State & Local WIC Agencies

Local WIC Agency Survey Items: Post-Implementation (P2)

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OMB Clearance Number: 0584-NEW Expiration Date: xx/xx/2011

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-NEW. The time required to complete this information collection is estimated to average 90 minutes per response. If you have any comments concerning the accuracy of time estimates or suggestions for improving this form, please contact: U. S. Department of Agriculture, Food and Nutrition Service, Office of Research & Analysis, Room 1014, Alexandria, VA 22302.

ello, my name is [INTERVIEWER]. Thank you for taking time today to help us. I spoke with you a few months ago over the phone and want to follow-up now that your State has implemented the WIC food package changes. You may recall I work for Abt Associates Inc., which is conducting a study sponsored by the U.S. Department of Agriculture’s Food and Nutrition Service to learn about the recent changes to the WIC food packages for postpartum women and infants.

The information will help us understand how the recent food package changes were implemented in your local agency/clinic. Your input is important to help us understand the different issues surrounding these changes and how your local agency/clinic addressed them.

The interview will take approximately 90 minutes. Your responses will not be attributed to you but will be merged with responses from other interviews we conduct in your local agency/clinic to create an overall summary of the implementation process. Do you have any questions before I begin?

[Answers for questions in italics given during P1 interview will be reviewed to see if any of these things have changed in the interim]

General Site Characteristics

1. How many staff members work in your agency? How many (if any) clinics do you have and what are the types of communities that they serve?

2. What are the racial/ethnic characteristics of the WIC participants you serve? (Make sure adds up to 100%) Approximately what proportion are recent immigrants?

3. Are pregnant women routinely given information from WIC staff about breastfeeding prior to delivery? If so, when is this information given? How is it communicated? (Obtain copies of any written materials.)

4. During certification appointments for pregnant and postpartum women, are food package options typically discussed with WIC participants? (always, often, occasionally, rarely, never). Is this done with all WIC participants or only with certain ones? Please specify.

5. During follow-up or Nutrition Education Sessions, are food package options typically discussed with the WIC participant? (always, often, occasionally, rarely, never)

6. During voucher pick-up, are food package options typically discussed? (always, often, occasionally, rarely, never)

7. How long does a certification appointment usually take for a postpartum woman? For an infant? How much time, if any, is spent discussing food package options for mother and infant?

8. How often do postpartum women change food packages during the first month? (e.g., from breastfeeding to non-breastfeeding)? (often, occasionally, rarely). How much of an administrative burden does this present?

Breastfeeding Information and Support [Answers from P1 interview will be reviewed to see if any of these things have changed in interim]

9. What proportion of your staff who see WIC participants have received a lactation counselor certificate or lactation management training? Which staff receives training? How often do they receive it?

10. Do you have a lactation consultant on staff? How many FTEs?

11. Please answer the following questions for the local hospital where WIC participants served by your agency most frequently deliver. (Obtain name of hospital. If two hospitals equally serve WIC participants, obtain information for both).

1. Has this hospital been designated a Baby-Friendly Hospital, as outlined by UNICEF and the World Health Organizations?

2. Is there rooming-in for newborns?

3. Are mothers encouraged to breastfeed within the first hours after birth?

4. Are breastfeeding infants routinely given any supplementation, including water?

5. Are formula discharge packs provided?

6. Are there lactation consultants on staff?

7. Has hospital staff received training in lactation management in the last 3 years?

8. Does the hospital have any discharge lactating support programs?

9. Does WIC staff provide education to newly delivered women in the hospital?

10. Are WIC certifications of newly delivered women and their infants done while in the hospital?

12. Does your agency have a Loving Support breastfeeding program or other peer counseling program? If yes, please describe.

1. How many women do peer counselors contact in the average month?

2. If you have a grant, what is its size?

3. Did your agency receive other funding for peer counseling, and if so, how much?

13. In addition to any peer counseling your agency may offer, does your agency provide other breastfeeding promotion services or programs (e.g. support groups, classes, educational materials) for WIC participants?

1. If yes, please indicate the breastfeeding promotion activities available to WIC participants in your local agency:

• Media campaigns and /or posting materials in public places

• Making lactation consultants and other trained specialists available to WIC participants

• Support groups or classes

• Equipment (e.g., pumps)

• Peer counseling or other counseling to WIC participants that is different than Loving Support peer counseling

• Special training to nutritionists and other WIC staff, hotline, other.

Implementing Food Package Changes for Postpartum Women and their Infants

14. Please describe how the changes to postpartum food packages were implemented. What were your biggest logistical issues? How did you address them?

15. What systems, if any, were changed or put in place to accommodate the Interim Rule. (computers, printers, software, new forms, etc.)? Were they implemented?

16. How long did it take to fully implement these changes? Did it take shorter or longer than you expected?

17. Please describe any problems, if any, which occurred during implementation. Did any of these problems affect the process of providing women with the correct food packages? How long did the problems last and how were they fixed?

18. Were any staffing changes made as a result of the implementation of the Interim Rule? (new hires, changes in job descriptions, added job responsibilities, other)

Information and Support to WIC Staff on Food Package Changes

19. How did the process of information dissemination to local WIC agency staff work? (i.e., Did the State agency inform WIC directors who in turn informed their staff?)

20. How was WIC staff informed of the food package changes? (through meetings, trainings, written materials, other)

21. Did the staff receive written materials about the new food packages for partially breastfeeding women and their infants?

1. What kind of written materials did they receive? (posters, pamphlets, manuals, other) [Collect examples]

2. Who provided the written materials?

3. How were these materials used?

22. What kind of training did the following Local WIC Agency staff receive?

1. WIC Director:

2. WIC Nutrition Staff:

3. WIC Peer Counselor Staff:

4. WIC Clerical Staff:

5. Other WIC Staff:

23. How many times did the staff receive training?

1. WIC Director:

2. WIC Nutrition Staff:

3. WIC Peer Counselor Staff:

4. WIC Clerical Staff:

5. Other WIC Staff:

24. Who conducted the training for the following staff?

1. WIC Director:

2. WIC Nutrition Staff:

3. WIC Peer Counselor Staff:

4. WIC Clerical Staff:

5. Other WIC Staff:

25. What did staff like about the new food package for breastfeeding women and infants in general? What didn’t they like?

26. What types of questions did local WIC staff have about the new food package changes for partially breastfeeding women?

27. What types of concerns did local WIC staff have about the new food package changes for breastfeeding women and infants? (e.g. increased workload; concerns for WIC participants; concern regarding understanding the changes; other).

28. How were these questions and concerns addressed? (additional training or meetings; changes in written materials; additional communication; etc)

29. Overall, how supportive were WIC staff about the food package changes for women who partially breastfeed?

Information on New Postpartum Food Packages

30. Did you inform WIC participants about the food package changes for partially breastfeeding women and infants? If yes, how were they informed? (notified by mail, phone, in person, other).

31. When were WIC participants informed of the changes? (at certification or follow up appointments? By phone or mail prior to appointments?)

32. Were the changes publicized within WIC clinics? If so, how were they publicized (posters, pamphlets, verbally by staff, written on vouchers)

33. Were any written materials explaining the changes provided to WIC participants [collect copies]? Were the materials directly handed to the WIC participants or were they available to pick up? Were the materials written in languages other than English? If so, what languages?

34. Were the written materials prepared by the State office or by a staff member in your local agency?

35. Who was responsible for explaining the changes to the WIC participants? (nutritionists, clinic assistants, clerical staff, other)

36. How were the changes explained (from a nutritional, practical, monetary or other standpoint)?

37. Did communication to WIC participants about the partial breastfeeding changes go according to plan? Explain.

38. Other than local WIC agencies, were the food package changes communicated to other places in the community? If so, where? (local physicians, hospitals, health centers, stores, community or daycare centers, schools, churches, other) How was this information communicated (written materials, posters, word of mouth, information sessions, other)?

39. Did community-focused communication about changes go according to plan? Explain.

Food Package Use of Postpartum Women

40. How well do you think WIC participants understand the differences between the full- and partial- formula packages?

41. What were WIC participants’ reactions to the food package changes? Did they have any concerns and if so, what were they? How did you address these concerns? Did these concerns change over time?

42. What are the reasons WIC staff hear from participants as to why they change from exclusively breastfeeding to another package? To what degree does the content of the food packages affect these decisions?

43. If a women switches to packages with more formula, how much time generally passes before they switch? Have you seen this time period change with the implementation of the Interim Rule?

44. Do you think these changes are due to problems with breastfeeding? If they are due to breastfeeding issues, what steps do you generally take, if any? (refer to peer counseling or other breastfeeding supports) How effective are these steps?

Effects of Food Package Changes

45. How do you think the Interim Rule change as related to fully and partially breastfeeding participants has affected breastfeeding initiation? Duration? Intensity?

46. Do you have any supporting data or is this purely anecdotal?

47. Do you track the effects of postpartum food package changes on breastfeeding outcomes? If yes, please explain how.

48. Do you collect data on initiation, duration or exclusivity (intensity) of breastfeeding? If so:

1. How are these data collected? (paper or electronic reports, entered into state or local database, survey sent by state to all LWAs).

2. How are these data used? (Needs assessment, reporting to State, local evaluation of Loving Support program, other).

49. Were there any program changes based on the results?

Abt Associates Inc. Local WIC Agency Interview Questions_P2 6