WIC Futures Study Group

Report on Meeting #1 held February 22, 2008

Meeting Room Montana Association of Counties, Helena, MT

 

Mary Beth Frideres

Montana Primary Care Association

900 North Montana, Suite B3

Helena, MT  59601

mbfrideres@mtpca.org

 

 

Introduction

 

In response to financial, structural, and operational challenges within the Montana Women, Infants, and Children (WIC) nutritional program, the WIC Futures Study Group was convened to evaluate and revise the WIC service delivery system to provide effective, efficient, and high quality services to the greatest number of participants possible.

 

First meeting of the group was held on Friday, February 22, 2008.  The following is a report of the meeting activities. 

 

Participants included:

 

Joan Bowsher                    DPHHS/WIC

Mary Beth Frideres          MPCA

Linda Stallings                  DPHHS/WIC

Mandi Zanto                      DPHHS/WIC

Kim Mondy                         DPHHS/WIC

Mark Walker                      DPHHS/WIC

JoAnn Dotson                    DPHHS/FCHB Chief

Jane Smilie                         DPHHS/PHSD Adm.

Ellen Leahy                        Missoula CCHD

Lora Wier                           Teton County Health Dept.

Linda Best                          Deer Lodge/Beaverhead                                               County WIC

Melody Anacker                Broadwater/Meagher/Jefferson                                  County WIC

Tom Mexicancheyenne     Northern Cheyenne Tribal                                           Health

Bill Hodges                        Big Horn County Public Health                                   Dept.

Jane Timpano                    HRDC Dist. 6 Fergus Co. WIC

Tara Cutler                        HRDC Dist. 6 Fergus Co.WIC

Riki Handstede                  Hill County Health Dept.

Linda Campbell                 Broadwater County WIC

Kari Dawson                      Hill County WIC

Debbie Hedrick                 Yellowstone CCHD

Gayle Espeseth                  Yellowstone County WIC

Dorothy Bradshaw            Lewis and Clark CCHD

Carol Keaster                    Cascade City CCHD

Mary Pittaway                   Missoula CCHD

Melanie Reynolds                            Lewis and Clark CCHD

 

The meeting was facilitated by Mary Beth Frideres of the Montana Primary Care Association.  The desired outcomes for the day were as follows:

 

By the end of the session -

  • Participants will meet each other and gain an understanding of the group or perspective each represents;
  • Participants will review and have input into the proposed meeting structure;
  • Agreement will be reached regarding participant commitment to the process;
  • Participants will gain understanding of the WIC program on the national, state, and local level;
  • Federal mandates/areas where the state may interpret directives and develop approaches will be clarified; and,
  • An agenda for the next meeting will be developed and future meeting dates will be identified.

 

 

Opening Comments

 

Opening comments were made by Jane Smilie, DPHHS, Here is a copy of her notes:

Joan [Miles, Director DPHHS] was sorry she had to miss this meeting and was grateful for the invitation to say a few words to kick off this process.  Public health is still her real passion you know and that has been a really great thing for all of us! 

She wanted me to be sure and thank each of you on behalf of the Department, for your commitment to this process.   

As you are all aware, the WIC Program is facing significant challenges across the country and in our state.  Without your help, Montana will struggle to serve those in need with a high quality, cost effective and efficient WIC Program that will take us into the future.  We all understand how important WIC is to the health of our communities and to the operation of a local health department…and I want you to know the Department is also fully committed to doing the best possible job we can for WIC clients. 

When we first contemplated convening a group like this, quite honestly, we didn't fully recognize all of the issues that would need to be addressed.  But it has become clear that there could not be a better time to step back and take a thorough look at the program. 

·        Federal funding is not increasing.  At the same time, we are experiencing dramatic increases in the cost of food  

·        Local agencies are having difficulty continuing to provide high quality services to those in need as the program is currently configured and funded  

·        A new, more contemporary and nutritious food package is about to be rolled out, but it is also more expensive and will further stress the WIC budget  

·        Montana is about to transition to a new (and much needed) contemporary IT system.  Systems of this magnitude can be more difficult and expensive to implement  than we realize going into the project  

·        Our economy has been very good in recent years…however, projections are for a downturn, even a recession.  The state of MT is projecting it will generate $70 million less this year than last.  This environment is likely to increase the number of clients in need of WIC services.  

·        WIC continues to be a complex program with a myriad of federal regulations to which we all must attend.  The Department has done a good job in the last two years getting program audits where they need to be.  We just have to stay on track with this so we do not jeopardize any of our already limited funding.  

The work you are about to begin will be intense.  Unless something dramatic changes in terms of program requirements and/or funding, you will have to make difficult decisions and recommendations.  It will be important for all of us to keep our focus on the "big picture," while we each bring our valued and unique experience and expertise to the process.  

But, we are up to the challenge and we have the expert help with our process. 

Joan wanted me to be sure to thank Mary Beth Frideres for leading us in this effort.  You will find her facilitation will make this process not only productive…but fun.  We are really glad to have her help in this.  

Again, many thanks!

Introductions were then made and the group reviewed the agenda. 

 

Mary Beth offered that WIC is about getting nutritious food into moms and babies.  She reminded the group that DPHHS has the authority to set up the WIC program, define the rules, and enforce them - but the administrators of the WIC program have decided that the best decisions are made with broad-based input and they wish to be as inclusive as possible.  That is why the email list for communication about the meetings is long; representation on the Study Group covers governmental, tribal, and non-governmental entities and small, medium and large communities; and surveys to gather input from many will precede each meeting.

 

Mary Beth then described the process model for the series of meetings - a problem solving framework.   This will include work to determine what the problems are and why they exist, visioning to identify what an ideal system would look like, identifying solutions that everyone can live with, and development of an action and evaluation plan.

 

Overview of the WIC Program

 

Joan Bowsher gave a PowerPoint presentation (available at:  http://www.dphhs.mt.gov/PHSD/family-health/nutrition-wic/WIC-futures-study-group.shtml) which outlined the Federal and State Structure of the WIC Program. She provided a handout which explains the WIC Funding Formula (also available at the website noted, above.) Joan reviewed the history of the state program and told the group that there are areas where the implementation of the WIC Program is left up to state “interpretation” of Federal guidelines. She assured those present that those interpretations are open for discussion in this study process.

 

Voices from the Front Line – WIC Delivery on the Local Level

 

The group then heard from a panel of local WIC directors representing urban and rural programs.  Mary Pittaway, Missoula, reviewed a handout of WIC tasks and the amount of time each task takes (available on the website noted above.) She described the need for services in Missoula, and the desire for a business model.  Jane Timpano, Fergus County, talked about the satellite model they use.  The strengths of their program lies in the relationships the staff have with the clients.  She noted that referrals to other programs are easy and that they get good support from the HRDC. Challenges include the necessity to cut the hours the clinic is open due to funding concerns vs. an increase in user participation. Also, rural areas have fewer resources, longer distances clients have to travel, lower wages, and less accessible medical care.  Melody Anacker, Broadwater County, spoke next.  Strengths include the fact that the staff knows the clients well and the support they receive from the counties they serve. This advice was offered to the committee: don’t let small agencies go away, they are the gateway to other services and they are there to serve clients.

 

Future Meeting Dates

 

The group agreed on the following dates and locations for future meetings:

 

March 19th in Helena (MACO meeting Room) 10:00 – 5:00

April 7th and 8th in Great Falls (location to be announced) first day 10:00- 5:00, second day 8:00 – 3:00

May 6th and 7th in Helena (location to be announced) first day 10:00- 5:00, second day 8:00 – 3:00

An additional meeting may be scheduled, if needed.

 

Agenda Topics for Next Meeting

 

- Report and questions for the Federal WIC Regional representative – what have other states done?

- Report on State vs. Federal requirements (state leeway to interpret Federal guidelines)

- Detailed State WIC budget review (historic, current, trends, local funding formula, IT breakdown, MCH/WIC comparisons,)

- WIC in Montana - data from epidemiologist (% of eligible population and % of population served)

- Report from small (Riki Handstede), medium (Lora Weir), and large (Ellen Leahy) program administrators - regarding local support of the WIC Program

- Report on results of query to statewide WIC directors regarding tasks that take the most time

 

 

Public Comment

 

Melanie Reynolds offered that ongoing good communication is important. Gayle Espeseth appreciated the level of participation. 

 

Evaluation

 

The group performed a short evaluation of the strategic planning process.  Several people noted that this was a “good” or “great” start. One person said,” We all got a good basis of where everyone is coming from and what we want to accomplish.” Two noted that it was a productive meeting and that they “liked hearing from the locals.” One person liked the way Mary Pittaway presented information. Another person liked that the group identified future meeting dates and felt that the pre-meeting survey information was good. One person said that the meeting was what she was looking for. One person mentioned that they appreciated that top administrators were present. One person liked seeing her colleagues. Two people present noted that they appreciated “having a voice.” Another liked the atmosphere and the facilitator. One participant liked the “linear progression” of the meeting. Another liked the process, hearing about the agencies, and the working lunch. One person liked the PowerPoint presentation.

 

Regarding things that should change or could improve the session, several participants would like longer meetings so more can be accomplished. Several would also like the handouts to be posted on the meeting website. Some would have liked more tribal participation. One person suggested that future meetings be held in Lewistown and another said (jokingly) that they would like to meet at a resort. One local agency director did not have some information that went out in the packets. A couple of people suggested that the materials for the meeting, including presentation materials and handouts be sent at least five working days before meetings. Another would have liked the survey information summary earlier, as well. Communication with the locals is important, one person said, and they should have access to all documents. One person would like everyone to bring data similar to that presented by Mary Pittaway.

 

Addendum

 

Documents, presentations, and the report of this meeting are available at:  http://www.dphhs.mt.gov/PHSD/family-health/nutrition-wic/WIC-futures-study-group.shtml