Exam 2
lactation consultants
Funding to promote breastfeeding at WIC clinics increased the availability of:
- food labeling and dietary guidelines - expansion of EFNEP to 7000 paraprofessionals - expansion of food stamp program - expansion of school lunch program
The White House conference was a catalyst for change in which of the following areas?
EFNEP
WIC originally partnered with which organization to provide nutrition education?
- 2007 USDA revised WIC food packages to better fit with current nutrition concerns in low-income populations, such as overnutrition, poor diets, and nutrient deficiencies - revised to better fit the dietary guidelines and made to be a supplement to the participants' diets - revision reduced the max amount of formula that can be received under the partial breastfeeding package to encourage mothers to breastfeed more - revisions expected to improve both the attractiveness of the program to participants and its success in meeting the WIC program's goals
why were revisions made to WIC food packages?
CACFP adult snack meal pattern
- Select two of the five components for a reimbursable snack - Only one of the two components may be a beverage
- monitoring participation - amount of cash value vouchers being redeemed
How does WIC measure the success of their program?
CACFP adult lunch & supper meal pattern
Must serve all five components for a reimbursable meal
CACFP adult breakfast meal pattern
Must serve all three components for a reimbursable meal
USDA
The Granville Vance County WIC Office receives funding from the ________
processing assistant
complete the integrity screenings for incoming WIC participants
CACFP child lunch & supper meal pattern
select all five meal components for a reimbursable meal
voucher program (IFIF)
vouchers could be redeemed for nutritious food as well as infant formula
- WIC benefits are not limited to only food. - Participants have access to a number of resources, including health screenings, nutrition and breastfeeding counseling, immunization screening and referral, substance referral, and more.
what additional benefits are available to WIC participants?
Headstart and Food Pantries
what are some community partners with WIC?
- images shows most benefits of breastfeeding - in addition, breastfeeding can increase bonding with the baby and provide rich vitamins, minerals and nutrients for the baby
what are the benefits of breastfeeding?
- Income must be less than 185% of the federal poverty level ($3,746/month for a family of four). - In addition to meeting the income requirements, WIC participants must be at nutritional risk (this criteria matters more if the budget falls short on a particular year and those at higher risk are given priority)
what are the current eligibility requirements of WIC?
- First goal of any federal child nutrition program is to enhance food security and prevent hunger - Second goal of any federal child nutrition program is to promote nutrition and health
what are the goals of any federal child nutrition program?
1. expaded to 6 food packages - infants 0-3 months - infants 4-11 months - children 1-4 years - pregnant/breastfeeding women - nonbreastfeeding postpartum - children/women with special needs 2. added peanut butter and dried beans 3. set limit of 6g of sugar per dry ounce for cereals
what were the significant changes to WIC in 1980?
- established the Farmers' Market Demonstration Project - allowed WIC participants to use vouchers at the Farmers' Market - permanently established in 1992
what were the significant changes to WIC in 1989?
1. 1990: national standardization of "nutritional risk" - increased emphasis on breastfeeding promotion - infant formula had reached 40% of WIC budget 2. 1991 Act: required secretary of agriculture to promote breastfeeding as best method of infant nutrition 3. 1992: enhanced WIC package for breastfeeding mothers whose infants are not receiving formula - added carrots and tuna, increased amounts of juice, cheese, beans/peas, and peanut butter 4. 1994: funding to promote breastfeeding at WIC clinics - increased availability of lactation consultants
what were the significant changes to WIC in 1990s?
1. 2006: first major changes to the food packages since 1980 (implemented in 2009 & revised in 2015) - changed food packages to better align with dietary guidelines - emphasizing those nutrients likely to be missing from clients' diets, such as potassium & fiber 2. to better align infant/child feeding practices from american academy of pediatrics - promotion of breastfeeding - reduction in juice consumption - reduction in fat consumption via low or nonfat dairy
what were the significant changes to WIC in 2000s?
- infants, women & children, and children with special needs - also identified specific foods and amounts (i.e. infant formula, milk, cheese, eggs, infant & adult cereal, & fruit juice)
what were the three food packages initially offered by WIC?
dyadic nature of breastfeeding
when the infant is breastfed, the mother has greater nutritional needs related to milk production
1975 - also included funding for nutrition education and was administered through the states via health departments
when was WIC established as a permanent federal program?
USDA funds WIC in addition to NC's specific FNS branch, which then supports local WIC agencies
where does funding for WIC come from?
- women - infants over 4 months - children 1-5 years *anyone who is eligible for WIC*
who does FMNP serve?
- breastfeeding is a priority in the WIC program because breast milk is the most nutritious and complete source of food for infants and less than 30% of infants in the US are breastfeed at 1 year of age - WIC provides breastfeeding support via peer counselors, the buddy program, and breastfeeding experts - many women don't know how to breastfeed properly, the equipment to use, and women can give up if breastfeeding gets challenging without support from other women in WIC
why is breastfeeding support part of WIC nutrition education?
adjunctive income eligibility
- Procedure that states that if you are eligible for one federal food assistance program, you may be eligible for other federal assistance - For example, participants in other programs, such as SNAP and Medicaid, may be eligible for WIC
CACFP child snack meal pattern
- Select two of the five components for a reimbursable snack - Only one of the two components may be a beverage
discretionary/nonentitlement
- WIC is considered this type of program (different than SNAP) because spending levels are determined in annual appropriations legislation - For example, not everyone who is eligible for WIC is able to receive aid based on funding, so they are put on a waiting list
public law 97-35 (1981)
- added private for-profit facilities receiving Title XX, Social Security Act, compensation of at least 25 percent of the children enrolled at each center in each calendar month were Title XX beneficiaries - also permitted eligible non residential child day care institutions to receive children reimbursement for feeding children 12 years of age and younger and set the age for children of migrant workers at 15 years or younger - expanded the program to include mentally or physically handicapped persons, regardless of their age, who were enrolled in an institution or facility caring for a majority of children 18 or younger
The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA)
- changed the meal reimbursement structure for family child care homes - established two tiers of reimbursement rates, with higher rates applying to homes in low-income areas or operated by low income persons
farmers' market nutrition program (FMNP)
- eligible WIC participants are issued FMNP coupons in addition to their regular WIC benefits - these coupons can be used to buy eligible foods from farmers, farmers' markets or roadside stands that have been approved by the state agency to accept FMNP coupons - permanently established in 1992 to to provide fresh, unprepared, locally grown fruits and vegetables to WIC participants, and to expand the awareness, use of, and sales at farmers' markets
Child Nutrition Amendments (1978)
- eliminated the means test for family child care homes - separated the reimbursement of sponsors' administrative costs from the meal reimbursement for family child care homes - made the Child Care Food Program permanent expanding it to cover all public or private nonprofit institutions or sponsored facilities, licensed or approved to care for children
CACFP Farm to PreSchool
- encompasses efforts to serve local or regionally produced foods in early child care and education settings; provide hands-on learning activities such as gardening, farm visits, and culinary activities; and integrate food-related education into the curriculum - involves sourcing local foods, tips for menu planning & edible gardens
commodity supplemental food program (1969)
- food program that planned to build commissaries next to clinics in low-income areas - doctors could "prescribe" commodity foods to patients - target population was pregnant women and children up to 6 - one commissary actually opened in ATL
St Jude's Children's Research Hospital
- found many children in surrounding poor communities malnourished - 26% of children were anemic and had retarded growth - found that a child's growth pattern is established in the first 6 months of life - started commodity food program for pregnant women and young children
The Child Care Food Program Roundtable (CCFPRT)
- founded in 1977 - influential voices nationally for the Child & Adult Care Food Program (CACFP)
iron-fortified infant formula program (IFIF)
- program started by Dr. David Paige who treated lots of iron-deficiency anemia among poor children - figured out that poor nutrition was already affecting cognition before school-age - developed program to deliver iron-fortified formula to newborns - got a federal grant from community services administration to expand state-wide - worked via a voucher program
child and adult care food program (CACFP)
- program with the broadest scope of any of the USDA food programs - subsidizes nutritious meals and snacks served to infants and children in participating day care facilities, emergency shelters, and at-risk afterschool programs, and to adults who receive day care in participating facilities - majority of the participants (and many of the providers) are from low income households
history of CACFP
1965: Older Americans Act - legislation designed to keep older adults healthy and independent (i.e. meals on wheels) 1968: CACFP started as a 3-year pilot program to help low-income women - called "special food service program for children - provided grants to states to serve meals at child care centers in limited resource areas 1975: Separated into two programs - Child care food program (i.e. day care centers) - Summer School Food Service 1978: Expanded coverage to home-based child care programs - institutions providing day care for the functionally impaired 1987: Amendment to the Older Americans ACt - allowed participation of certain adult day care centers as part of the Child Care Food Program 1989/1990: Renamed to "CACFP" - via the Child Nutrition and WIC Reauthorization Act of 1989
- processing assistants - nutritionists
As WIC Director, Lauren supervises which of the following?
CACFP infant breakfast meal pattern
Breastmilk or formula, or portions of both, must be served
CACFP infant lunch & supper meal pattern
Breastmilk or formula, or portions of both, must be served
CACFP infant snack meal pattern
Breastmilk or formula, or portions of both, must be served
procurement
Farm to Childcare focuses on which of the following processes in order to implement their program?
one each trimester
If a woman applies for WIC in her first trimester, how many assessments will she receive upon receiving benefits?
yogurt
In 2015, states were authorized to substitute which of the following as a milk substitution?
- children two years of age - children one year of age
In which two categories does WIC participation drop the most?
offer-versus-serve policy
Policy that states that the School Food Authorities (SFA) must offer sufficient components for a reimbursable meal, but the child may decline to take some components
5-10
The pilot program for Farm to Childcare initially involved how many childcare programs?
children 1-2 years of age
What age group receives whole milk as part of their food package?
- participants must reside in the county from which they are receiving WIC benefits - participants have to become income eligible - participants can be approved through adjunctive eligibility
What does "integrity" mean in the initial screening process of WIC participants?
participants don't like what they are offered
What is one of the biggest obstacles that WIC faces?
To connect farmers with local childcare centers to provide fresh produce to children
What is the mission of Farm to Childcare?
cost of fresh produce
What is the perceived barrier that many childcare centers brought up when Farm to Childcare was trying to get involved with their center?
to assist childcare center and family childcare home directors and staff to take the concept of Farm to Childcare and put it into action
What is the purpose of the Farm to Childcare Toolkit?
- fiber - potassium
What nutrients were targeted in the revised food packages because they were likely to be missing from participants's diets?
beans as a protein source
What topic is the focus of the Granville-Vance County WIC Processing Assistants' family education, this month?
to deliver iron-fortified formula to infants
What was the purpose of the IFIF program?
- women up to 6 months postpartum - children up to 5 years of age
When WIC was first established, who was eligible to participate?
1975
When was WIC enacted into legislation?
- dental office referral - drug abuse referral - referral for SNAP benefits
Which of the following are additional participant benefit associated with Granville Vance County WIC Office?
john rex endowment
Which organization provides the funding for Farm to Childcare?
vendor
a person who sells something
Hunger Prevention Act of 1988
allowed for a fourth meal for children in care 8 hours or more per day in child care centers and outside school hours centers only
Agricultural Risk Protection Act of 2000:
changed eligibility criteria, expanded the at-risk afterschool care component of CACFP
Child Nutrition and WIC Reauthorization Act of 1989
changed the name of the program to the Child and Adult Care Food Program (CACFP), funded the expansion of family day care homes into low-income or rural areas, permitted snacks for schools participating in CACFP
nutritional risk
defined by the present nutritional status and risk of impairment of present status, due to increased requirements caused by stress metabolism of the clinical condition
public law 90-32 (1968)
established the Special Food Service Program for Children (SFSPFC) as a 3- year pilot program
Healthy Meals for Healthy Americans Act of 1994
extended eligibility for free meals for children participating in Head Start
Consolidated Appropriations Act of 2001
extended eligibility to for-profit centers and outside of school hours care centers serving low-income children
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
federal assistance program of the FNS of the USDA for healthcare and nutrition of low-income pregnant women, breastfeeding women, and children under the age of five
1. defined nutritional risk - anemia, underweight, overweight - those most in need would be given priority in times of limited funds - specifics left up to the states 2. defined eligibility requirements - linked to free/reduced lunch criteria 3. required nutrition education be available at all sites - could partner with EFNEP 4. required attention to be paid to fat, sugar, & salt content of prescribed foods 5. required sites to coordinate referrals for other health/social services - immunization, family planning, child, alcohol/drug abuse prevention
how did legislation in 1978 impact WIC?
- most participating facilities offer "free" meals/snacks to participants - may include cost of food in their overall cost to the participant ("paid" participant) - USDA determines reimbursement based on number of "paid," "reduced price," "free" meals - foods being served must meet federal nutrition-based guidelines
how does CACFP work?
- measure success by looking at participation numbers in the program and get monthly reports from the state agency showing how many people are participating in the county. - in addition, get local reports daily (supposed to see 50-60 people per day for the specific county talked about). - also measure success by looking at how many actually go out and spend their benefits, and the no-show rates for appointments
how does WIC measure success?
research shows that WIC is effective at reducing food insecurity, improving dietary intake, addressing obesity, and improving other health outcomes
how successful is WIC in achieving its goals?
- Sen. Humphrey in Memphis used data from St Jude's to sponsor legislation for USDA to fund 2-year national pilot program based on Dr.Paige's voucher model - this led to the first pilot program for WIC opening in KY in 1974
how was the pilot testing for WIC proposed?
1. expansion of food stamp program - participation went from 3.6-9.3 mil within 10 months with almost all counties administering the program 2. expansion of school lunch program - 1970 amendment to national school lunch act expanded program to every school 3. expansion of EFNEP to 7000 paraprofessionals 4. ultimately led to food labeling and the dietary guidelines
how was the white house council conference on food, nutrition, and health (1969) a catalyst for change?
Child Nutrition and WIC Reauthorization Act of 2004
increased the minimum state administrative expense funding; changed the frequency of tiering determination from 3 to 5 years; for military personnel living in privatized housing, excluded counting the household allowance in the determination of eligibility for free and reduced-price meals
CACFP child breakfast meal pattern
select all three meal components for a reimbursable meal
public law 94-105 (1975)
separated the Child Care Food Program (CCFP) and the Summer Food Service Program
market forces
the economic factors affecting the price of, demand for, and availability of a commodity
equity
the quality of being fair and impartial
- WIC was established as a permanent program in 1974 to safeguard the health of low-income women, infants, and children up to age 5 who are at nutritional risk - this mission is carried out by providing nutritious foods to supplement diets, nutrition education (including breastfeeding promotion and support), and referrals to health and other social services - major goal of WIC is to improve the nutritional status of infants - WIC mothers are encouraged to breastfeed their infants, unless medically contraindicated - goals of WIC food packages are to enhance intake of particular nutritents and fruits, veggies, and whole grains
what are the mission and goals of WIC?
- Retention rates are very good during pregnancy, but that depends on if the mother is coming to WIC in the first or last trimester - Infancy also has a good retention rate (0-12 months), but drops off a little bit around 1 and 2 years old
what are the retention and participation rates within WIC?
1. Medically-based risks - anemia, underweight, history of pregnancy complications, or poor pregnancy outcomes, etc. 2. Dietary risks - inappropriate nutrition/feeding practices or failure to meet the current dietary guidelines for americans
what are the types of nutritional risk recognized by WIC?
- time period where lots of attention was being focused on poverty and malnutrition - Hunger USA, Hunger in America documentary, & the Poor People's March on Washington - led to a white house conference in 1969 on food, nutrition, and health
what is the history of WIC in the 1960s?
- women up to 6 months postpartum and children up to age 5 - had to be at nutritional risk with inadequate income (these factors were not defined at the time)
what was the eligibility criteria for WIC when it first opened in 1975?
- supplemental foods must contain nutrients known to be lacking in the target population (i.e. protein, iron, calcium, and vitamins A & C) - program was designed to be supplementary to food stamps
what was the supplemental foods criteria for WIC when it first opened in 1975?
1. switch to low fat /nonfat milk (everyone >2) - allow substitutions of soymilk, tofu, yogurt for milk and cheese 2. switch to whole grain bread - option to subsitute to whole grain tortillas, pasta, rice, etc. 3. no formula routinely issued in first 30 days to breastfed infants and reduced amounts of formula overall 4. decrease amounts of juice, milk, cheese, eggs 5. provide cash value vouchers for purchasing canned, frozen, fresh fruits & veggies (can include white potatoes) - cannot have added fats, oils, sugars
what were specific examples of how WIC changed based on the 2000s recommendations?
- nutritional needs of low-income pregnant/lactating women and infants - there were no federal programs directly addressing this issue at the time
what were the major concerns of the white house council conference on food, nutrition, and health (1969)?