PART Il LOCAL AGENCY OPERATIONS

SECTION A LOCAL AGENCY CHARACTERISTICS

5. How many WIC participants did your agency serve as of November 19927 [/nsert number for each
type of participant.]

Number of Participants
Pregnant women
Breastfeeding women
Postpartum women
Intants
Children
Total

TT

6. Which one of the following WIC service settings best describes your local agency? [Check the box
next to the best description -- check only ONE box.]

State health agency
District health agency
Multi-county health agency
Single county health agency
Municipal health agency
Community health agency
Community action agency
Indian health agency
Public hospital

Private voluntary hospital
Private proprietary hospital

Other (specify

noaadcanonanaaAaaADA

10


When you have completed this questionnaire, please be sure you have entered your name, title,
Phone number, and date on page 2 of this questionnalre. A mailing envelope with postage has
been provided for your use. In case the envelope was lost, please send this questionnaire to:

WIC Dynamics
Atin: CSO
Macro International
8630 Fenton Street, Suite 300
Sliver Spring, Maryland 20910

Again, we thank you for your cooperation. Your answers will be extremely helpful to understanding
what Is happening In the WIC program across the nation.

31



33. In what language(s), other than English, is nutrition education provided in your local agency?
[Check the box next to each language that applies.]

Spanish
Vietnamese
Cambodiar/Khmer

Laotian

Thai

Hmong

Chinese

Haitian/Creole

French

Portuguese

Native American Language
Sign Language
Other [specify]

onoa0gen oaeanaaaA

34. Are any nutrition education services currently retmbursed by Medicaid? [Check one.]

O Yes
O no
Os Dont know

35a. During a 6-month certification period, how often does a participant receive nutrition education?
[Please all that apply for each type of participant.)

High Risk Non-High Risk
Participant Participant

Once per certification period oO Oo

Twice per certification period
Monthly
Bi-monthly (every 2 months)

Other (specify)

27


PART! CHANGES IN THE WIC PROGRAM AND THEIR IMPACTS ON STATE

ta.

AGENCIES

Since 1988, there have been many changes in WIC. Infant formula rebates and additional funding
have increased participation, and new program requirements have been placed on the WIC program
(e.g., drug abuse education, breastfeeding promotion). In addition, many states and local
communities have suffered economic hardships. Below is a list of events, requirements, and
circumstances that may have affected the way state WIC agencies operated between 1988 and 1992.
Please review the following list and indicate for each item whether the item affected the WIC program
in your state between 1988 and 1992.


PART! CHANGES IN THE WIC PROGRAM AND THEIR IMPACTS ON LOCAL

AGENCIES

SECTION A GROWTH AND CAPACITY

ta.

1b.

2a.

Since 1988, this agency's caseload has: [Check one.]

Stayed About

How would you characterize these changes In caseload? [Check one.]

No changes in caseload since 1988

Generally steady growth

Generally steady decline

Growth every year, with one or more years of peak growth
Decline every year, with one or more years of sharp decline
Constant up and down fluctuations, with no peaks

Constant up and down fluctuations with peak growth

Constant up and down fluctuations with sharp declines

Haadagagaoanad

Other [specify]

How close are you to operating at maximum capacity (relative to the size of your WIC caseload
and your capability to deliver services effectively)? [Check one.]

If your agency tapped all of the resources you know to be currently available to you, up to how many
more WIC participants could you serve while maintaining your current level of services? [Please
estimate to the nearest 100. Insert number below.)



SECTION E QUALITY

18.

19.

What are the five most important factors that currently promote high-quality WIC services in your
state? [Please list those factors that relate to your state agency.)

1.

2.

3.

4

5.

What are the five most important factors that currently hinder high-quality WIC services in your
state? [Please list to those factors that relate to your state agency.]

sro pn

SECTION F CAPACITY

20a.

20b.

In your opinion, at what capacity are local agencies in your state currently operating? [Check only
ONE box.]

O Far above capacity

1 Somewhat above capacity

TD at capacity

DD somewhat below capacity

© Far below capacity

If your current local sponsoring agencies tapped all of the resources you know to be currently

available to them, how many more WIC participants could your state serve while maintaining the
current level of services? [Please estimate to the nearest 100. insert number below.]

13



14. Listed below are 11 factors that the state agency may consider when assigning caseload Increases
or decreases to a local agency. Please read the entire list and then rank the factors by whether they
are very important, somewhat important, not very important, or not used. Please use the following
scale to rate the factor: 1= very important, 2= somewhat important, 3= not very important, 4= not
used.

© The state agency considers the local agency's Affirmative Action Ranking when allocating
caseload slots to local agencies.

© the state agency considers the percent of potentially eligible being served by the local
agency.

D The state agency considers the local agency's historical ability to serve the number of caseload
slots allocated to it.

( The state agency considers the WIC priority groups currently being serviced by the local
agency.

O The state agency considers new or expanded services for high-risk maternity patients at a
local agency.

( The state agency considers whether matemity care Is co-located with WIC services.
The state considers first any areas which remain unserved in the state.

© The state considers the average food cost per participant in a local agency.

TD The state considers the local agency's Proven ability to grow at a certain rate.

CO The state agency considers management or staffing problems which might hinder the local
agency's ability to serve participants.

DD The state considers factors other than those listed here which it considers important in
allocating caseload limits. They are:

0 other [please specity]

O other [please specify]

"



25d.

Is the level of automation described above a change in automation since 1988? [Check all
applicable boxes.]

0 No change.

(© small shit from local recordkeeping to centralized state processing.

LD. Large shitt from local recordkeeping to centralized state processing.

CO smail shitt from central state processing to more locally based processing.

oO Large shift from central state processing to more locally based processing.

. Was there a shift in the type and location of equipment since 19887

STATE LEVEL [Check only ONE box.]

CO ves, there is substantially more mainframe equipment used.
CO Yes, there somewhat more maintrame equipment used.

C1 No significant change.

D yes, there is somewhat less mainframe equipment used.
( Yes, there is substantially less malntrame equipment used.
LOCAL LEVEL [Check only ONE box.]

D Yes, there is substantially more mainframe equipment used.
LD Yes, there somewhat more mainframe equipment used.

1 No significant change.

D Yes, there is somewhat less mainframe equipment used.

DO Yes, there is substantially less mainframe equipment used.

17





10.

11.

Check the box opposite the statement that best describes this state's method of computing
administrative funding formulas for its local agencies. [Check only ONE box.]

1 The state considers historical conditions of the local agencies such as the number of participants
they have served in the past, the local agency infrastructure, the local agency's willingness to
serve more participants, etc.

C The state considers other factors about the local agency service area such as statistics about the
number of people potentially eligible for WIC, the area's poverty level, birth and death statistics,
high risk matemity statistics, and/or the percent of need being met by the program currently.

CO The state agency considers most of the factors listed in A and B.

CO The state agency considers conditions other than those listed in A or B. They are:

How long has the current method of determining local agency administrative grants been in
place?

Enter approximate month and year when currem method began: Z

How many times during the most recently completed Federal fiscal year (October 1, 1991 to
September 30, 1992) did the state allocate or re-allocate administrative funds to local agencies?

Enter number of administrative funding allocations and re-aliocations

Indicate the percentage of administrative funds used for local level expenses and the percentage
of state-level expenses for the previous fiscal year. [Insert percentage.]

% local level
% state level


13. Overall, has there been a change in the level of funding for items such as space utilities, equipment,
or other expenses since 1988? [Check the box under the appropriate column.]

Funding for
Non-Labor Items

Wic FUNDED:

Space

Utilities

Computer equipment

Medical equipment or supplies

Educational equipment or supplies

Other (such as office supplies, travel, etc.)

(Please specify)

oo gogaagag agg
oad ooooaa
oo anaaad
oo gaaoaaadda

NON-WIC FUNDED:

Space

Utilities

Computers

Medical equipment or supplies
Educational equipment or supplies

Other (such as office supplies, travel, etc.)

(Please specify)

oOo agaaoagoaoddn
oo aagqaogadn
oo oooagagn0
oo agaooaado

14





Sampling and Estimation Section 5(3)
nS

Sample Size

The determination of the exact number of agencies to be sampled was based on whether or not
the agencies were affected by factors related to Federal and State legislative and regulatory
initiatives and by growth patterns during the period of study. This required analysis of the
participation patterns for States using FNS-191 information between 1988 and 1991, as well as
identification of those States that were influenced by cost-containment and other factors that
would have affected participation. For a random sample of 250 agencies, the 95 percent
confidence interval of an estimate at the local agency level for population estimates would be
plus or minus 5.74 percent in the case of a categorical variable where 50 percent answer each
way (the worst case scenario) when one corrects for the number in the population. These figures
apply to a random sample, and to the extent that stratification is effective or not, the number
would vary. We therefore estimated, from partial review of one FNS file, that we would need
a sample between 250 and 300 agencies.

The sample was set at 300 local agencies as listed in the FNS-191. Of these, 16 were
nonrespondents; resulting in 284 local agencies went into the final sample.

Stratification

The FNS-191 files for 1987, 1989, and 1991 were merged, even though there was no unique
identifier that permitted an exact merger. The State agency codes changed from year to year and
the local agency IDs also did not seem to be completely well defined. A match was made on
State postal code and local agency ID, and where local agency IDs were duplicated (presumably
because they were associated with different State agencies), a match on city was required. On
examination of the files, it was found that there were a number of false matches and presumably
some failures to match. Thus an exact determination of which agencies exhibited change was
not possible. Even on examining the name and address, one was not always able to tell whether
one was dealing with the same agency or not.

However, an exact determination was not needed. A stratification variable was established
separating slow growth agencies from the rest. Slow growth was defined as less than 10 percent
growth. Being classified in this category meant a match had to have taken place (and on
examination of cases, it seems that a true match was accomplished in most cases). The purpose
of matching was to ensure proper representation of slow growth and fast growth agencies. A
stratification with a small number of misclassifications is still useful as a means of increasing
precision. The sampled units were later reclassified for analytic purposes.

A second variable was defined as to whether or not the growth from 1987 to 1989 expressed as
a percentage was greater than the growth from 1989 to 1991. Thus overall growth and timing
of growth formed a two-way stratification of the sample. Each of the four cells was ordered by
region and the frame was ordered by size within cells.


29b. What were the main difficuities? {Check all that apply.}
O We have not experienced problems obtaining needed services
Services not available or available on a limited basis.
Waiting list for services.
WIC participants not eligible for needed services.
Services not offered during convenient times.

Lack of or limited transportation to access services.

oHoaodaaa

Other [specify]

a

Other [specify]

30. Since 1988, in how many of your clinics has there been a change in the amount of staff time spent
on referrals for participants? If your agency has more than 6 clinics, please provide estimate for
the 6 largest clinics. [Enter the number of clinics.]

Time on Referrals
Substantially © Somewhat About Somewhat = Substantially
Less Less the Same More More
Number of clinics
spending:
SECTION D NUTRITION EDUCATION

31. Enter the number of staff responsible for nutrition education duties who are licensed, registered,
or eligible for registration as a dietician. [Complete all categories that apply]

Total Statf
Licensed/registered/certitied or eligible for registration

Paraprofessionals (less than a 4-year degree)

Other professionals (i.e. nurse, health educator or others with a 4-year degree)

25


7. What is the best description of the geographic area served by your local agency? [Check the box
next to the best description - check only ONE box.]

gnogqgqgaandoaaAdg ao

o

A single neighborhood

A group of neighborhoods

Acity

A portion of one county (or parish)
One county (or parish)

Portions of several counties
Multiple counties or parishes

A state-designated health district: Enter number of counties

Special populations throughout the state [For example, the local WIC agency serves a special population
group regardiess of place of residence in the state. A public hospital drawing high risk, indigent matemity patients
from a wide area of the state might fit this designation.)

The entire state: Enter number of counties

The next series of questions are about your clinic/service sites.

8. Please enter the total! number of local agency service sites that provide any type of WIC services.

8b.

8c.

8e.

Enter number of sites:

How many of these sites provide all the following WIC services: certification, nutrition
education, and tood instrument [e.g., voucher] issuance?

Enter number of sites:

How many sites have health care services available on site or available within the same
building complex?

Enter number of sites:

How many sites have social services available on site or available within the same building
complex?

Enter number of sites: ___

How many sites operate on a part-time basis? [Part-time means the site offers WIC services
only some days or some portions of each weekday.)

Enter number of sites:
How many sites operate with extended hours, offering weekend or evening hours?
Enter number of sites:

"


16a. Please check the category that describes whether it is difficult to recrult and hire staff for vacant
staff positions. [For each type of staff, check one box.]

Staff Positions No Vacancies Not Difficult Difficult
Professional o ob o

Paraprofessional o o o
ClericaVsupport Oo o o

16b. Has the degree of difficulty recrulting and filling vacant staff positions changed since 19887
[Check one.]

Less Difficult About the Same More Difficult

o Oo Oo

17. What were the main problems filling vacant positions? [Check ail that apply.]

Os There were no problems
Oo Hiring freeze
Oo Shortage of certain types of staff

[specify]
Salary and/or benefits not competitive

Poor working conditions
Safety of the facility and/or neighborhood

Other [specify]
jat were the main problems contributing to high staff turnover? [Check all that

z~oaqQqaa

18.

a

There were no problems

Salary and/or benefits not competitive
Poor working conditions

Safety of the facility and/or neighborhood
Work load

Low morale

goqgo00c0o00 Og

Other [specify]

7


11a. Do you currently use any contract or consulting staff to provide WIC services? [Check one.]

O Yes
O No

11b. If yes, how many staff are consultants or contract staff?

Enter number of staff:
What positions do they hold? /Please specify ]

11¢. How many staff travel from one site to one or more other WIC sites to provide WIC services?
[Enter the number of staff in each category]

Professional
Paraprofessional
Clerical/support

12. For each of the following non-labor items, check the box which best describes the funding source.
{Check the box under the appropriate column.]

Non-Labor Items Exclusively Exclusively Funded Exclusively Funded by a Combination of
Funded by by a Non-WIC Charitable = WIC, non-WIC Government
wic Government Source Sources and/or Charitable
Sources

Space Oo o oO Oo
Utilities oO o Oo

Computer equipment oO o oO

Medical equipment oO o o

Educational equipment o o Oo

(audio/visual)

Other (specify)

ooa
ooo
ooo



32. In the table below, please indicate the nutrition education topics offered during the past year.
[Check the boxes that indicate the method used to deliver the information. Check all that apply.]

Topics Offered in Not Verbal Printed Audio/Visual Computer-
Nutrition Education and Offered Presentation Materials Assisted
Counseling Sessions, by (Group or

Delivery Method Individual)

Management of the oO Oo oO im} o

individua!'s certified
nutritional risk or medical
condition (e.g., anemia)

Importance of nutrition to o o o im o
participant's health status

Description of basic good o o o Oo i]
diet

Major nutrients provided

Wwe” FO GO OF 0
Other sources of particular oOo oOo o Oo oO
nutrients such as iron,

Vitamin A, and Vitamin C

\ of diet for f

Importance diet for fetal o o o oO i]
Breastteeding Oo o im im} Oo
Handling of infant formula oO o oOo oOo o
Use of whole cow’s milk o o o oO o
Solid and table foods o bo im] Oo o
I f nutri

monn OO 0 0 a Qo
Nutritious snacks oO 0 Oo oO i]
Dental heath o oOo Oo Oo Oo
Risks of substance abu

fincluding drugs. smoking, 0 o oO Oo Oo
coffee, alcohol]

Other [specify] o ob oO Oo Oo



oo0o00eqcod
oaonoogo0a0n

g
3

gooogo0n0ognoo0o0o0go0000 oo aaqg

ooooooooo0ood AaAooa Ooo aad

issued muttiple food instruments

Issued single food instrument

Issued standard packages more often

Prepared food instruments before determining eligibility
Implemented classes on how to use food instruments
Wrote food instrument at local agency level
Computer-generated food instruments at local agency
Other [specify]

Began appointment system or rigorously held to appointment schedule
Over-booked WIC participant appointments

implemented less flexible clinic activity schedules (limiting services to a particular type
at a particular time or on a particular day)

implemented more flexible clinic activity schedules

Extended clinic hours beyond regular business hours, such as Saturday, early moming,
or evening clinics

Shortened clinic hours

Extended clinic days of service (for clinics not typically open every day)

Cut back on days of service (for any clinic)

Other [specify]

Utilized volunteer staff to a greater extent

Utilized volunteer staff to a lesser extent

Utilized contract/consuttant staff to a greater extent

Utilized contract/consuttant staff to a lesser extent

Used more itinerant staff (who traveled to the various sites)
Used less itinerant staff (who traveled to the various sites)
Used more paraprofessional statt

Used fewer paraprofessional staft

Used more clerical staff

Used fewer clerical staff

Used more professional staft


PART IV RELATED PROGRAM INITIATIVES

26.

27.

30.

Have coordination efforts involving WIC and other programs, such as maternal and child health
programs, as well as Medicaid, changed since 1988? [Check only ONE box.]

© Yes, they have substantially increased
C Yes, they have somewhat increased
O Yes, they have somewhat decreased
D Yes, they have substantially decreased
D1 No, they stayed about the same

In your state, does the Medicaid program currently reimburse for WIC services, such as nutrition
education? [Check only ONE box.]

Dyes

0 No

CO Don't know

Does the WIC program currently participate in any Joint program efforts with the health department,

maternal and child health providers, and other agencies to provide services to women and young
children? [Check only ONE box.]

D ves, toa large extent [please specify}

OD No, not at all

Does the WIC program participate in any initiatives to improve the Immunization status of young
children? [Check only ONE box.]

o Yes, to a large extent [please specify]

0 no, not at all

in your state, do WIC applicants need to visit a physician or other non-WIC clinic prior to
certification to obtain biochemical and anthropometric data or to verify pregnancy? [Check only ONI
box.] .

D yes
DI no

19





SECTION C REFERRALS
27. On Site Health Care Services.

For the following health care services, please estimate the number of clinics at which service is or
is not available on-site. If your agency has more than 6 clinics, please provide estimates for the 6
largest clinics. (Enter the number of clinics.]

Health Care Services Number of Clinics by Service Avallability
Available on Site Not Available on Site Don't Know

Dental care _
Obstetrical/gynecological care
Breastfeeding support program
Pediatric care

Family planning services

Immunizations

EPSDT

Other health screening
Medicaid screening
Other [specify]
Other [specify]
Other [specify]

28a. On Site Application for Other Services.

For the following non-health care referral services that may be available to a WIC participant,
please estimate the number of clinics at which the service is or is not available on-site. if your
agency has more than 6 clinics, please provide estimates for the 6 largest clinics. [Enter the number
of clinics.]

Number of Clinics According to Service Avallability
Available on Site | Not Available on Site Don't Know

AFDC

Food assistance programs
Social services program
Head Start

Child care

Transportation
Substance abuse counseling

Housing
Adult education/job training
Other [specify]
Other [specify]
Other [specify]

23


PART Ill PARTICIPANT SERVICES

SECTION A SERVICES OVERVIEW

23a. What is the variation and typical number of minutes that a WIC participant spends walting for
following WIC services: {f your agency has more than 6 clinics, please provide estimates for the 6

largest clinics. [Enter number of minutes.]

Walting Time

Variation in # Minutes

Certification

Typical #
Minutes

Group nutrition education

Individual nutrition education

Issuance

Food pick up

23b. How has the amount of time a WIC participant spends walting for services changed since 1988?
[Check one for each service.]

Watting Time

Decreased | About the Same
Certification

Group nutrition education

Individual nutrition education

Issuance

Food pick up

Increased

Not Applicable

20



Sampling and Estimation Section 5(5)
SS

used in this study. Indeed, since the sample was drawn systematically, there is no unbiased
estimate of the variance. However, there are a number of approximations that are commonly
used. The most common of these is obtained by collapsing the noncertainty units into strata of
two or three, where adjacent units in the systematic order are placed in the same stratum. Then
one calculates the variance for a PPS sample without replacement.

One must take into account that the sampling intervals do not correspond to where the size of
the local agencies will fall. Thus the probabilities of selection will not be exact but will be
sufficiently close to make the design correspond with a fair degree of accuracy to the one used.

The design was prepared such that each sampled unit was assigned to a stratum, corresponding
to the segment of the frame from which it was sampled. These were arranged so that the size
Measures were as equal as possible among the strata. Unit nonresponses also required special
treatment. Strata yielding unit nonresponse were omitted, but population counts for those strata
were added to the remaining strata. This is essentially equivalent to spreading nonresponse
across strata (since adjustments were made to the totals for the entire population). Then adjacent
pairs of strata were collapsed (with one collapsed cell of three sampled units). Certainty units
were assigned a cell of their own. All certainty units were respondents.

The SUDAAN procedure for unequal probability sampling of PSUs without replacement was
used. Joint probabilities of selection used the approximation presented by Hartley and Rao
(Hartley, H.O. and Rao, J.N.K. 1962. Sampling with unequal probabilities and without
replacement, Ann. Math. Statist. 33, pp. 350-374).

For most of the tables there was no second stage sample. The crosstabulation procedure was
used, using either the adjusted weights or the adjusted weighted participant counts as weights.
Because the weights had been adjusted to a fixed total, there was no variance in the total; instead
of using the variance of the weights, the product of the variance of the percentage and the total
count was used.

The exception was in the estimation of the variance for tables referring to principal clinics. Here
the agency weights had been adjusted, but not the principal clinic weights. It was decided that
the weight variances (which provide variances for the total) would present a conservative
estimate, given that they do not take into account the partial adjustment. Here a second stage
sample was defined, but one where 100 percent of the principal clinics were sampled.


Sampling and Estimation Section 5(4)
te i _ EEE

The FNS 191 files for 1988 and 1992 were obtained after the sample was drawn and the data
collected. These files did not enter into the draw of the sample but were used in adjusting the
weights and for analytic purposes.

Weights

Each agency was assigned an initial sampling weight 1/p where p is the probability of selection.
This probability is 1.0 for the certainty agencies and (k(n-c))/K’ where k is the agency size (the
transformed measure of the number of participants), n is the number of agencies sampled, c is
the number of certainty agencies, and K’ is the sum of the sizes of the noncertainty agencies.

After the data were collected, the weights of the noncertainty respondents were adjusted so that
the total weights would total to the number of local agencies in the 1992 FNS-191 file. After
the adjustment of the local agency weights, the weighted number of participants were adjusted
so that they would add up to the exact number of participants according to the same file.

Description of the Procedure Used to Draw the Sample

The 13 largest agencies (all agencies with over 30,000 participants) were first sampled with
certainty. Then the agencies were sorted by overall growth (slow versus fast), timing of growth,
region, and within region in descending order of size. The square root of the population was
calculated for each agency and the square roots were added. The total was divided by 287 (the
number of noncertainty agencies to be sampled) and this ratio became the interval size. At this
point it was verified that no agency’s size measure (square root of the participant total) exceeded
the interval size. A random number from 0 to the interval size was selected. The cumulative
sum of the size measures was obtained for each agency, thus defining a segment for each agency.
The agency in whose segment the starting point fell was sampled. Then one interval was added
to the starting point and the segment in which that number fell determined the next sampled
number. The process was repeated until all 287 noncertainty agencies were sampled.

To represent this quantitatively let X, ... X, represent the noncertainty agencies ordered by region
and size (the square root of the population) within region. Let s, .. 5, correspond to the measure
of size of each agency. Let b = (s, + 8; +... + §,)/287. Now let c, = s, + 5; + ... +s, where Cy
= 0. A random starting value e is selected between 0 and b. The sample is the set of
noncertainties X, for which ¢,, <e + ib Sc; for some integer i where 0 < i < 286.

Standard Error
Standard error estimations were carried out using SUDAAN (Professional Software for Survey

Data Analysis), software developed by Research Triangle Institute, that calculates Taylor series
standard error estimates. However, SUDAAN does not calculate standard errors for the design



Yes No

im] oO Used fewer professional staff

O C _ Cunailed or canceled staff meetings
DO D0  Cutback training activities for statt

OO increased training activities for staft

O 0 Other fspecity

Watting Lists

OT initiated or increased use of waiting lists
© C1 _ propped waiting lists

O C1 otter fspecity

Administrative

O OC Postponed or canceled special projects
oO Delayed completion of "paperwork" and reports
O OC Streamiined recordkeeping

O OC Streamtined case management

O Ds Made greater use of computers

O © tnereasea Paperwork

O (decreased paperwork

O OC sExpanded case management

O C1 Otter {specity)

Facilities

DO OC Moved to new facilities

O C1 Added clinic sites

DO CO Eliminated ciinic sites

O OC Made more efficient use of space

O C1  Cortocated with health care provider
O OD Other fspecity)

Other

OC. _ tnitiatea special projects

O C Piannea, scheduled, and held regular statt meetings
DO CO other [specityy

O ODO oOtner [specify]



Section 6

Survey Instrumentation


14a. We are interested in the current suitability of staffing — that is, the number of staff and the

appropriateness of their skills and experience. For each type of staff, please check the box that
describes the sufficiency of your current staff in terms of number of staff and appropriateness of
skills and experience. [For each type of staff check one box.]

Number of Staff

More Than Less Than Not
Sufficient Sutficient Sufficient Applicable

Professional

Paraprofessional

Clerical/support

Appropriateness of Skills and Experience in Providing Nutrition Education/Nutrition Services

"Suficlont” __Suffciont__‘SufteontTM _Appleable
Professional Oo Oo o o
Paraprofessional o o o o
Clerical/support o o o o

ristoness of Skills and Experience In Performing Non-Nutritiona! Services
Appropriateness (01g. referrats to social sorviews) rene

More Than Less Than

Sufficient Sufficient Sutticient Apy le

Not
plicabl
Professional o
go
QO

15


Section 5

Sampling and Estimation


4b. Since 1988, what have the major changes in state agency operations been? [Briefly describe below. ]
Since 1988 — Staffing:

Since 1988 — Funding policies:

Since 1988 — Nutrition education, including breastfeeding promotion and support and use of
standards:

Since 1988 — Coordination with other agencies and programs that serve WIC participants:

Since 1988 — Monitoring and vendor management procedures:

Since 1988 — Paperwork, including the development of request for proposals (RFPs):



IDENTIFYING INFORMATION

[LABEL]

Is information on the above label correct? If not, change any incorrect information. Thank you.
INSTRUCTIONS

Most of these questions should be answered by the WIC Director. Other WIC staff members may also
have information that will help in answering the questions.

In the space provided below, please enter your name, title, phone number, and the date on which you
compteted this questionnaire. Please write legibly in this section and throughout the questionnaire. You
may be contacted by staff from Macro International it any of your answers need clarification. tf you have
questions about any of the items please call Ms. Cindy Morgan or Ms. JoAnn Kuchak collect at (301) 588-
5484.

Your name:

Title:

Telephone Number:

Date:

To analyze your answers, we need to know if your agency was sub-divided or consolidated at any time
from 1988 to the present. Hf so, please list the name of each affected agency on the lines below and check
whether the agency was consolidated with your agency or split off from your agency.

Consolidated Separated
with From
oOo Oo
im} oO
o Oo
oOo Oo
Oo Oo



OMB Clearance No. 0584-0436
Expires December 31, 1993

LOCAL WIC AGENCY QUESTIONNAIRE
WIC DYNAMICS STUDY

INTRODUCTION

The WIC program has undergone many changes in the last few years. There have been some new
Program requirements and the number of WIC participants has grown nationally. These changes have
probably had an effect on your agency and have modified the way your agency provides services to WIC
participants.

Because the experience of your agency will assist in the planning for the future of WIC, we would like to
find out how the WIC program is operating in your agency and what concems you have. At the present
time there is considerable discussion about the impact of potential WIC funding and participation increases.
We are particularly interested in learning about how agencies currently operate, how this differs from the
past, and changes that might occur in the future.

This questionnaire has three major sections. The first section asks you to describe how you view changes
that have ocourred in the program since 1988. The second and third sections ask you to describe your
local agency and the services that you provide.


25f.

STATE LEVEL [Check only ONE box.

O ves, there is substantially more PC/mini-computer equipment used.
0 Yes, there somewhat more PC/min-computer equipment used.

D No significant change.

O Yes, there is somewhat less PC/mint-computer equipment used.

O Yes, there is substantially less PC/min-computer equipment used.
LOCAL LEVEL [Check only ONE box.)

O Yes, there is substantially more PC/min-computer equipment used.
O ves, there somewhat more PC/mint-computer equipment used.

© No significant change.

O Yes, there is somewhat less PC/mini-computer equipment used.
(Yes, there is substantially less PC/minl-computer equipment used.

Overall, how do you perceive that these changes in automation affected productivity and quality
in the program? [Check ONE box for productivity and ONE box for quality]

PRODUCTIVITY [Check one] QUALITY [Check one]

DD No effect in productivity CT No effect in quality

DO Substantial improvement CO Substantial improvement
(© Some improvement D some improvement

© some dectine : 0 some decline

CO substantial deciine OD substantial dectine

18




SECTION B CERTIFICATION

25. Please indicate the number of clinics in your agency that use the methods listed for obtaining
hematological measurements. If your agency has more than 6 clinics please provide estimates
for the 6 largest clinics. [Enter the number of clinics.)

Methods Typically Used Not Used Don’t Know
On site by WIC staff
On site by non-WIC staff

Off site by health care personnel; results
brought in by applicant

Off site by health care personnel; results
brought in by someone other than applicant

Other [describe]

26. In how many clinics are hematological measurements coordinated with local lead screening
efforts? If your agency has more than 6 clinics, please provide estimates for the 6 largest clinics.
[Enter the number of clinics.]

Number of Clinics

Coordinated with lead
screening

Not typically coordinated with
lead screening

Don't know


Since 1988 — State administrative rules, regulations, and policies:

Since 1988 — Quality of service:

Since 1988 — Other operational changes:



24a. What is the variation and typical number of minutes that a WIC participant spends recelving the
following WIC services? (i.e. personal transaction time) lf your agency has more than 6 clinics,
please provide estimates tor the 6 largest clinics. [Enter number of minutes].

Time Recelving Services
Variation in # Minutes | Typical # Not
Minutes | Applicable
Certification From to o
Group nutrition education (Not high From to o
risk)
Group nutrition education (High risk) From to oO
Individual nutrition education (Not high From to oO
risk)
Individual nutrition education (High risk) From to oO
Issuance From to o
Food pick up From to o
———|

24b. How has the amount of time a WIC participant spends receiving services changed since 19887
[Check one for each service.)

Time Receiving Services

Decreased About the Same
Certification o o o o

Group nutrition education

Individual nutrition education

Issuance

Food pick up

oaaoad
oocda
ooodo
oaaqda

21




10a.

8t. | How many of these sites have been established since 1988?

Enter number of sites:

8g. Since 1988, how many sites were eliminated or consolidated?

Enter number of sites:

Does your agency use vans, moblle untts, or other motorized facilities to provide WIC services?
[Check one.]

O yes
O No

Some local WIC agencies use staff funded from other sources. For the following types of staff
that perform WIC services, enter the current number of FTE positions (1 FTE = 40 hrs per week) by
funding source. [Enter number.]

]
‘Statf Number of Positions

Funded by a Volunteer/
Charitable

Professional

Paraprofessional

Clericalsupport

WIC tunded staff
Non WIC-funded staff

10c.

Do any non-WIC funded medica! care providers perform certifications? [Check one]

Dyes
O No

12


25b. What proportion of local agencies in your state are using mainframe support? [Check only ONE

box.]

OD an
D Most
0) some
O Few .

. Please indicate, for each functional area, the best description of the current state of automation in

WIC operations.
ENROLLMENT [Check only ONE box.]

D Local agencies fill out paper forms and send to state or contract agency for key entry into a
central database.

D tocal agencies key data on terminals linked to a central computer (state, regional or contractor
data processing center).

T Local agencies enter data on micro- or mini-computer and later transmit all or part to central
database.

0 other [please specity]
FOOD INSTRUMENT PRODUCTION [Check only ONE box.]

D state Produces bulk automated checks/drafts/vouchers and sends to local agencies; locals
write manual checks/drafts/vouchers.

D state Produces bulk automated checks/drafts/vouchers and sends to local agencies; locals
Produce "manuats” (i.e., first visit food instrument) using on-line terminals or computers.

DD Local agencies produce all food Instruments on-site using computers or terminals.

DO Etectronic Benefit Transter card is used.

CO otner [please specity)
APPOINTMENT SCHEDULING [Check only ONE box.]

1D There is only manual scheduling.

D There is automated scheduling on computer at local level, but it is not part of the state-wide
WIC data system.

O There is automated scheduling at the local level that is part of WIC state-wide data system.
D There is automated scheduling that is part of a local WIC data system.

D other jplease specity]

16


36b. Are the following nutrition education materials and methods used in group nutrition education sessions?
[Check one for each medium.]

| Group Instruction:

Lectures/oral discussions

<
tf

Pamphlets

Food models

Food demonstrations
Tests

Audio tapes

Slides

Films/videos
Flip charts

Computer-assisted
instruction

Oo00o0gagnv oo00n00
Oaag0g0gngovo vn oag0;

Other [specify]

37. In your opinion. what is the quality of nutrition education that your agency is currently able to offer
compared to the quality your agency provided in 19887 [Check one.]

Substantially Somewhat Lower About the Same Somewhat Higher Substantially
Lower Higher

Oo o 0 oO o

38. What are the barriers to your agency providing high-quality nutrition education? [Check all that apply.]

o
Oo
Qo
Oo
Do
oO
oO
o
o
Oo
oO

There are no barriers’

Space

Too few staff

Too little staff time per participant
Participant interest

Transportation

Child care

Participant time

Cultural issues/language difficulties
Difficulty recruiting qualified staff
Other [specify]

29



39. This agency provides nutrition education directly to: [Check all that apply.)

Caregiver of
infants
(0-12 months)

Caregiver of
children

Children

SECTION E QUALITY

40. In your agency, what are the flve most Important factors that currently promote high quality WIC
services to participants?

1.

41. In your agency, what are the flve most Important factors that currently hinder high quality wic.
services to participants?

1.

30



15.

In the past when you have had rapid growth in your caseload, what was the most frequently used
method the state agency used to increase caseload allocation limits to the local agencies? [Check
the box next to the statement that best describes your method.}

D. alt local agency caseload limits were increased systematically by a certain percentage without
taking other factors into consideration.

D Local agencies were asked how many participants they could serve and were generally increased
up to the level stated or requested.

D tocar agencies were only granted additional caseload slots if they met certain conditions (such
as that they must serve a certain proportion of pregnant women and infants, or must increase the
number of Priority 1 and/or Priority 2 groups served).

CO other [please specity)

O not applicable; we have not had rapid participant growth.

SECTION D STAFFING

16a. Has the state agency developed WIC local agency participant-to-statt ratlos [Check only ONE box]

D Yes{[piease specify}
Ono
16b. How long have participant-to-staff ratlos been in effect in your state? [Please enter the number of
years.] years
not applicable

17.

Are WIC-funded employees who work at the local agency level in the direct delivery of WIC service
considered to be: [Check only ONE box.]

(2 State employees (with salary and fringe benefits set by state personnel policies).

O District (mult-county) employees (with salary and fringe benefits set by statewide employment
policies).

Oo County employees (with salary and fringe benefits set by the various county govemment units).
Oo City employees (with salary and fringe benefits determined by city government units).
DD A combination of WIC employment settings exists.

© other [please specity]

12


19a. Retaining staff once you have hired them may also be a problem. Is it difficutt to fetain staff? [For
each type of staff, check one box.}

Not Difficult

Professional

Paraprotessional

| Clerical/support

19b. Has the degree of difficulty retaining staff changed since 1988? (Check one.]

More Difficult About the Same Less Difficult

Oo o o

20. Indicate the languages for which staff are available to act as interpreters for WIC participants.
[Check all that apply.]

Os Spanish
Vietnamese
Cambodian/Khmer
Laotian

Thai

Hmong

Chinese

Haitian/Creole

French

Portuguese

Native American Language
Sign Language
Other [specify]

nooooaaaanoaad

18



23a.

23b.

24a.

24b.

What is the average frequency of Issuing vouchers or food instruments to WIC participants?
[Check the box opposite the average frequency.]

© Less than one time a month
C1 once per month

LD once every 6 weeks

OD once every 2 months

0) once every 3 months

0 No issue schedule

O other [please specify]

Does this Issuance schedule vary across local agencies? [Check only ONE box.]

D ves, it varies significantly
O ves, it varies somewhat
T No, it does not vary

Have your food package Issuance policies and procedures changed since 19887 [Check only
ONE box.]

O ves
0 no
O Don't know

How many years have you been using current food Issuance policies and procedures? [Please
enter the number of years.]

years
. What proportion of the local agencies in your state are using PC or mini-computer support? [Check
only ONE box.]
Dal
D) Most
D some

O Few

15



provide national estimates of participants while maintaining adequate representation from smaller
agencies. In addition, many of the research questions were directed at examining agency
behavior and the impact that this behavior has on participants. Thus, it became as important to
adopt a sampling strategy that will allow us to say "X percent of participants are being affected
by nutrition education procedure Y," as it is to say to say "X percent of agencies use nutrition
education procedure Y” with maximum precision.

In general, the probability of selection according to PPS would have reflected the relative
proportion of participants served by an agency relative to all participants served. In contrast, the
probability of selection with simple random sampling would have been equal for all agencies.
In order to increase the opportunity of selecting larger agencies (to reflect issues concerning
number of participants) and yet to obtain a fair representation among smaller agencies (to address
issues related to agencies), we used a square root transformation that would attenuate the size
differences between agencies. The sample was selected with probabilities proportional to the
square root of the number of participants, enabling the research to address the needs for
information at both the participant and agency level.

Defining Local Agencies

Upon examination of the FNS-191, it became clear that the definition of “local” agency was
ambiguous. In some States (Delaware, Arkansas, Louisiana, Puerto Rico) there are no local
agencies per se. Instead, there is one local agency (the State) and numerous clinics. In others
(e.g., Oklahoma) there is one major agency as large as many State agencies and a few small
ones. Finally, there are some large city agencies that are also larger than many State agencies.

Based on conversations with the States, it was found that all had some type of administrative
units between the State and the clinics, generally in the form of a regional administrative unit.
However, the role of the regional level varies, and based on discussions with each State, it was
apparent that some of the local agency survey questions (e.g., staffing and budgeting) could best
be answered by the "State/Local" agency with the remainder answered by various regional staff.

Using regional administrative units as the definition of local agency would be inconsistent with
FNS practice and would affect the selection of local agencies in other States. This led to the
decision to sample as planned (defining a local agency to be one listed as such in the FNS-191
file for 1991, with number of participants greater than 0), but then to subsample the larger
agencies as needed to obtain information from the regional administrative units.

All agencies with more than 30,000 participants were sampled with certainty, and it is for this
set of agencies that sampling lower level units was considered. A total of 13 such agencies were
identified.


[Please check the appropriate box to indicate whether these changes impacted the WIC program.]

WIC PROGRAM CHANGES
1988 - 1992

i
ae
:

CASELOAD
Infant formula rebates

Other caseload increases or decreases
Other cost containment efforts
Other [specify]
ECONOMIC CONDITIONS
Federal funding policies
Availability of state funds for WIC
Downtum in local economies
State budget cuts
Food cost fluctuations
Other [specify]

NEW PROGRAM REQUIREMENTS
Breastfeeding promotion requirements

Drug abuse education requirements
Homeless service requirements
Immunization requirements
Prenatal care initiatives
Vendor management initiatives
Other [specify]

OTHER FEDERAL INITIATIVES

Medicaid expansion (expanded eligibility
for Medicaid)

Coordinatiorvintegration of services (e.9.,
one-stop shopping, self-sufficiency programs)

Other [specify]

OTHER FACTORS
Computerization/automation initiatives

OOH o800 @000000 Q2@A000Gad ooaa
00 g00 O000000 AangonooOooO aanag

i)
oO
oO
QO
Oo
o
Oo
oO
oO
Oo
o
i)
oO
Oo
o
oO
oO
oO
o
o
oO

Other [specify]


IDENTIFYING INFORMATION

[LABEL]

Before completing this questionnaire, please review the information on the above label and change any
incorrect information. Thank you.

INSTRUCTIONS

Most of these questions should be answered by the state WIC Director. Other staff members may also
have information that will help in answering the questions.

In the space provided below, please-enter your name, title, and phone number, and the date on which you
completed this questionnaire. Please write legibly in this section and throughout the questionnaire. You
may be contacted by staff from Macro International if any of your answers need clarification. if you have
questions about any of the items please call Ms. Cindy Morgan or Ms. JoAnn Kuchak coliect at

(301) 588-5484. °

Your name:

Title:

Telephone Number:

Date:

CONFIDENTIALITY

Although we ask for identifying information for follow-up, your responses will be held contidential by Macro
International and names will not, under any circumstances, be shown to USDA/FNS. Responses will not
be attributed to you or your state. All information obtained from this survey will be presented in the
aggregate or contained in a computerized file of responses without identifiers.

OUR THANKS

We know how busy all WIC staff are and are grateful for your cooperation. We hope you view this as an
opportunity to be heard and have input into decisions made at the national level.


SECTION B PROGRAM CHANGES

3. Since 1988, there have been many changes in WIC. infant formula rebates and additional funding
have increased participation, and new program requirements have been placed on local WIC
agencies (e.g., drug abuse education, breastfeeding promotion). In addition, many states and local
communities have suffered economic hardships. Below is a list of events, requirements, and
circumstances that may have affected the way local agencies provided WIC services between 1988
and 1992. Please review the following list and indicate for each item whether the item affected your
local WIC agency.

[Please check the appropriate box to indicate whether these changes had an impact on the delivery of
services at your agency.]

WIC PROGRAM CHANGES

1988 - 1992
No Not

Changes Impact Impact Applicable
CASELOAD FLUCTUATIONS

Caseload increases o oO im}

Caseload decreases o o Oo

Reprioritizing or targeting caseload o o im]

Other [specify] im] Oo oO
ECONOMIC CONDITIONS

Federal funding Oo Qo Qo

Availability of state funds for WIC Oo oOo im

Availability of local funds for WIC o i] o

Downtum in local economy Oo Oo Oo

State budget cuts o Oo oO

Food cost fluctuations o o oO

Infant formula rebates O oO Oo

Other [specify] Oo o Oo



PART Ill WIC PROGRAM INITIATIVES

21a.

21b.

2tc.

Has the state developed and implemented WIC program performance standards? [Check only
ONE box.]

O ves, they are developed and in use

LD Yes, they are under development

O No, we have not developed program standards

Do these standards include nutrition education and nutrition services? [Check only ONE box.]
0 Do not use standards

DD Yes, the standards primarily focus on nutrition education

D Yes, the standards focus somewhat on nutrition education

0 No, the standards do not address nutrition education

Does the state agency use these standards to monitor or evaluate local agencies? [Check only
ONE box]

D. Do not use standards

D ves, they are used for monitoring

O Yes, they are used for evaluation

D Yes, they are used for monitoring and evaluation activities

D No, they are used for other activities [please specify]

Does the state WIC agency currently sponsor any of the following breastfeeding promotional
activities? [Check ail applicable boxes.]

D Providing materials—such as pamphlets, posters, etc.
© Co-sponsoring local activities

TO Hot lines

D0 Public Service Announcements

U1 Coordinating with hospital maternity wards

LD. inservice training programs

0 Peer counseling program training

C1 other [please specify]



31a. Are there other new program efforts targeting low-income women and young children currently
underway in your state that relate to and impact the WIC program? [Check only ONE box.]

O yes
DI No

31b. If so, please briefly describe what these program efforts are.

When you have completed this questionnaire, please be sure you have entered your name and title,
phone number, and date on page 2 of this questionnaire. A mailing envelope with postage has
been provided for your use. In case the envelope was lost please send this questlonnalre to:

WIC Dynamics
Attn: CSO
Macro International
8630 Fenton Street, Suite 300
Silver Spring, Maryland 20910

Again, we thank you for your cooperation. Your answers will be extremely helpful to FNS.

20

st US. GOVERNMENT PRINTING OFFICE: 1995 386-124/00572 -—=



4. Please identity the changes that have taken place since 1988. [Check all applicable statements.]

Certitication

Yes No

Stopped doing walk-in certifications

Started doing walk-in certifications

Scheduled less time per certification per person
Scheduled more time per certification per person
Replaced one-on-one interviews with self-administered forms
Conducted group certifications

Dropped group certifications

Reduced priorities served

Limited caseload to certain priorities

Added priorities served

Other [specify]
Nutrition Education

Increased group nutrition education

0Dao0o0googggagono
onogo0o0oocgconoo0 go

Canceled or postponed group nutrition education

Canceled individual sessions

Added more group nutrition education sessions and offered fewer individual sessions
Added more individual nutrition education sessions and offered fewer group sessions
Placed more emphasis on breastfeeding

Increased statf time per participant in nutrition education

Decreased staff time per participant in nutrition education

Relied more on paraprofessionals to deliver nutrition education

Used more handouts and pamphlets to supplement or minimize staff

Increased class sizes

Decreased class sizes
Other [specify]

oo0000gc ooo 0gn 00
noaonoonooononoongnnood0



Sampling and Estimation Section 5(1)

Respondent Universe

There were three components to the study:
. A survey of State agencies;

. A survey of local agencies; and

. A set of case studies of local agencies.

The respondent universe was composed of all WIC State and local agencies funded by the U.S.
Department of Agriculture, Food and Nutrition Service (FNS). This included agencies in all 50
States, the District of Columbia, Commonwealth of Puerto Rico, the Virgin Islands, and Guam.
The case studies were limited to local agencies in the continental United States.

The State Agency Mail Survey was a census survey. All 85 State agencies, including those
operated by Indian Tribal Organizations, were surveyed. The case studies were purposively
selected. Thus the sampling issues, including weighting and variance estimation, refer
exclusively to the Local Agency Survey.

Objectives of the Local Agency Sample Design

The goal of the local agency sampling design was to provide estimates on selected current
operating features of local WIC agencies, to determine the extent to which change has occurred,
and to assess the impact of changes on these features. The focus of the research is on local WIC
agencies’ decisions to implement certain procedures or to modify practices between 1988 and
1993. Thus, as one objective, it was necessary to use the local agency, which is the main
decision-making unit, as the unit of analysis. As a second objective, it was important to estimate
the number of participants who have been affected by changes.

General Sampling Design

Any sample design for the present study had to take these two objectives into account and try
to balance them. The difference between the two objectives requires some discussion. Since the
overriding interest is to obtain national estimates at the participant level (i.e., the number of
participants affected), the preferred method of sampling agencies is to sample with probabilities
proportional to size (PPS). But PPS sampling would have resulted in underrepresentation of
smaller agencies (in the sense that a very small proportion of such agencies might be selected).
Pure PPS would have resulted in a sample with a strong predominance of larger WIC agencies.
On the other hand, if a random sample had been drawn, participants from larger agencies would
be underrepresented. We therefore needed to develop a method that would have allowed us to


35b. What type of session does your agency employ to provide nutrition education? [Please check all
that apply for each type of participant]

High Risk Non-High Risk
Participant Participant

Individual oO Oo

Small group (2-9)
Medium group (10-19)
Large group (20-29)

Very large group (30+)

36a. Are the following nutrition education materials and methods used in Individual nutrition education
sessions? [Check one for each medium]

Individual Instruction:

Verbal discussion’ counseling
Pamphlets

Food models

Food demonstrations

Tests

Audio tapes

Slides

Films/videos

Flip charts

Computer-assisted instruction

ooooc0aogoo0o0o0 08

Yes
Oo
Oo
Oo
Oo
o
im
Oo
oO
Oo
Oo
Oo

Other [specify]

28



14b. Please identity how the suitabllity of you! staff has changed since 1988. For each type of staff,
please check the box that describes the change in the sufficiency of your staff relative to 1988 in
terms of size and appropriateness of skills and experience. [For each type of staff, check one box.]

Number of Staff
More Than No Change Less Than Not
Sutticient Sufficient Applicable

Appropriateness of Skills and Experience in Providing Nutrition Education/Nutrition Services

More Than No Change Less Than Not
Sufficient Sutficient Applicable

Appropriateness of Skills and Experience in Performing Ni
(og. referrals to social services)
More Than No Change Less Than Not
‘Sufficient Sufficient Applicable

araprofessional

lerical/support

15. Enter the number of vacant positions that your agency currently has. [Enter number.)

Number of Current
Vacant Positions
Professional
Paraprofessional
Clerical/support
Total

16





PART Il STATE AGENCY DESCRIPTION

SECTION A BACKGROUND

2a.

2c.

Does the WIC program operate In all areas of your state? [Check only ONE box.]
O ves
O No
How many counties remain unserved?
Enter number of counties
How many individuals do you estimate to be unserved? [Estimate number or check "Don't know”.]

# of unserved WIC eligibles
Don’t know

What period of time is covered by the state fiscal year definition?

Enter month and day: From to

Has the state fiscal year changed since 19887 [Check only ONE box.]

O ves, it changed

T No, it remained the same

SECTION B FUNDING

4.

In addition to Federal funding to support WIC program operations in your state, what other funding
sources are currently used? [Check all applicable boxes.]

D state appropriated funds are used
D Private grants are used
| County or local funds are used in some jurisdictions

D other sources are used [please describe]

(2 No other sources are available


28b. For the following non-heaith care referral services that may be available to a WIC participant,

please estimate the number of clinics that offer WIC participants the opportunity to apply for

services. If your agency has more than 6 clinics, please provide estimates for the 6 largest clinics.
[Enter the number of clinics.] .

Other Services Number of WIC Clinics that Typically Offer
Opportunities to Apply for Social Services

Typically Offered Not Offered Don't Know

AFDC

Food assistance programs
Social services program
Head Start

Child care

Transportation

Substance abuse counseling

Housing

Adult educatior’

job training

Child Support

Other /speciyL
Other [specify]
Other [specify]

29a. in how many of your clinics, have you or your staff experienced problems or difficutties obtaining
needed non-WIC services (listed in Questions 27 and 28 above) for WIC participants during the
past year? If your agency has more than 6 clinics, please provide estimates for the 6 largest clinics.
[Enter the number of clinics.]

Number of Clinics

Typically a Not a
Problem Problem

Health care
service

Non-heatth
care service

24


OMB Clearance No. 0584-0436
Expires December 31, 1993

STATE WIC AGENCY QUESTIONNAIRE
WIC DYNAMICS STUDY

INTRODUCTION

The WIC program has undergone many changes in the last few years. There have been some new
program requirements and the number of WIC participants has grown nationally.

To help plan for the future of WIC, we would like to find out how the WIC program is operating at the state
and local level and what concems WIC state directors have. At the present time there is considerable
discussion about whether to increase WIC funding and participation. We are particularly interested in
teaming about how agencies currently operate, how this differs from the past, and changes that might occur
in the future.

This questionnaire has four major sections. The first section asks you to describe how you view changes
that have occurred in the program since 1988. The second section asks descriptive information about your
agency; the third, WIC program initiatives; and the fourth, other related program initiatives. Please review
the entire questionnaire before writing your answers.


SECTION B SPACE AND FACILITIES

21. — In your opinion, is your local agency's current space adequate for the number of staff, participants,
and program responsibilities? [Check one.]

Decreased About the Same
im)

19


CONFIDENTIALITY

Although we ask for identitying information for follow-up, your responses will be held confidential by Macro
International and names will not, under any circumstances, be shown to USDA/FNS. All information
obtained from this survey will be presented in the aggregate or contained in a computerized file of
responses without identifiers.

OUR THANKS

We know how busy all WIC staff are and are grateful for your cooperation. We hope you view this as an
opportunity to be heard and have input into decisions made at the national level.



Ta.

7c.

Has the availability of funding from sources other than the Federal source changed since 19887
[Check only ONE box.]

O Yes, additional funding sources became available
O ves, tewer funding sources were available
D No, funding sources remained the same

Has the amount of funding from sources other than the Federal source changed since 1988?
[Check only ONE box]

D Yes, more funding became available
Oo Yes, fess funding became available
1 No, the amount of funding remained the same

If state appropriated funds are not spent during the state fiscal year, may these funds be carried
forward or must they be returned to the state? /Check only ONE box.]

CO State funds may be carried forward
CO state funds must be retumed

CO other [please describe]

Do you currently use an administrative cost per participant formula to allocate administrative funds
between local agencies within your state? [Check only ONE box.]

Dyes
0 No

Has the method of computing administrative costs per participant changed noticeably since 1988?
[Check only ONE box.]

O Yes
D no
What is the current administrative grant per participant for local agencies?

Enter average amoum per participant $.

.


SECTION C CASELOAD ALLOCATION '

12. Considering current caseload, what method is currently used to Increase or decrease caseload
{lmits to the local agencies within the state? [Check the box next to the statement that best describes
your method.]

OD The state agency assigns a caseload maximum, or number of caseload slots, for each local
agency on the basis of the number of pregnant women and/or infants on waiting lists.

OD The state agency assigns a caseload maximum, or number of caseload slots, for each local
agency on the basis of the number of eligibles meeting specific priorities.

D The state agency assigns a caseload maximum, or number of caseload slots, for each local
agency on a basis other than items 1 and 2 above.

D Local agencies must require a certain caseload limit from the state which is then negotiated with
the state agency based on additional factors. [Describe factors.]

O Other [please specify]

13. How long has this method been used? [Please enter the number of years.]

years

10


Changes

NEW PROGRAM REQUIREMENTS
Breastfeeding promotion requirements

Drug abuse education requirements
Homeless service requirements

Vendor management initiatives

ooaa
ooaa

Other [specify]

OTHER INITIATIVES
Medicaid expansion (expanded eligibility
for Medicaid)

o
Oo
oO

Coordination/integration of services
(e.g., one-stop shopping, self-sufficiency programs)

Other [specify]

OTHER FACTORS
Shortages of physicians

Shortages of nutritionists

Increases in non-English-speaking
population
Computerization/automation initiatives

Agency reorganization (e.g., changes in
local agency catchment areas)

Other (specify)

oHoaagcv.aod6dvo LO
ooo aogd. oo 0 DO
ooagoaah6ao Oo