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.