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Population, Family and Reproductive Health

hpril programHPRIL

Hopkins/USDA Participant Research Innovation Laboratory for Enhancing WIC Services (HPRIL)


The United States Department of Agriculture (USDA) Food and Nutrition Service (FNS,) through the Special Supplemental Nutrition Program for Women Infants and Children (WIC), is responsible for providing federal grants to states for supplemental foods, nutrition education as well as health care and social service referrals for low income pregnant, breast-feeding and postpartum women and infants and children up to age five who are found to be at nutritional risk. Almost one half of all newborns in the U.S. participate in the program. Approximately 7 million WIC participants currently receive an age specific monthly food package that include fresh fruits and vegetables to supplement the diets of pregnant and postpartum women as well as children’s diets during critical periods of growth and development. Half of all infants born in the U.S. are enrolled in WIC. WIC services are available in all fifty states. The program annually serves seven million clients nationally. Half of all infants born in the U.S. are enrolled in WIC. The WIC program has been extensively evaluated and considered to be one of the nation’s most effective and successful nutrition programs.

Despite the extraordinary success of the USDA Supplemental Nutrition Program and its impact on reducing preterm birth, low birth weight, and early childhood morbidity and mortality in the first year of life, continued participation and retention of high risk children 1 to 4 years of age during critical periods of growth and development remains a challenge nationally. Multiple family, programmatic, and administrative impediments to enrollment and continued participation have been identified.

Common reasons cited for non-participation include lack of knowledge of the program, of eligibility, general problems faced by participants in terms of lack of transportation, language barriers, immigration problems, and lack of child care. Issues with the quality of service delivery are also barriers, and include problems with core client services (scheduling, timing, wait times/time burden, not liking WIC foods), and with vendor services (hard to find WIC foods, vendor hours, problems with purchasing and interactions with vendors).

The early termination of WIC services irrespective of the stated reason, results in a compromised diet leading to a cascading series of short, intermediate and long term health consequences, including high morbidity rates as well as developmental delays, stunted growth and poor school performance. The individual burden is lifelong, the cost is enormous and the loss to society incalculable. Accordingly it is a priority to identify WIC infants at risk for early termination and intervene early and effectively to reduce the number of children who fail to continue in the program. Many chronic diseases associated with increasing age are inextricably linked to poor nutrition in early childhood.

HPRIL is the laboratory for the Johns Hopkins Bloomberg School of Public Health working cooperatively with FNS and competitively selected local WIC agencies nationally to explore through innovative and replicable interactive tools how to accurately determine the family characteristics that predict early termination and employ family based interactive tools and social media to retain eligible high risk children ages 1-4 in the WIC program for maximum benefit.

Hopkins/USDA Participant Research Innovation Laboratory for Enhancing WIC Services

The Hopkins role in collaboration with the USDA is to support and evaluate local efforts to develop interactive tools, technical resources, or innovative solutions that improve customer service and thereby improve retention. To achieve this objective the Hopkins Participant Research Innovation Laboratory (HPRIL) will execute and manage a competitive research program in which up to five local agencies(Sub-Grantees) are chosen for an 18 month period to develop and test innovative projects to improve participation and retention. While the overall objective is to improve child retention, the specific focus of the HPRIL project, is local WIC agency use of their clinic-based management information system (MIS) to identify participants at a high risk for early termination. Priority will be given to projects that emphasize practical solutions that are innovative, replicable, and cost neutral.

A logic model will guide the nationally competitive selection of sub-grantees and serve as the basis for identifying metrics to evaluate process and outcome. The sub-grantee research projects utilizing the Local Agency (LA) MIS will both build on and extend our understanding of the complexity of the issue, the challenges inherent in identifying a solution while proposing innovative strategies to end early termination. The local WIC agency research will be continuously supported by HPRIL from inception to conclusion. Workshops, site visits, video and ongoing conference calls to establish a Collaborative Innovation Network (CoIN), augmented by identified HPRIL personnel immediately available to respond to sub-grantee enquires will ensure required support. HPRIL evaluation of grantee, sub-grantee and identified FNS projects will be a continuous and rigorous ongoing responsibility. Proposed strategies and solutions will be evaluated for their impact on participant satisfaction and retention. Results will be published and widely disseminated. A final product of this effort will be a manual for other WIC agencies on how to utilize the MIS to monitor and track participation, identify clients at risk for early intervention and develop enhanced WIC service strategies to enhance satisfaction and improve retention.

The HPRIL team has the qualifications, experience and expertise to successfully carry out this project. The research team supported by the institutional resources provides the necessary platform to address the multiple responsibilities in this cooperative agreement. The principal members of the Hopkins team have had decades of experience in researching multiple aspects of the WIC program, engaged in the clinical issues of the program and have participated in providing WIC services. In addition, the team members are experienced educators, preceptors and mentors; qualities that are important in training and guiding local agency professionals and staff members. The experience of each team member is reflected in their successful participation in numerous federally funded complex projects requiring a myriad of skill and expertise both individually and jointly that intersect with every skill required in this cooperative agreement.

The focus of the Hopkins’ project is to maximize the use of the information contained in the WIC MIS platform to identify children 1-4 years of age at risk for early termination from the WIC program. The MIS system is a rich database and an untapped resource to identify demographic patterns, client food behavior, and nutrition education compliance among other variables.

The MIS system allows for the opportunity to identify and pinpoint gaps in service, test innovations and harvest data to evaluate outcomes within a framework that is cost-neutral and scalable nationally. This has been demonstrated in WIC related research focused on retention and is underscored by Whaley et al (2017), Colorado WIC (2015) and Sekhobo et al (2017). MIS are relatively new and vary by state, they can be exploited as a tool for quality improvement research.

Supporting WIC agencies in utilizing their MIS for identification of participants at risk for early termination is consistent with an identified national priority to improve access to timely data to evaluate the impact of WIC services and leverage best practices across State agencies (Geller et al., 2016). Moreover, WIC State and local agencies are interested in moving from reactive standard reports to proactive data analytics. To do this, state and local agencies must work with MIS and system reports to understand the potential of the system to improve their work and inform policy decisions on a local and state level.

The project will solicit proposals from local WIC agencies and will emphasize the use of the MIS to identify the population at risk for prematurely withdrawing from WIC and to evaluate the impact of their proposed innovative intervention to improve retention. They will be required to propose two subprojects 1) that will be common across all sub-grantee projects and 2) a project which will link WIC MIS with available eWIC (EBT) and mWIC (mobile) technologies or other tools to test and evaluate their impact on the participation/retention problem they identify. HPRIL will support the local agency in the design, execution, evaluation of their project and dissemination of their findings. In addition to the dissemination of the projects, a final product of this program will be a manual for other WIC agencies on how to harness the power of their MIS to conduct this type of work, thus multiplying the reach and capacity building of this USDA/FNS investment in WIC-related research.

For more information, please send your inquiries to the HPRIL inbox.