grocery store shelf, making the healthy choice the easy choice!

Clinton County Health Department Food Drive Success

By: Kelsey Barnes, Clinton County Public Health Nutrition Educator

Healthy donation items include: whole wheat pasta, canned fruits in 100% juice, low sodium canned vegetables, peanut butter and canned tuna in water.

Healthy donation items include: whole wheat pasta, canned fruits in 100% juice, low sodium canned vegetables, peanut butter and canned tuna in water.

The Clinton County Health Department (CCHD) exceeded their expectations for the pilot food drive. Between October 26th - November 18th, Clinton County Health Department employees were tasked with donating healthier food items to a Department wide food drive. A total of 188 food items were collected and distributed to the area's main food pantries, Plattsburgh Interfaith Food Shelf and JCEO Outreach Center, just in time for the Thanksgiving holiday. Of the items collected, 87% met the healthy criteria outlined for employees at the last agency meeting. Selecting healthier, non-perishable food items requires some thought and label reading, but can be fairly easy if you know what to look for. For example, knowing that canned fruit in 100% fruit juice is a better choice nutritionally than canned fruit in heavy syrup, can make all the difference.

Collecting healthier donations from the community allows Clinton Counties local food pantries to spend their budgets on perishable items that clients would like to see in their food package, such as fresh fruits and vegetables. When the fresh produce is available at the pantries, clients take full advantage because many do not have the opportunity to access fresh produce otherwise.

The next step for CCHD is to partner with community organizations that coordinate their own food drives. CCHD will be able to provide engaging promotional materials and other resources to help encourage healthier donations.

Loudoun County Fights Childhood Obesity

By: Natalie Mulloy, CPHMC Communications & Reporting Assistant

Loudoun County Health Department, located in Leesburg, Virginia, is one of the local agencies participating in the Community Partnerships for Healthy Mothers and Children (CPHMC) project, through NWA’s cooperative agreement with the CDC.

Loudoun County was recently highlighted in a local newspaper, The Loudoun Tribune, for their accomplishments in reducing childhood obesity. In Loudoun County, the childhood obesity rate among low-income residents is almost double the national average. Part of their efforts to combat childhood obesity involved a partnership with a professor in George Mason University’s Department of Nutrition and Food Studies, Dr. Gallo. This partnership has broken down silos in the area, and has resulted in cohesive collaboration within the community. 

Some of the interventions planned include, a program that aims to bring more fresh, local produce to families who need it most, a ‘Living Healthy in Loudoun’ resource guide, and increased access to breastfeeding services in the area. We applaud Loudoun County for their ingenious efforts and innovative strategies developed to combat childhood obesity in their community. 


Loudoun County Presents at the Virginia Department of Health!

By: Anna-Maria Roache, Senior Program Manager CPHMC Project

On December 8th 2016, members of ACOG and the National WIC Association attended a lunch and learn presentation at the Virginia Department of Health, in Richmond, Virginia. The presentation, entitled “Bridging the Gaps in a Child's First Food System”, was given by Dr. Janine Rethy of Loudoun County and Dr. Sina Gallo of George Mason University to present the findings of their WIC survey. The Loudoun County Health Department has successfully partnered with Dr. Gallo, a professor in the Department of Nutrition and Food Studies at George Mason University, for the past several years. Previous work included a survey of physicians’ breastfeeding knowledge, the results of which helped guide the development of Loudoun County Health Department’s “Best Practice Breastfeeding Support Implementation Guide for the Outpatient Office Setting”.

This summer as part of the CPHMC project, the Loudoun County Health Department and George Mason University team conducted a survey of women who are participating in the WIC program to determine current breastfeeding practices, breastfeeding goals, timing and reasons for introduction of formula, and also vitamin D supplementation practices. The survey also assessed food shopping patterns and also chronic disease risk factors to determine conclusions and recommendations to help increase breastfeeding rates and retention within their county. 

Dr. Rethy and Dr. Gallo also presented on the current efforts spearheaded by Loudoun County through the CPHMC grant, which included the creation of the Loudoun County Business Case for Breastfeeding Toolkit for local businesses and government agencies, as well as the installation of two permanent breastfeeding rooms in their County Government offices and the introduction of a comprehensive lactation support policy, the first of its kind in the state of Virginia. It was a great experience for the CPHMC team to see this local agency present their data and show their work to others and to see all the great initiatives that Loudoun County has implemented. After the presentation, there were several in depth discussions regarding this topic and how to further Loudoun County’s initiatives. We are excited to hear about more of their innovative work for the remainder of the project!

Increasing Access to Healthy Environments in the Early Childcare Setting: San Juan Basin Health’s Partnership with Tri-County Head Start

By: Sloan Gingg, MPH, SJBHD Grants Coordinator

Research shows that reaching children at a young age improves their chances of embracing healthy messages and behaviors for a lifetime. Early childcare education has been established as a critical strategy in the fight against childhood obesity and other chronic diseases and provides the opportunity to shape healthy behaviors through education.  As part of our chronic disease-prevention grant through the National WIC Association’s Community Partnerships for Healthy Mothers and Children (CPHMC) Project, San Juan Basin Health (SJBH) is partnering with Tri-County Head Start to sponsor the implementation of an evidence-based coordinated school health curriculum. Tri-County Head Start stood out as an obvious partner; Head Start programs are income-based and all children and families are automatically income-eligible for WIC, so working with Tri-County Head Start enables us to reach our target population of low-income children and families. The partnership we’ve established is multifaceted and has led to implementation of four main efforts to increase access to, and education about, healthy foods among Head Start students and families. 

During the summer months, SJBH partnered with the Garden Project of Southwest Colorado to implement a free, weekly farm stand called Manna Market. Due to an excess of produce and our existing partnership with Tri-County Head Start, we were able to facilitate the initiation of an additional free farm stand on-site at Roberta Shirley Center (RSC) Head Start (the only center that meets throughout the summer months). Produce at both markets was locally-grown, either from local community gardens or donated by farmers and producers. The two farm stands combined served roughly 400 people (not including repeat visitors) and an estimated 6,000 pounds of produce was given to food-insecure families. The Manna Market became a hub for them to learn about food assistance services and programs in our community, including Cooking Matters, WIC, SNAP, and Double Up Food Bucks. In addition to the free farm stand that provided fresh, local produce to Head Start children and families, we also provided recipe cards for dishes incorporating food available at the farm stand. We were able to tailor the recipes throughout the season, so families always had access to information and ways to use each food we had on hand. “We’re excited to partner with SJBH and The Garden Project to provide families with more opportunities to be exposed to healthy food,” said Tri-County Head Start Health and Safety Manager, Amber Beye. “Families and teachers at RSC are excited about this opportunity.” 

To introduce healthy foods in the classroom, we were able to partner with a local registered dietician to provide each center under Tri-County Head Start with a laminated, bound booklet of twelve “Food of the Month” lessons. The lessons include images of the fruit or vegetable, the plant it comes from, and prompt teachers to run through a few fun questions with the kids (i.e. is it crunchy? Is it sweet?). The lessons incorporate as many farm-to-preschool foods as possible, and provide the kiddos with more opportunities to try new, healthy foods, and learn about where the foods come from. 

Although we are excited about the farm stand and monthly taste test lessons, we wanted to help Tri-County Head Start implement comprehensive, sustainable changes. Fortunately, the curriculum director was interested in incorporating healthy messages into everyday programming. We were able to suggest and sponsor staff training and implementation of an evidence-based coordinated school health curriculum, CATCH (Coordinated Approach to Child Health) Early Childhood (CEC). Staff from five Tri-County Head Start sites began implementing CEC in October 2016. CEC is designed to nurture a love of physical activity, provide introduction to classroom-based gardening and nutrition, and encourage healthy eating in children. The curriculum was developed in a way that meets Federal Head Start academic guidelines, and provides nine nutrition-based and ten gardening-based lessons to encourage healthy eating behaviors, as well as over 400 activity cards with music aimed at promoting physical activity. We used CPHMC grant funds to purchase CEC and host a comprehensive training for Tri-County Head Start educators and administrators. Although the centers have only recently begun to use the curriculum, initial feedback has been very positive!

Finally, we are also working with the Garden Project of Southwest Colorado and Healthy Community Food Systems to establish small preschool gardens in three Head Start locations in La Plata and Archuleta Counties. The preschool gardens that we’ll establish at three Head Start locations will be raised beds and/or container gardens and will supplement the implementation of CATCH Early Childhood. The new gardens will make the project more comprehensive and more likely to be successful in increasing consumption of fruits and vegetables   (and ultimately reducing chronic disease). SJBH is working to establish internal garden coordinators – either on-site staff or passionate parents – to ensure the gardens will be cared for and sustained beyond the timeline of this project. 

We are very excited about the strong partnership we’ve developed with Tri-County Head Start and foresee us working together in myriad ways moving forward. The combined effect of all initiatives stemming from our partnership – free farm stand, taste test lessons, implementation of CATCH Early Childhood, and new school gardens – has no doubt lead to increased access to and education about healthy foods, and should have the long-term effect of reducing risk of chronic disease. We’re looking forward to seeing the fruits of this partnership grow and evolve. 

Clinton County Media Spotlight

linton County Health Department in Upstate NY was highlighted in their local newspaper for success with their healthy food pantry initiative where they are conducting outreach to the community encouraging healthier food donations to local food pantries.  A recent food drive at the health department resulted in 87% of food donations being healthier options. Clinton County has also been going into pharmacies and daycare centers sharing new information about the WIC program.

Check out their great newspaper coverage below:

“Clinton County Food Pantries Start Healthy Eating Initiative”
By: Teah Dowling
The Sun Community News
November 21, 2016

“Grant Focuses on Healthy Options at Clinton County Food Shelves”
By: Stacey DeSilva
November 22, 2016


Lastly, Capital Region Eat Smart NY retweeted Clinton County’s twitter post about their pilot food drive at the Health Department!

Way to go Clinton County – keep up the great work!

Preserving the Children’s Health Insurance Program: A No-Brainer to Protect Children in Working Families

By: David Rubin MD, MSCE

As a pediatrician, I have a front-row seat to how health insurance impacts the well-being of children. Nearly half the patients I see are covered by Medicaid or the Children’s Health Insurance Program (CHIP), both of which have comprehensive sets of benefits and are historically thought of as safety nets for the unemployed. However, you might be surprised to learn that the fastest growing users of these public health insurance programs for their children are employed and unable to afford or receive health insurance for their children through their employer health plans. 

New PolicyLab Study Shows Importance of CHIP, Medicaid to Working Families

To learn about this recent trend, our team at PolicyLab used survey data from 2008-2013 to understand the health insurance decisions working parents were making on behalf of their children. What we found is that low- and moderate-income families between 100 percent and 400 percent of the federal poverty level ($23,550-$94,200 for a family of four), whose parents were receiving insurance through their employer, increasingly looked to Medicaid or CHIP to insure their children.

By 2013, the proportion of such families electing to cover their children through CHIP or Medicaid increased by 20 percent overall, and by more than 30 percent among families with household incomes between 100 percent and 200 percent of the federal poverty level, or up to $47,000 a year for a family of four. By 2013, one-third of working families in that income bracket were relying on CHIP and Medicaid to extend coverage to their children. These findings, published today in the December issue of Health Affairs, show just how important CHIP and Medicaid have become for working families.

A Changing Health Insurance Landscape

Some might question why families increasingly made the decision to move their children’s coverage off of an employer-based plan, and whether they should have been permitted to do so. Simply put, families were responding rationally to rapidly changing financial pressures.

As employers faced the rising cost of premiums to insure their workers’ families (which increased by 41 percent to $17,000/year between 2008 and 2015), a cost that far exceeded that of providing single coverage (which reached $6,000 by 2015), their offerings began to change. Some employers began to drop dependent coverage from their available insurance plans, if they even offered insurance to their employees at all. Other employers increased costs that workers must contribute toward family plans, whether by increasing the premium they needed to pay, by increasing out-of-pocket deductibles they could expect to pay if their children got sick or by restricting the providers their children could see. 

Employees faced a dilemma: insure yourself for less money, or choose a plan that was either unaffordable or did not provide complete health benefits to your children. For many, the cost to cover their children became prohibitive: annual worker contributions to family premiums rose from $3,400 in 2008 to $4,700 in 2015. Deductibles also became more common, with the average deductible for an employer-based family plan rising from less than $800 in 2008 to more than $2,000 by 2015. What’s more, many employer-based plans did not offer reimbursement for vision, dental or mental health providers, which are commonly included in public insurance programs for children.

As lower-income families experienced these changes, CHIP and Medicaid (if their children were eligible within their state) may have been the only affordable option if they wanted to continue insuring their children.

By 2016, 35 million children in the United States were covered by Medicaid or CHIP, contributing to the nearly universal rate of children’s health insurance coverage in this country.

By 2016, 35 million children in the United States were covered by Medicaid or CHIP, contributing to the nearly universal rate of children’s health insurance coverage in this country. However, CHIP funding is set to expire in September 2017 if Congress does not act to renew it.

The Limitations of the Affordable Care Act (ACA) to Help These Families

The arrival of the ACA in 2011, and the emergence of the health insurance exchanges by 2014, provided new options for parents to obtain subsidized coverage for themselves and their children if they could not receive insurance through work, or if employer coverage was unaffordable. Yet, like employer plans, exchange plans were often not promising for working families. Deductibles remained high, and they overwhelmingly lacked the comprehensive benefits that CHIP and Medicaid offer for children. Other parents were also unable (through a “family glitch” in the ACA legislation) to receive tax subsidies to enroll their children in the exchanges because the test for affordability only considered the cost of individual coverage, not family coverage that is much more expensive. Therefore, CHIP and Medicaid became the backstops for children in working families during this time, and will remain important if the ACA is not improved or replaced with law that provides better options for working families to cover their children.

The Future of Children’s Health Care Coverage

So, where does this leave us for protecting the nearly universal nationwide coverage we’ve achieved for children over the last 20 years? On the heels of this study, and with the change in our national direction following Election Day, many working families will rely entirely on Medicaid and CHIP to provide cost-effective and comprehensive coverage for their children. The maintenance and protection of these programs is now more important than ever. 

One need only look at a secondary finding in our study that serves as a bellwether warning for what might happen if Congress does not renew funding for CHIP before it runs out in September 2017. For working families between 200 percent and 300 percent of federal poverty level ($47,100-$70,650 for a family of four), who were not offered or could not afford dependent coverage for their children through their employer, we detected a 53 percent rise in uninsurance for their children. This was likely due to more restrictive eligibility levels for Medicaid and CHIP in their states, which left them with no affordable options and nowhere to turn for help. Families in those states were asked to make the difficult decision to uninsure their children and hope for the best.

If Congress fails to re-fund CHIP next year, we will see this difficult decision play out for families all across the country in numbers we’ve never seen before. Protecting CHIP is now a no-brainer for the future health of our nation’s children. 

This article was reposted with permission from Policy Lab from The Children's Hospital of Philadelphia. Original post can be found here