1. Changing demographics of the WIC customer base due to an increasing Hispanic and Asian populations require that services including outreach and translation be increased in order to maximize participation in DWCNS programs.

2. Virginia’s participation in the CROSSROADS consortium for development of a common WIC computer system in four states will require that business processes be examined, revised and/or re-engineered. This could have significant impact on the operation of the Virginia WIC Program at the state and local levels.

3. Limited funding resources will direct the population groups which can be served.

4. Availability of grant funds and the focus of those funds will determine the future direction of Community Nutrition Services.

5. New contracts for banking services, covert compliance operations and infant formula rebate will impact the future of WIC services.

6. Beginning July 1, 2006, the Virginia WIC Program entered into a new infant formula rebate contract and subsequently faced a significant overall increase in food costs. As a result, the Program has taken numerous cost containment measures including working collaboratively with the Department of Medical Assistance Services (DMAS), the agency that is now acting as the primary payer for exempt formula and medical foods for Medicaid participants also on WIC. The Virginia WIC Program has acted as primary payer in the past.

1. Due to absent additional funding, current efforts to address obesity prevention across the lifespan will have to be reduced to focus strictly on childbearing women and children up to 18 as covered by WIC and MCH. Division activities will not provide any attention to males over 18, older women, or seniors.

2. Reduced funding may require that all Community Nutrition Services be limited to obesity prevention efforts.

3. Breastfeeding Peer Counselor programs will have to be funded from base WIC funding in the future. This may cause a change in the design of the breastfeeding program overall.

4. The WIC Farmer’s Market Nutrition Program may face additional cuts in federal funding, which could result in a reduction of the number of participants and markets involved in the FMNP.

5. The CHAMPION process for community level prioritization of issues and solutions will become a new service offered to public health professionals across the country. This is an innovative and original method of developing statewide plans that is already receiving recognition.

6. The Statewide Breastfeeding Advisory Committee will provide value leadership for breastfeeding promotion activities in the Commonwealth. This service area will support the group financially and with staff resources.

7. The WIC Program has consistently rewarded local agencies who outperform their projected participation goals with financial incentives. The Virginia WIC Program is actively pursing the converse action, wherein monies provided to local agencies in anticipation of achieving projected participation levels will be recouped by the State WIC Office for underperformance.

8. In anticipation of USDA’s approval of the Institute of Medicine (IOM) food package changes, the Virginia WIC Program will develop a food package change implementation plan pending guidance from USDA. These food package changes will have a significant impact not only from a nutritional perspective, affecting the types of supplemental foods WIC participants may receive, but from a program operations and training perspective.

9. Value Enhanced Nutrition Assessment (VENA) was developed by the Food and Nutrition Service and the National WIC Association. According to USDA, VENA guidance provides a process for completing a comprehensive WIC nutrition assessment including the content of such an assessment and an outline of the necessary staff competencies. The Virginia WIC Program will prepare to implement VENA by submitting a plan to USDA, obtaining federal approval for related policies and procedures and identifying training resources. A VENA Advisory Committee has been formed to aid in the implementation process.

• WIC Program WIC provides Federal grants to States for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, to infants less than one year old and children less than five years old who are found to be at nutritional risk. WIC is operated through local health districts in Virginia. WIC provides high-quality nutritional care and food to eligible participants. The program provides milk, cheese, eggs, juice, cereal, dried beans or peas, peanut butter and iron-fortified formula that supply crucial nutrients such as protein, iron, calcium, and vitamins A and C essential to maintain health. In addition to access to healthy foods, WIC also provides nutrition education, healthy recipes, private and group sessions with a nutrition expert, free nutrition checkups, support and help with breastfeeding and referrals to other community services.
• Grant Administration Federal funds are awarded to each state through a complex formula utilizing food package cost and past program participation. Maximizing the amount awarded to Virginia, as well as assuring the state pays no penalties, requires constant monitoring. Inflation in food costs can reduce the number of clients the grant will support during the year requiring administrative action. Likewise, Local Agency failure to provide services to the anticipated number of clients can cause the state to under-spend their food grant resulting in penalty. In order to reduce overall food costs, and as required by federal regulations, Virginia contracts for a single brand of infant formula. This relationship adds $25 million to the federal grant but requires significant administrative management, reporting and billing. USDA requires the state to obtain prior approval for many actions, and significant routine reporting as well. In order to assure maximum utilization of the grant by participants, the service area manages a comprehensive marketing effort throughout the state. To facilitate Local Agency client services as well as collect all needed data, a central automated system is developed and managed for the entire state.
• WIC Nutrition Education Nutrition education is a core service provided by the WIC Program. Local agencies must make nutrition education available to all participants at no cost. Nutrition education is designed to meet the two basic goals of teaching participants the relationship between proper nutrition and good health, and assisting participants in making positive changes in their food habits. Methods of nutrition education include individual and group counseling as well as web-based and multi-media educational opportunities. These services are also coordinated and integrated with other clinics and services. Virginia WIC local agencies are required to make obesity prevention a major goal for WIC services each year.
• Retail Store Management The Division of WIC and Community Services recruits, trains, authorizes and monitors more than 800 retail stores which provide food and formula benefits to 140,000 eligible participants. Authorized stores consist of small, independent businesses, military commissaries, and multi-state grocery chain stores. Authorized stores must be competitively selected based upon objective factors such as store location, variety of foods sold and prices charged to the WIC Program. Individual store’s level of program compliance is monitored using both overt, onsite visits, as well as “covert” undercover compliance investigations. Stores documented to be non-compliant with state and federal WIC Program requirements can face substantial financial penalties, e.g., up to $40,000 fine.
• Local Agency Management Oversight The Division of WIC and Community Services is responsible for the development, implementation, and management of an ongoing monitoring and evaluation system of local health departments and has developed the Local Agency Management Evaluations (LAME) automated process for this service. The LAME process provides a mechanism to monitor local agency operations, review financial and participation reports and require corrective action plans to resolve deficiencies as needed. Operations subject to evaluation include, but are not limited to, management, referrals, outreach, participation, eligibility, certification, time and effort reporting, civil rights compliance, accountability, financial management systems and food delivery systems. On-site evaluations of local agencies are performed every two years; the local agency performs a self-evaluation during the years in which an on-site evaluation is not conducted. The Division also works in conjunction with the USDA to complete State Technical Assistance Reviews (STAR). STAR reviews are conducted by the USDA and assist the Division in performing quality assurance tests. STAR reviews routinely consist of: • Caseload and Food Funds Management; • Certification and Eligibility; • Civil Rights; • Farmers Market Nutrition Program (FMNP); • Food Delivery Systems & Food Instrument Accountability; and • Post Implementation and Monitoring - Audit. The State WIC Office enters into a Memorandum of Agreement (MOA) with each local agency upon receipt and approval of that local agency’s WIC Services Plan (WSP). The WSP is another method by which the State WIC Office helps to ensure that the local agencies are in-line with both State and Federal goals.
• Statistical Analysis/Data Management This service area provides data-related support for all WIC products and services, delivers participation and financial data to USDA and disseminates various WIC Program reports to the central office and local WIC agencies. Tabular reports, charts and maps are needed for the central office on an on-going basis to support outreach efforts, local agency and retailer monitoring and local agency performance measuring. WIC program data is collected and analyzed using a variety of established research methods, procedures, statistical formulas and techniques. Trends are identified and projections are developed for financial and participation data in order to report program expenditures and participation projections to USDA.
• Training Program This service area provides a variety of both mandatory and voluntary training opportunities to Virginia WIC employees including: 1.ACO (Addressing Childhood Overweight Training) – was provided to local health departments throughout the Commonwealth on “Addressing Childhood Overweight in Our Communities”. The purpose of the training was to allow local WIC staff the opportunity to join together with others from within the community in order to create an environment for fighting childhood overweight. The training discussed resources that are available to healthcare professionals and the clients they serve; techniques in discussion and confronting the issue with parents and caretakers, identifying roles that they play in battling childhood overweight. 2.WIC Nutrition 101 – an introductory course regarding the purpose and goals of the WIC Program 3.Civil Rights Training – to train WIC Program staff with all applicable Civil Rights requirements and provide an understanding of pertinent, proper procedures 4.Special Formula Training – to familiarize all Virginia WIC staff, at the state and local agency level on the proper procedures for ordering special formula from the Community Action Program (CAP) Distribution Center 5.Racial/Ethnic Data Collection Training – to inform the user of the purpose for collecting racial and ethnic information of enrolled WIC participants, as well as the proper procedures for doing so
• WIC Farmers’ Market Nutrition Program The Farmers’ Market Nutrition Program (FMNP) is a separate grant sponsored by USDA. It provides locally grown fresh fruits and vegetables and fresh cut herbs to WIC participants. Virginia’s FMNP is a pilot program currently operating in seven localities: Arlington, Chesapeake, Fairfax, Hampton, Norfolk, Peninsula and Virginia Beach. The focus of the FMNP is to provide a combination of nutrition education, locally grown fresh fruits and vegetables and health care oversight to eligible women and children while simultaneously increasing the awareness, use of and sales at farmers’ markets. Participants receive four $5.00 food instruments that can be redeemed for fresh fruits, vegetables and fresh cut herbs from locally certified farmer vendors at designated Farmer Market sales locations. In collaboration with the Department of Agriculture and Consumer Services, approximately 65 farmer vendors are recruited, trained and authorized to accept WIC food instruments for eligible participants to purchase locally grown fresh fruits and vegetables. The Farmers Market Program runs from July 1 to October 31st, yearly.
• Community Nutrition Services • Obesity Prevention and Control This service area has placed greater and greater emphasis on obesity prevention and control over the last ten years. Virginia was one of five states to receive funding for the FitWIC grants to address obesity in the WIC population. Grant applications for the CDC Nutrition and Physical Activity grant have been submitted and approved but not funded. In the past the Division has functioned in the area of interventions, however, is now moving into a leadership role to coordinate obesity prevention and control efforts across the state and make Virginia agencies more competitive for grants in this area. • 5 A Day for Better Health Program Eating fruits and vegetables can reduce the risk of many chronic diseases such as heart disease and cancer as well as play a significant role in reducing obesity. DWCNS offers the 5 A Day for Better Health Program, a public awareness campaign that encourages Virginians to eat 5 or more servings of fruits and vegetables every day for better health. Technical assistance and 5 A Day materials are provided to local programs. • CHAMPION CHAMPION (Commonwealth’s Healthy Approach and Mobilization Plan for Inactivity, Obesity and Nutrition) is a process for developing a state wide plan that addresses prevention and control of obesity in Virginia. This program was created in response to an increase in the number of adults, adolescents and children who are overweight or obese in Virginia. The goals of the program include developing an aggressive coordinated strategic plan that addresses obesity in Virginia and compiling a state wide electronic resource guide to include a directory on successful community and state programs and locality-specific data relative to obesity. CHAMPION is working with stakeholders throughout the Commonwealth to improve nutrition and physical fitness health for all Virginians. • “Eat Smart Virginia” Program In response to the USDA call for faith-based initiatives, the service area has developed and will implement nutrition program targeted to faith-based communities in Virginia. “Eat Smart Virginia” will provide nutrition and physical activity materials to support healthy eating and physical activity. • Employee Wellness Program The Division of WIC and Community Nutrition Services (DWCNS) developed an Employee Wellness Program, “Step ‘n’ Up for a Healthier Virginia”, for Virginia Department of Health (VDH) employees. DWCNS tested the prototype in the Virginia Department of Health’s Madison building. The program promoted stair climbing as a means of increasing physical activity during an employee’s workday. The program information will be prepared to be available to all State agencies. The program materials will be available on the web inclusive of the site administrator guide book, graphics, and posters. • Breastfeeding Promotion This service area promotes breastfeeding as the preferred infant feeding method by creating a positive health care setting environment, providing information on the health benefits of breastfeeding and supporting breastfeeding women. The goals of this program are to improve infant and family health by making breastfeeding the cultural norm and to increase the rates of breastfeeding initiation and duration among the general public and WIC participants. In addition, breastfeeding has been shown to have an effect of preventing obesity for children who are breastfed. Goals are accomplished through efforts such as the Electric Breast Pump Loan Program and the Statewide Breastfeeding Advisory Committee of Virginia. The WIC Breastfeeding Peer Counselor Program also supports breastfeeding by providing counseling from peers to WIC participants. This project receives special funding from USDA through a separate grant. • School Nutrition Program Staff within this service area collaborate with other divisions within the Office of Family Health Services and the Department of Education to provide training to school nurses and health and physical education teachers across the state. This same group has collaborated to develop web based curriculum materials for teachers to use to integrate nutrition and physical activity into a variety of classes.

Objective Description

In order to remain fiscally responsible and ensure that the benefits of the WIC Program are reaching as many participants as possible, the service area will focus on optimizing the use of federal funding. A vital dimension of this objective means the Division will direct resources towards identifying a strategy to further reduce food package costs associated with the selection of WIC approved foods. Implementing more effective screening controls will position the service area to further reduce its food costs. Increasing the number of pregnant women who are certified for participation in WIC is the second part of this objective, which also ensures that federal funding is being utilized to the fullest extent. By promoting the WIC program and the WIC informational telephone line, awareness of the program will increase, as will the number of certified participants.

Objective Strategies

Objective Measures

Objective Description

Over the last decade, Virginia has seen an alarming increase in the number of adults, adolescents, and children who are obese or overweight. According to the CDC, fifty-eight percent of Virginia's adults are overweight or obese. This trend is also true for Virginia's children and adolescents. In addition, national research indicates that Virginia’s health care costs are rapidly rising due to obesity rates; Virginia has the 14th highest health care costs in comparison to the fifty states. The Division of WIC and Community Nutrition Services adopted a community-based process for developing a state wide plan addressing prevention and control of obesity in Virginia. In order to assure the participation of stakeholders throughout Virginia, the Division of WIC and Community Services has conducted six regional meetings in Southwest, Roanoke, Blue Ridge, Central, Northern Virginia & Hampton Roads for the Commonwealth’s Healthy Approach and Mobilization Plan for Inactivity, Obesity and Nutrition (CHAMPION). A CHAMPION a meeting was also held for healthcare providers and payers. DWCNS hosted a similar meeting focusing on minorities. The goal of these meetings was to establish recommendations and solutions for addressing obesity on a community level. At the meetings, participants divided into workgroups and shared their insight on the contributing factors and potential solutions related to inactivity and poor nutrition within their region. Workgroups reported on the top three issues and solutions identified for inactivity and nutrition. When results from each of these focus groups were compiled, the conveners identified four common themes for solutions. The themes are media intervention, nutrition education, community involvement, and public policy. The information gathered at these meetings can be accessed in the CHAMPION Summary Report, which describes in greater detail the process of the regional meetings as well as the results. Department of Health staff members are evaluating existing programs and interventions that address the four themes mentioned above. Those that pass this evaluation process will be recommended for further review by a Governor-appointed statewide advisory committee. The committee’s function is critical, as its review process will determine which initiatives will be included in the final Plan. That plan will be a public guidance document that will embody all of the best resources, practices, information and ideas borne of the entire CHAMPION initiative.

Alignment to Agency Goals

Objective Strategies

Objective Measures

Objective Description

The service area promotes breastfeeding as the preferred infant feeding method. The Division works to improve infant and family health by making breastfeeding the cultural norm, and makes efforts to improve the rates of breastfeeding initiation and duration in Virginia's WIC program to meet the National Healthy People 2010 Breastfeeding Objective of: 75% of women breastfeeding at hospital discharge and 50% breastfeeding their infants at 6 months. In order to achieve the Healthy People 2010 objective for all Virginians, the Division of WIC and Community Services is bringing together representatives of state and national organizations who are “experts” in pediatrics, health care and nutrition through the formation of a statewide Breastfeeding Advisory Council. The Breastfeeding Advisory Committee is working to increase the incidence and duration of breastfeeding among mothers and provide a statewide organizational vehicle for communication, collaboration, and coordination of breastfeeding services in the Commonwealth.

Alignment to Agency Goals

Objective Strategies

Objective Measures