State, Local, or Tribal Government Responsive

Appendix F.3

WIC local agency staff case study interview protocol

OMB #0584-XXXX

Public Burden Statement

This information is being collected to assist the Food and Nutrition Service to better understand the implementation and impact of the Special Supplemental Nutrition program for Women, Infants and Children (WIC) modernization efforts on WIC State and local agencies, WIC vendors and WIC participants. This is a voluntary collection and FNS will use the information to monitor and strengthen WIC program modernization efforts. This collection does not request any personally identifiable information under the Privacy Act of 1974. 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-[xxxx]. The time required to complete this information collection is estimated to average 60 minutes (1.0 hours) per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Service, Evidence, Analysis, and Regulatory Affairs Office, 1320 Braddock Place, 5th Floor, Alexandria, VA 22306, ATTN: PRA (0584-xxxx). Do not return the completed form to this address.

Expiration Date: XX/XX/20XX

WIC & FMNP MODERNIZATION EVALUATION
WIC Local Agency Staff Case Study Interview Protocol

NOTE: This protocol is a guide not a script. It has been developed to use with staff from local agencies and clinics participating in the case studies. Interviewers will need to ask questions that are relevant to the specific agency and focus of their modernization activities and will need to tailor or add probes to further explore the responses provided.

A. Introduction

Hello, my name is [NAME], and I work for [Mathematica/MEF/NPI]. We are researchers working with USDA’s Food and Nutrition Service (FNS) to learn about how WIC modernization projects are going. In an effort to increase WIC/FMNP participation and improve the WIC/FMNP participant experience, FNS is working with State and local agencies (as well as key partners) to modernize the programs. Today’s interview is part of a study to help FNS better understand the experiences of local agencies with the modernization activities. We want to learn from you about what has gone well, what has been challenging, and how program changes have affected you and your agency. FNS will use this study to inform future modernization efforts.

This interview should take about one hour. Before we start, I want to let you know that participating in this interview is voluntary and we will keep your identity private, except as required by law. We’d like you to answer as many questions as you can, but you may refuse to answer any question and you can stop the discussion at any time. There are no risks or benefits to participating in this study and interview. We can leave a copy of this consent statement with you for your records.

We will take notes during the interview and, with your permission, record it to make sure we didn’t miss anything in our notes. [IF INTERVIEW IS ON A VIDEOCONFERENCE PLATFORM: we would like to audio and video record this interview]. No one outside our research team will listen to the recording or be able to read the notes. We will combine your responses with those of others we interview and present a summary of the information in our public evaluation reports; you and your agency will not be individually identified. We will destroy the recordings and the notes at the end of the project. You can contact the survey director, Caroline Lauver, at [EMAIL] or [PHONE] if you have any questions.

Do you give your permission to record this interview? (Yes/No) – IF YES, PRESS RECORD

Do you agree to participate in this study and this interview? (Yes/No)

Do you have any questions before we start?

B. Respondent and local agency or clinic background

Interviewer instructions: Fill out the background information before the interview and confirm during the interview with this set of questions. Ask this set of questions for all respondents.

First, I’d like to confirm a few things about [LOCAL AGENCY/CLINIC NAME], your current job position, and the population your organization serves:

1. [JOB POSITION/TITLE] is your official job title or position, correct?

2. How long have you held this position?

3. [IF OVERSEES OTHER CLINICS] How many WIC clinics does your organization oversee?

4. Please describe the communities your [local agency/clinic] primarily serves, including whether the communities are rural or urban and the primary language(s) spoken by the populations served.

Interviewer instructions: Now ask the respondent the following questions to understand which modernization activities they are aware of and can answer questions about. This will guide which questions you will focus on during the interview. Depending on what we want to learn, we may focus on one modernization activity and area or several activities that span multiple areas. Be sure to tell the respondent the time frame we are referring to.

The [STATE NAME] [WIC/FMNP] State agency is implementing several efforts to modernize [WIC/FMNP]. Today, we’d like to discuss the following activities that have taken place in the last [TIME FRAME] at your local agency. Please let me know how familiar you are with the following:

1. Are you familiar with [ACTIVITY 1]?

2. Are you familiar with [ACTIVITY 2]?

3. Are you familiar with [ACTIVITY 3]?

Interviewer instructions: Based on the respondent’s answers indicating which activities they are familiar with, only ask the sets of questions relevant to those activities in this interview.

C. Outreach, services, and support to WIC applicants and participants

Interviewer instructions: Customize this set of questions based on information learned from the document review completed before the interview. You may also use information from previous rounds of interviews to customize this protocol. You may be using some of the questions to confirm information.

I’d like to ask you some questions about your experience and [LOCAL AGENCY/CLINIC NAME]’s experience carrying out some of the outreach, services, and activities to support WIC applicants and participants. We want to hear about what has gone well and what has been challenging over the last [TIME FRAME].

ONLINE APPLICATION

Does your [agency/clinic] use an online application? By online application, we mean an online form or website that allows potential participants to start the application process for WIC services. This form or website is more detailed than simply an online interest form and it collects baseline data ahead of certification. If yes, ask the below set of questions:

1. Does [LOCAL AGENCY NAME] own the online application or is it owned by the State agency?

1. IF OWNED BY STATE AGENCY: Please describe how the State agency communicated with you and [LOCAL AGENCY NAME] about the online application.

2. Was training provided for staff to use the online application? IF YES: How was training provided? Who provided the training? Did you feel confident after training to rollout the online application?

2. Please describe the type of online application your agency uses. For example, what type of information does the online application collect and where is that information saved?

3. What did the rollout of the online application look like for you and [LOCAL AGENCY NAME]? By rollout, I mean the process of sharing the online application with WIC-eligible individuals and getting them to use it.

4. What tasks and what staff were part of the rollout process? Did you have enough staff to do these tasks? Did staff need training for implementing and supporting use of the online application?

5. When did the online application become available to potential WIC participants?

6. How has the online application changed the certification process for applicants, including the certification appointment?

1. In your opinion, how has the online application made the certification process easier or more difficult for potential participants?

2. What percentage of applications are now coming through online versus other channels?

7. In what ways has the online application changed how staff process applications and conduct certification appointments?

8. Please describe your experience with the online application, such as being notified about application data, accessing that data, entering it into MIS, and then using that data. What has gone well and what has been difficult.

1. How has the use of this online application affected collection of proofs (i.e., income, identification and residence documents)?

9. Have you heard from WIC applicants and participants about their experience using the online application? IF YES: What have they shared with you?

1. What do WIC applicants/participants like about the online application?

2. Are there barriers to WIC applicants/participants using the online application? Please describe.

3. How have you and your staff helped applicants/participants overcome these barriers?

10. Would you make any changes to the online application to make it more useful or easier to use? Please describe.

1. Would you add any features or change existing ones?

2. What barriers, if any, have staff faced when trying to retrieve and use information from the online application?

11. Thinking about the online application, if you had to give advice to another local agency or clinic just starting to roll it out, what would you tell them?

1. What has worked best?

2. What would you do differently?

12. Have you used FNS’ Online Application Toolkit to help you with the online application process?

1. IF YES: What did you think about the Online Application Toolkit? In what ways was it helpful? Do you have any suggestions for improving it?

2. IF NO: Are you aware of the FNS Online Application Toolkit? Do you have any barriers to using it?

OUTREACH TO POTENTIAL PARTICIPANTS

1. We understand that outreach is happening at [State and/or local agency] level(s) as part of your State agency’s modernization efforts. Please describe the outreach activities your local agency is leading and/or conducting in partnership with other organizations.

1. Which outreach activities seem to work best and why?

2. What barriers have you faced as you’ve implemented these outreach activities?

2. What did the rollout of the outreach activities look like for your local agency? By rollout, I mean the process of getting outreach activities out into the community to reach WIC-eligible people.

1. What tasks and what staff were part of the rollout process? Did you have enough staff to do those tasks? Did staff need training for implementing or supporting the outreach activities?

2. What was the timing of the rollout of these outreach activities? By this, I mean when did you and your local agency start conducting these outreach activities in your community?

3. If your [LOCAL AGENCY/CLINIC NAME] uses data sharing activities to guide outreach to potential WIC participants, could you tell me about what this process looks like? Data sharing is when data from healthcare providers or other programs, such as SNAP or Medicaid, is used to identify WIC-eligible individuals. This data sharing process can help inform outreach activities to potential WIC participants.

1. What has gone well with the data sharing activities and what has been challenging?

4. How satisfied are you with your local agency or clinic’s outreach activities to potential participants?

1. What contributed to your level of satisfaction or dissatisfaction?

2. What could improve your satisfaction with the outreach activities? What changes would you make to the types of outreach or ways that your [agency/clinic] conducts outreach to potential participants?

5. Thinking about the outreach activities that we’ve discussed, if you had to give advice to another local agency or clinic just starting to roll them out, what would you tell them?

1. What has worked best?

2. What would you do differently?

VIRTUAL APPOINTMENTS

These next questions are about virtual appointments – in other words, appointments for activities such as certification, nutrition education, and breastfeeding education, promotion, and support that are not in-person. Does your clinic offer virtual appointments? If yes, ask the below set of questions:

1. Please describe how your clinic operates virtual appointments. For example, what type of staff conduct virtual appointments? What type of skillset do you like these staff to have? Are staff who conduct virtual appointments in the office or working hybrid/from home?

2. Do virtual appointments take place via phone, via video, or both? What virtual platform do you use (for example, Zoom, Skype, etc.)?

3. What type(s) of appointments are typically held virtually – for example, certification, nutrition education, and breastfeeding support? What types of activities or tasks typically happen during a virtual appointment?

1. Can everything be completed through a virtual appointment, or are any WIC applicants and/or participants still required to come in person to complete their specific appointment? Please describe.

2. Does your agency have access to WIC applicant/participant data via something like a Health Information Exchange or through doctors/health care providers to help with this process? Please describe.

4. How are applicants and participants made aware of the availability of virtual appointments? Are virtual appointments geared towards all WIC applicants and/or participants or are they available only under certain circumstances (e.g., personal preference, weather emergency, transportation issues, medical conditions)? Please describe.

5. What did the rollout of the virtual appointments look like for your local agency? By rollout, I mean the process of making virtual appointments available to WIC applicants and/or participants.

6. What tasks and what staff were part of the rollout process? Did you have enough staff to do those tasks? Did staff need training for implementing or supporting virtual appointments?

7. What was the timing of the rollout of virtual appointments? By this, I mean when did you and your local agency start conducting virtual appointments for WIC applicants and/or participants?

1. Were there changes in the timeline for rolling out virtual appointments? What led to these changes?

2. IF OFFERED BEFORE 2022: Since 2022, have there been any changes or improvements in the virtual appointment process?

3. Today, what proportion of appointments are virtual compared to in-person?

8. Did you upgrade or obtain any new hardware or software to be able to offer virtual appointments or improve the virtual appointment experience?

1. IF SOFTWARE UPDGRADED – please describe what software was upgraded and whether it has also been integrated into the MIS.

2. IF VIRTUAL APPOINTMENTS ARE OFFERED FOR CERTIFICATION: Does your MIS allow staff to select the date the anthropometric data was provided from another source or is the date of the appointment automatically selected for that data?

9. How have virtual appointments changed how you and your clinic staff deliver services to WIC applicants and/or participants? For example, what activities happen ahead of time to ensure all certification information is available and staff can complete a full assessment (i.e., anthropometric/bloodwork data, income, residency, and ID verifications)

1. In what ways have virtual appointments made it easier to deliver services?

2. In what ways have virtual appointments made it harder to deliver services?

10. Have you heard from WIC applicants and/or participants about their experience participating in virtual appointments? IF YES: What have WIC applicants and/or participants shared with you about their experience with virtual appointments?

1. What do WIC applicants and/or participants like about the virtual appointments?

2. Are there barriers to WIC applicants and/or participants using virtual appointments? Please describe.

3. How have you and your staff helped applicants and/or participants overcome these barriers?

11. What do you and other staff at your local agency think about virtual appointments – what has your experience been like using them?

1. What do you like about virtual appointments?

2. Are there barriers to conducting virtual appointments?

3. Would you make any changes to the way you or your agency/clinic conducts virtual appointments to make them more useful for you and/or WIC applicants and/or participants?

12. Thinking about virtual appointments, if you had to give advice to another agency or clinic just starting to roll them out, what would you tell them?

1. What has worked best?

2. What would you do differently?

DIGITAL SERVICES

Now I’d like to ask you some questions about your [agency/clinic]’s digital services, which are the tools or products you use to deliver WIC services. These services could include, but aren’t limited to, things like appointment scheduling tools, electronic document sharing or signatures, text messaging tools, MIS, mobile apps, or a participant portal.

1. Have you and [LOCAL AGENCY/CLINIC NAME] started using any new digital services in the last [TIMEFRAME]? Which ones?

2. Please describe what implementation has looked like for [DIGITAL SERVICES]. We understand that many of these services are launched at the State agency level – how did local agency staff support this implementation?

1. What digital services came from the State? What digital services, if any, came from the local level?

2. What has been easy and what has been hard to make available to WIC applicants/participants in terms of digital services?

3. What software is used with the different digital services?

4. What did the rollout of each [DIGITAL SERVICES OFFERED] look like for you and [LOCAL AGENCY NAME]? By rollout, I mean the process of giving staff and WIC applicants and/or participants access to [DIGITAL SERVICES OFFERED] and getting staff and applicants and/or participants to use them.

1. What tasks and what staff were part of the rollout process for each [DIGITAL SERVICE OFFERED]? Did you have enough staff to do those tasks? Did staff need training for implementing and supporting the use of [DIGITAL SERVICES OFFERED]?

2. When did each [DIGITAL SERVICES OFFERED] become available to WIC applicants/participants?

5. Are any of the [DIGITAL SERVICES OFFERED] integrated into your agency’s MIS? Please describe what this integration looks like and how it helps with the use of these digital services.

6. How have the [DIGITAL SERVICES OFFERED] changed the process for applicants/participants getting information from the program? In what ways have [DIGITAL SERVICES OFFERED] changed how staff deliver information and services to WIC applicants/participants? ASK THIS QUESTION AND PROBES FOR EACH DIGITAL SERVICE OFFERED.

1. In what ways have [EACH DIGITAL SERVICE OFFERED] made this process easier?

2. In what ways have [EACH DIGITAL SERVICE OFFIERED] made this process more difficult?

7. How do you feel about [DIGITAL SERVICES OFFERED]? Please describe your experience using these services, such as what you’ve liked about them as well as any difficulties you’ve encountered.

   1. What contributed to your level of satisfaction or dissatisfaction?

8. Have you heard from WIC applicants or participants about their experience using the [DIGITAL SERVICES OFFERED]? IF YES: What have they shared with you?

1. What do WIC applicants/participants like about [DIGITAL SERVICES OFFERED]?

2. What are barriers to applicant/participant use of [DIGITAL SERVICES OFFERED]?

3. How have you and your staff helped applicants/participants overcome these barriers?

9. Would you make any changes to [DIGITAL SERVICES OFFERED] to make them more useful to you?

10. Would you make any changes to [DIGITAL SERVICES OFFERED] to make them more useful to WIC applicants/participants?

11. Thinking about [DIGITAL SERVICES], if you had to give advice to another agency or clinic just starting to roll them out, what would you tell them?

1. What has worked best?

2. What would you do differently?

PARTICIPANT COMMUNICATION

1. Have you and [LOCAL AGENCY/CLINIC NAME] started using any new communication tools and methods in the last [TIMEFRAME] to communicate with WIC participants? (IF NEEDED: These could be tools like emails, chat bots, messages/notifications through the WIC mobile app, text messages, two-way texting, or an updated website).

2. What do you and [LOCAL AGENCY/CLINIC NAME] staff communicate with WIC participants about? What types of messages are sent through which channels? These could include things like appointment reminders, benefit reminders, program changes, local agency events, and so on?

1. Can participants opt-in to communications by topic or only by channel (e.g., could a participant request appointment reminder texts, but not recipe texts)? What does the opt-in process look like?

3. What types of communications are sent from the State agency and which ones are sent from your local agency?

1. What is the process of planning and coordinating these messages, both within your agency and with your State agency?

2. What staff skills and how much staff time are needed to manage these communication tools?

4. How have these communication tools changed the way you deliver services, or the way participants receive services?

5. What are the language needs of the WIC participants and applicants in your community, and how are communication tools being used to meet those needs?

1. Which communication tools are working well for meeting the language needs of WIC participants and applicants in your community?

2. What are opportunities for improvement when communicating with WIC participants and applicants with different language needs? What additional resources and tools would help?

3. How often do you and your staff encounter difficulties communicating when working with WIC participants that have limited English proficiency (LEP)?

4. What strategies are you and your staff using to overcome those communication difficulties?

6. Overall, have you noticed whether these communication tools and methods have had a positive impact on service delivery? For example, are there fewer missed appointments, more participants making and keeping appointments?

1. How are you measuring what is working/what isn’t working? Is there data you are reviewing or metrics you are relying on?

7. Would you make any changes to the communication tools or methods to make them more useful or easier to use? Please describe.

8. Thinking about the new communication tools and methods, if you had to give advice to another agency or clinic just starting to roll them out, what would you tell them?

1. What worked best?

2. What would you do differently?

D. Improving shopping education and the shopping experience

Interviewer instructions: Customize this set of questions based on information learned from the document review completed before the interview. You may also use information from previous rounds of interviews to customize this protocol. You may be using some of the questions to confirm information.

I’d like to ask you some questions about your experience and [LOCAL AGENCY/CLINIC NAME]’s experience with supporting and educating in-person shopping for WIC participants. We want to hear about what has gone well and what has been challenging over the last [TIME FRAME].

SHOPPER EDUCATION

1. How do you educate and prepare participants to shop for WIC-approved foods?

1. What is working well about this education and preparation process? What are opportunities for improvement?

2. How much time do you spend in a typical certification appointment preparing WIC participants for their first shopping experience? Do you feel this is enough time to prepare participants for shopping? If not, what are the challenges?

3. What are your priorities during the shopper education and preparation process? (For example, EBT, the State WIC app, the WIC Shopper app, food list education, how to find products in-store, how to shop online?)

4. Are there any other ways you support educating participants as they prepare to shop for WIC approved foods?

5. Over the last [TIMEFRAME], how has shopping education during WIC appointments changed?

   1. How are these changes meant to improve the in-store shopping experience for WIC participants?

SHOPPING EXPERIENCE

1. Have you heard from WIC participants about their experience shopping for WIC-eligible products in-person? IF YES: What have WIC participants shared with you?

1. What do WIC participants like about the in-person shopping experience?

2. Do WIC participants share any challenges with you about the in-person shopping experience? Please describe. How do WIC participants try to overcome these challenges?

3. How can the local agency address challenges with in-person shopping? Are there any digital solutions that your agency uses to resolve in-person shopping challenges?

2. Over the last [TIME FRAME], how has in-person shopping changed for the WIC participants you support? Please describe. Changes could include things like electronically redeeming their benefits at the store using mobile pay or purchasing WIC products using self-checkout.

1. How are these changes meant to improve the in-person shopping experience for WIC participants?

2. How are you measuring success?

3. Have you or staff at [LOCAL AGENCY/CLINIC NAME] supported these changes in any way? Please describe.

3. What did the process look like for informing WIC participants about these changes to the in-person shopping experience?

1. What staff were involved in this process? Did you have enough staff to accomplish this process?

2. What was the timeline for making WIC participants aware of the changes? Did this timeline vary for any reason (across the area or community)?

WIC APP SHOPPING TOOLS.

1. Approximately what percent of your participants are using the [STATE WIC APP]?

2. How do you and [LOCAL AGENCY/CLINIC NAME] help or support WIC participants in using the shopping tools in the [STATE WIC APP]? For example, do you tell participants about the app, do you encourage or help them download the app?

1. Do you have access to the app? Are people in your office trained to use the app? Specifically, the shopping related features in the app?

2. Do you show WIC participants how to use the app and its shopping related different features (e.g., scanner, store locator, benefit balance)? If not, why not?

3. Have you heard from WIC participants about their experience using the shopping tools in the [STATE WIC APP]? IF YES: What have WIC participants shared with you?

1. What features do participants use most or find the most helpful?

4. Do you have access to the app usage data? For example, data on the most used features, etc.

1. IF YES: how does this impact how you support participants?

2. IF NO: how would access to this type of data help you?

E. Adding online shopping

Interviewer instructions: Customize this set of questions based on information learned from the document review completed before the interview. You may also use information from previous rounds of interviews to customize this protocol. You may be using some of the questions to confirm information.

Now I’d like to ask you some questions about your experience and [LOCAL AGENCY/CLINIC NAME]’s experience with supporting online shopping for WIC participants. We want to hear about what has gone well and what has been challenging over the last [TIME FRAME].

1. What does the online shopping experience look like for the WIC participants you support? Please describe. (IF NEEDED: This could include the ability to redeem WIC food benefits online, then scheduling a time for curbside pickup or home delivery).

1. How are these changes meant to improve the shopping experience for WIC participants?

2. How do you or staff at [LOCAL AGENCY/CLINIC NAME] promote the online shopping experience to WIC participants? Please describe.

2. What did the process look like for informing WIC participants about the addition of online shopping?

1. What staff were involved in this process? Did you have enough staff to accomplish this process?

3. What was the timeline for making WIC participants aware of the ability to shop for WIC products online? Did this timeline vary for any reason (across the area or community)?

4. How have you or staff at [LOCAL AGENCY/CLINIC NAME] supported WIC participants with WIC online shopping? Please describe.

5. Have you heard from WIC participants about their experience shopping for WIC-eligible foods online? IF YES: What have WIC participants shared with you?

1. Have WIC participants shared with you or staff at [LOCAL AGENCY/CLINIC NAME] a positive online shopping experience? Please describe.

2. Did WIC participants experience any challenges with the online shopping experience? How did WIC participants try to overcome these challenges?

3. Do participants seem to prefer online shopping or in-person shopping? Please describe.

F. Improving the farmers’ market shopping experience

Interviewer instructions: Customize this set of questions based on information learned from the document review completed before the interview. You may also use information from previous rounds of interviews to customize this protocol. You may be using some of the questions to confirm information.

I’d like to ask you some questions about your experience and [LOCAL AGENCY/CLINIC NAME’s] experience supporting farmers’ market and/or roadside produce stand shopping for WIC/FMNP participants. We want to hear about what has gone well and what has been challenging over the last [TIME FRAME] with supporting electronic benefit redemption at farmers’ markets and/or roadside produce stands (including WIC CVB and FMNP eSolutions).

1. When WIC participants shop at a local farmers’ market and/or roadside produce stand, are they able to transact the WIC CVB? This could include using a WIC EBT card or mobile pay, for example.

2. IF YES to Q1: Are you or staff at [LOCAL AGENCY/CLINIC NAME] involved in carrying out or supporting WIC CVB transactions at the local farmers’ market and/or roadside produce stand? Please describe.

1. IF YES: What has worked well and what would you do differently?

3. IF NO to Q1: What are the barriers to being able to transact WIC CVB at farmers’ markets/roadside produce stands?

4. What did the process look like for informing WIC participants about transacting the WIC CVB at farmers’ markets/roadside produce stands?

1. What staff were involved in this process? Did you have enough staff to accomplish this process?

5. What was the timeline for making WIC participants aware of the changes? Did this timeline vary for any reason (across the area or community)?

6. When FMNP participants shop at a local farmers’ market and/or roadside produce stand, are they able to transact their FMNP benefits electronically? This could include eSolutions such as a mobile application, EBT card, or a printed or scanned QR code.

7. IF YES to Q6: Are you or staff at [LOCAL AGENCY/CLINIC NAME] involved in carrying out or supporting these eSolutions at the local farmers’ market and/or roadside produce stand? Please describe.

1. IF YES: What has worked well and what would you do differently?

8. IF NO to Q6: What are the barriers to being able to transact FMNP benefits electronically?

9. What did the process look like for informing WIC participants about transacting their FMNP benefits electronically at famers’ markets/roadside produce stands?

1. What staff were involved in this process? Did you have enough staff to accomplish this process?

10. What was the timeline for making WIC participants aware of the changes? Did this timeline vary for any reason (across the area or community)?

11. Can participants use the same eSolution to transact both their monthly WIC CVB benefits and their FMNP benefits electronically?

1. IF NO: What are the barriers to being able to transact their FMNP benefits and their WIC CVB benefits using the same eSolution?

12. Do your participants talk with you about the farmers' market and/or roadside produce stand? What do they say about it? Do they talk to you about using their WIC EBT card or FMNP eSolution at the farmers' market and/or roadside produce stand? IF YES: What have WIC/FMNP participants shared with you?

1. What do WIC/FMNP participants like about using a WIC EBT card or an eSolution at the farmers’ market and/or roadside produce stand?

2. Have WIC participants told you about any challenges using a WIC EBT card or an eSolution at the farmers’ market and/or roadside produce stand? Please describe.

G. Supporting the workforce

Interviewer instructions: Customize this set of questions based on information learned from the document review completed before the interview. You may also use information from previous rounds of interviews to customize this protocol. You may be using some of the questions to confirm information. These questions should be asked to local agencies involved with the workforce subgrants and/or the infrastructure subgrants.

Now I’d like to ask you some questions about your experience and [LOCAL AGENCY/CLINIC NAME]’s experience with efforts meant to support the WIC workforce and your staff’s ability to support participants of different backgrounds, as well as to address barriers to staff recruitment and retention. We want to hear about what has gone well and what has been challenging over the last [TIME FRAME]. I also want to note that this information will not be shared with your colleagues, or your local agency/clinic and you will not be identified in any way.

1. INFRASTRUCTURE – MIS. We understand that WIC staff have many responsibilities and sometimes technology can be used to help staff more quickly and easily serve WIC participants, such as through scheduling appointments or accessing participant records. Has your local [AGENCY/CLINIC] implemented any technology since 2022 to help staff more easily and efficiently serve WIC participants? Please describe.

1. In what new or improved ways have staff been able to use the MIS to help them better serve WIC participants?

2. In what other ways could the MIS be used to help staff work more efficiently?

2. WORKFORCE PREP TO SERVE PARTICIPANTS OF DIFFERENT BACKGROUNDS. Overall, do staff at [LOCAL AGENCY/CLINIC NAME] feel equipped and trained to provide quality services and support to WIC participants of different backgrounds?

1. Do staff have enough information about participants’ cultural food preferences to serve them? How do staff obtain this information?

2. How do your staff serve limited English proficiency (LEP) WIC participants? For example, what languages are WIC resources in? Do these languages reflect the WIC community your agency serves?

3. What has gone well with serving WIC participants of different backgrounds? What are opportunities for improvement?

3. WORKFORCE PREP TO SERVE PARTICIPANTS OF DIFFERENT BACKGROUNDS. Have staff at [LOCAL AGENCY/CLINIC NAME] participated in any trainings related to providing care that is tailored to meet participants’ social, cultural, and linguistic needs over the last [TIMEFRAME]? IF YES: What organization/company offered the training(s)?

1. When did these trainings take place and how often?

2. What topics did these trainings cover? Some examples include but are not limited to: tailoring nutrition counseling or motivational counseling to participants of different backgrounds, communicating with participants of different backgrounds, trauma-informed practice, etc.

3. How were the trainings meant to build staff’s skill set? How did staff incorporate training materials into their workflow?

4. WORKFORCE RECRUITMENT/RETENTION/GROWTH. First, I’d like to confirm that the following types of staff are employed at [LOCAL AGENCY/CLINIC NAME]: LIST STAFF TYPES – AND GATHER ANY ADDITIONAL TYPES OF STAFF NOT COVERED.

5. Please describe the staff recruitment process at [LOCAL AGENCY/CLINIC NAME] for [LIST RELEVANT STAFF POSITIONS]. What recruitment tactics are being used and how do they differ for the various staff positions?

1. What types of recruitment challenges does your local agency encounter? Do they differ depending on the staff positions? Are there any staff positions that are particularly difficult to recruit for and why?

6. Please describe staff retention at [LOCAL AGENCY/CLINIC NAME] for [LIST RELEVANT STAFF POSITIONS]. What tactics does your organization use to retain staff and how do they differ for the various staff positions?

1. What types of retention challenges does your local agency encounter? Do these challenges differ depending on the staff positions? Are there any staff positions where it is particularly difficult to retain staff and why?

7. Please describe what career mobility and growth opportunities look like at [LOCAL AGENCY/CLINIC NAME] for [LIST RELEVANT STAFF POSITIONS]. How does your local agency/clinic support career mobility/growth opportunities for the different staff positions? Does this support differ depending on the staff position and, if so, how?

1. What types of barriers are there for career mobility or growth opportunities for the different staff positions? What are some of the causes behind these barriers?

2. How do you try to help the different types of staff overcome career mobility barriers?

8. I’d like to close out this section by asking you a few questions about your own career at [LOCAL AGENCY NAME]. What successes and barriers have you personally experienced with growing your career at [LOCAL AGENCY/CLINIC NAME]?

1. What led to these successes?

2. What led to these barriers? How did you try to overcome them?

9. Are there other supports or resources you wish were available to help you grow your career and skill set at [LOCAL AGENCY/CLINIC NAME]? Please describe.

10. How does your agency/clinic show it supports and values staff’s knowledge of the needs of participants of different backgrounds and the lived experience of its staff? Please describe.

H. Closing

Interviewer instructions: Conclude the interview by thanking the participant for their time.

Thank you so much for speaking with me today. I don’t have any further questions. Do you have anything more you’d like to share that we haven’t already discussed?