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Texas WIC News November December 2010

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Volume 19, Number 6

 

2010 Year in Review

WIC Focused on Key Initiatives and Projects in 2010
WIC is Growing and Glowing
Conference Session Offered Opportunity to Learn About Client-Centered Nutrition Education
Food Redemption Patterns
WIC Wellness Works
Survey says…Participants Are Using the WIC Tools Provided
Planning Helps Pave the Way for Successful WIC Certification Specialist Trainings
What You Need to Know About Food Allergy, Intolerance and the New WIC Food Packages
WIC Streamlines the Process of Plotting through Growth XP
State Agency Spotlight - A Warm Farewell for a Friendly Welcome
State Agency Spotlight continued
Dallas County Shows Off EBT to Out-of-State WIC Staff

 

WIC Focused on Key Initiatives and Projects in 2010

From the Texas WIC Director
— Mike Montgomery

Congratulations on the completion of another successful year for the Texas WIC program! The end of the year provides an excellent opportunity to reflect on our many accomplishments. In 2010 we focused on several key initiatives and projects. We saw the development of a tool kit for the Client-Centered Nutrition Education (CCNE) program and a comprehensive training manual for the WIC Certification Specialist program. We also had several key breastfeeding initiatives such as the Better by Breastfeeding initiative, the Texas Ten Steps Star Achievement Program and the continuation of the Every Ounce Counts campaign.

The annual Nutrition and Breastfeeding Conference held in April was another highlight of the year and spotlighted many of our past accomplishments and ongoing projects. This issue of the Texas WIC News highlights several of the sessions presented at the spring conference. Tracy Erickson’s article on page 4 covers the information presented at the pre-conference session, “Using Loving Support to Grow and Glow in WIC.” The article on page 6 details the CCNE preconference session and the CCNE breakout session as well as provides information about next steps for the program. “What you Need to Know about Food Allergy, Intolerance and the New WIC Food Packages” on page 14 is very informative and covers the information the WIC Formula Team presented at the conference.

2010 also saw the first full year of implementation of the new WIC food packages. Through data obtained via the Electronic Benefit Transfer (EBT) system, Texas WIC is able to obtain and track information on our participant’s specific redemption patterns of all foods including the new additions. The article on page 8, written by Paula Kanter, provides very useful information on redemptions rates for specific items as well as some of the most commonly purchased brands within specific categories. The article, “Survey says…Participants are using the WIC Tools Provided” on page 11, details results of an online survey of our participants’ shopping habits and attitudes. The information in both these articles serves to validate the strengths of our program and at the same time provide us with information for improvement.

A big achievement this year was the purchase, installation and implementation of a new interactive voice response (IVR) system for the 1-800 line, which streamlined the referral process for our clients. Rachel Edwards will provide more information on the IVR system in our January/February Issue of Texas WIC News.

With so much to look back on and celebrate from 2010, it’s isn’t hard to imagine that 2011 holds promises of even bigger and better achievements. I am constantly amazed at the accomplishments our WIC staff continues to achieve! I look forward to another banner year.

 

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WIC Is Growing and Glowing

by Tracy Erickson, R.D., I.B.C.L.C.
WIC Breastfeeding Coordinator

Attendees of the 2010 Nutrition and Breastfeeding Conference were probably somewhat apprehensive about signing up for the pre-conference session, Using Loving Support to Grow and Glow in WIC. "Please, not another breastfeeding train-the-trainer course!" What a pleasant surprise it was for participants to discover the benefits and how-to’s of breastfeeding were not drilled into them once again. Instead the Grow and Glow training gave attendees new and refreshing ways to teach the “same ol same ol” when it comes to breastfeeding education.

Using Loving Support to Grow and Glow in WIC was designed by the U.S. Department of Agriculture to help ensure that all WIC staff attain a level of proficiency in the skills required to promote and support breastfeeding in WIC local agencies. Use of the curriculum is optional since Texas already has excellent breastfeeding trainings in place to train WIC staff, but that doesn’t mean you can’t utilize parts of all of the Grow and Glow training curriculum.

The curriculum consists of ten modules. The modules can be used individually or with several or all modules combined. For example, module 5, Promoting and Encouraging Exclusive Breastfeeding, would be a great module to use for an all-staff breastfeeding update, to incorporate into Peer Counselor trainings or monthly in-services or to present to health-care providers at your local hospitals.

The curriculum has many great ideas for providing breastfeeding education in a new and exciting way. Components of the curriculum can be used for:
 Annual breastfeeding updates for all WIC staff
 Monthly Peer Counselor updates
 Value Enhanced Nutrition Assessment
 Client-Centered Nutrition Education
 IBCLC and Peer Counselor consultations provided to WIC participants
 Pregnant group classes on breastfeeding
 Breastfeeding support group meetings
 Community-based World Breastfeeding Month celebrations and presentations
 In-services to health care and child care providers

The Using Loving Support to Grow and Glow in WIC train-the-trainer curriculum was mailed out on six disks to all local agencies in June. Quick Reference for the Lactation Professional books to accompany the curriculum were shipped to all agencies in September.

Educational Activity Kits that include five of the visual aids used in the Grow and Glow curriculum have also been developed. The kits include:
 Building Blocks – to compare how formula stacks up against breastmilk.
 Soft Breast Model – to demonstrate hand expression and reverse pressure softening.
 White Bean and Black Bean Jars – to demonstrate how formula can decrease breastmilk production.
 Grape Model – to demonstrate internal breast anatomy and teach the milk production and transfer process.
 Paddle and Balls – to demonstrate how prolactin and oxytocin receptor sites are formed in the first two weeks postpartum.

Each visual aid includes two sets of instructions – short instructions designed to be used with WIC participants and longer, more detailed instructions designed to be used with WIC staff and other health care providers.
All agencies received the Educational Activity Kits in August.

The five activities in your Educational Activity Kits are only a part of the activities used throughout the Grow and Glow curriculum. It’s full of other great activities that are inexpensive and great for the visual learner such as a recipe for baby poop to be used to demonstrate adequate diaper output and use of a clear container with a spout at the bottom to demonstrate the concept of supply and demand. All supplies needed to conduct any parts of the Grow and Glow training are WIC allowable expenses. Did you ever think you’d hear that recipe ingredients for baby poop are WIC-allowable?

Have fun with your new Using Loving Support to Grow and Glow in WIC curriculum. You should get lots of mileage out of it!


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Conference Session Offered Opportunity to Learn about Client-Centered Nutrition Education

by Carlos Galvan
Nutrition Education Consultant

The April 2010 Nutrition and Breastfeeding Conference offered an excellent opportunity for attendees from 68 local agencies to learn more about Client-Centered Nutrition Education (CCNE). During a CCNE breakout session, staff heard from peers about client centered approaches and were able to practice these skills. In an additional CCNE pre-conference workshop, local agency leadership learned about a newly released CCNE training toolkit and how to best use it at their local agencies.

The CCNE toolkit contains an overview document, five modules of training resources, and an accompanying DVD and CD. The overview document provides instructions on how to use the toolkit and outlines the content and purpose of the five modules. The DVD contains samples of CCNE classes facilitated by local agencies involved in the CCNE pilot program. The CD contains sample PowerPoint slides that could be used for training at the local level. Here is a snapshot of each of the five training modules that comprise the toolkit.

Module 1: Introduction to the Client-Centered Approach. This module introduces the movement toward CCNE and brings principles of Value Enhanced Nutrition Education into the classroom, creating a unified voice to all nutrition education at Texas WIC.

Module 2: Foundations of Nutrition Education. This module provides a basic foundation on adult learning principles and factors that influence behavior change.

Module 3: Fostering a positive Learning Environment. This module offers tools for creating and maintaining a clinic and classroom environment that promotes learning, both in terms of physical space and WIC staffs’ role.

Module 4: Creating Learning Opportunities in Nutritional Education. This module is intentionally designed to encourage creativity and flexibility when providing nutrition education. The content highlights steps local agencies have taken to create new lessons using this dynamic, client-centered approach.

Module 5: Hands-on Learning, Observation and Practice for Staff. This module offers tools and activities for trainers to facilitate opportunities for their staff to observe and practice client-centered techniques, share best practices, and support each other to improve their skills.

After reviewing the contents of the toolkit, conference attendees identified two resources that were relevant to their local agency. Working in small groups they discussed possible strategies for motivating staff and proactively addressing staff concerns regarding CCNE. Those agencies already implementing CCNE were asked to share their best practices. The final portion of the session was utilized to aid local agencies in finding ways to incorporate CCNE into staff training and nutrition education at their local agencies.

Since the conference, the CCNE team has continued to provide training via the QWEST conferencing system. These trainings have provided answers to questions as well as offered the opportunity for the sharing of ideas and best practices. The plans are to continue these Qwest calls in the future to assist local agencies in the development and implementation of CCNE at their local agencies. Future memos will indicate what dates have been selected to conduct the conference calls.

So what is next for CCNE?
The state agency is considering options for offering either regional “booster trainings” or developing a CCNE training to be conducted at the state office. Local agencies will be notified once a decision is made.

Plans are underway for making the documents and toolkit files available for download. The documents will include the five modules and additional resources that are to be utilized for training purposes. If you are in immediate need of these documents feel free to duplicate the information available in the toolkit or contact the NE team for additional copies of the toolkit.

Currently CCNE is not mandatory; however, this is the direction that Texas WIC is heading. A timeline has not been established for making CCNE mandatory, but many local agencies have taken the lead and have opted to begin the process. At this time, the majority of all lessons developed at the state are being written in the CCNE format. The state agency will soon begin to adapt existing lessons to CCNE formats. Many local agencies have begun developing new lessons as well as modifying existing lessons to better serve their participants. The state agency looks forward to assisting your local agency in making CCNE the norm.

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Food Redemption Patterns

By Paula Kanter, R.D.
Clinical Nutrition Specialist

Electronic Benefit Transfer (EBT) provides a lot of information. Before EBT, the State agency was unable to track participants’ specific food choices. We relied on WIC clinics to conduct food surveys to analyze participant’s preferences. Since Texas implemented EBT statewide in August 2009, the state agency can run reports on the EBT data to determine what participants are purchasing with their WIC benefits. This article provides information on the foods that WIC participants are redeeming.

The table below provides information on food redemption from October 2009 through July 2010.

 

 

Food Redemption Rates October 2009 - July 2010
Food Item
Oct Nov Dec
Jan Feb Mar Apr May Jun July
Baby Food Fruit or Veg 4 Oz 53% 58% 56% 60% 59% 63% 61% 62% 62% 62%
Baby Food Meat 2.5 Oz
60% 58% 54% 55% 51% 53% 50% 49% 49% 49%
Bread/Tortillas/Rice/Oatmeal 52% 56% 58% 62% 59% 64% 63% 64% 64% 64%
Cereal 74% 75% 73% 75% 70% 73% 71% 72% 73% 72%
Cheese 81% 83% 84% 85% 82% 83% 82% 83% 83% 83%
Dry Beans 67% 66% 63% 61% 57% 60% 57% 57% 57% 57%
Dry Beans or Peanut Butter 61% 64% 63% 65% 62% 65% 62% 63% 63% 63%
Eggs-A or AA Large/Med/Small 86% 88% 89% 89% 85% 87% 86% 86% 87% 87%
Fruits and/or Vegetables 65% 73% 73% 76% 74% 78% 77% 78% 79% 78%
Juice 48 Oz and/or 12 Oz Frz 66% 72% 72% 75% 72% 74% 73% 73% 74% 73%
Juice 64 Oz and/or 16 Oz Frz 66% 72% 72% 76% 73% 76% 75% 76% 77% 77%
Milk Skim ½% 1% 2% Gal 77% 81% 82% 83% 79% 82% 80% 81% 81% 81%
Milk Skim ½% 1% 2% Qt 31% 34% 41% 48% 45% 52% 50% 51% 52% 53%
Whole Milk Only Gal 86% 87% 88% 89% 85% 87% 86% 86% 87% 87%
Whole Milk Only Qt 39% 45% 50% 56% 52% 58% 57% 58% 59% 60%

The following tables provide redemption data for July 2010:

The most commonly purchased brands of bread:
• Sara Lee
• Roman Meal Sungrain
• HEB Bake Shop

The most commonly purchased brands of corn tortillas:
• Mission
• HEB
• Guerrero
The most commonly purchased brands of whole wheat tortillas:
• HEB
• La Banderita
• Porras

The most commonly purchased brands of brown rice:
• Great Value
• HEB
• Parade

 

Grains
Food Type Percent Redeemed
Bread 53% (406,748)
Corn tortillas 30% (229,555)
Oatmeal 7% (57,915)
Whole wheat tortillas 6% (49,864)
Brown rice 4% (30,390)

Milk
The table (right) shows what women and parents of children two years of age and older purchased in July. Although we encourage low-fat milk (1%), over 90 percent of our participants are purchasing reduced fat milk (2%).

 

Milk
Milk Type Percent Redeemed Gallons & Half Gallons Percent Redeemed Quarts
2% (reduced fat) 92% 91%
1% (low-fat) 5% 1%
Fat Free/Skim 2% 8%
Lowfat Buttermilk <1%  
½% <1%  

Juices
Over 70% of juice issuance is redeemed for children and women. Of the quantity redeemed, the table below shows the redemption percentages for the top 5 juices.

 

Juices for Children
Children Percent Redeemed
64 oz plastic 89% (721,263)
64 oz refrigerated 9% (73,543)
16 oz frozen 2% (13,007)
Juices for Women
Women Percent Redeemed
48 oz plastic 90% (401,633)
12 oz frozen 10% (43,156)

 

 

Top Brands-Children's Juices
Top 5 Brands of Children's Juices Percent Redeemed
Hill Country Fare Apple Juice 64 oz 9% (65,085)
Texsun Apple Juice 64 oz 7% (50,331)
Parade Apple Juice 64 oz 7% (47,747)
Hill Country Fare Orange Juice 64 oz 5% (38,662)
Fiesta Apple Juice 64 oz 4% (28,349)

 

 

Top Brands-Women's Juices
Top 5 Brands of Women's Juices Percent Redeemed
Texsun Apple Juice 48 oz 10% (42,005)
Big Tex Apple Juice 48 oz 8% (33,058)
Hill Country Fare Apple Juice 48 oz 8% (30,352)
Texsun Orange Juice 48 oz 6% (25,705)
Big Tex Orange Juice 48 oz 6% (24,404)

Dry Beans and Peanut Butter
Of the five types of beans approved by Texas WIC, redemption for July is shown below. The table (below right) shows the top five brands purchased of 18 oz jars of peanut butter.

 

Beans
Type of Bean Percent Redeemed
Pinto 76% (298,427)
Black 14% (56,767)
Lentils 6% (24,068)
Navy 3% (10,005)
Split peas 1% (2,868)

 

 

Peanut Butter
Top 5 Brands of Peanut Butter Percent Redeemed
JIF Creamy Peanut Butter 32% (57,532)
JIF Extra Crunchy Peanut Butter 10% (17,664)
Parade Creamy Peanut Butter 7% (11,627)
Hill Country Fare Peanut Butter 6% (11,357)
Great Value Creamy Peanut Butter 6% (9,779)

Cereal
72% of issuance was redeemed in July. Cereals purchased most often by participants are listed in the table (right). Most of the cereal redemptions are, unfortunately, for cereals that are lower in whole grains.

 

Cereal
Top 5 Cereals Percent Redeemed >51% whole grain
Post Honey Bunches of Oats with Almonds 18 oz 13% (123,835) No
General Mills Dora the Explorer 18 oz 11% (106,283) No
Post Honey Bunches of Oats Honey Roasted 18 oz 9% (89,482) No
Kellogg’s Corn Flakes 18 oz 8% (77,320) No
Kellogg’s Rice Krispies 18 oz 7% (71,943) No

Baby Food Fruits and Vegetables
As indicated in the Food Redemption Rate table (page 8) only 62% of baby food (fruit or vegetable) was redeemed in July.

 

Baby Food Fruits and Vegetables
Top 10 Baby Food Fruits and Vegetables Percent Redeemed
Gerber Applesauce 4 oz 14% (360,847)
Gerber Bananas 4 oz 13% (333,583)
Gerber Pears 4 oz 11% (284,457)
Gerber Sweet Potatoes 4 oz 8% (198,557)
Gerber Carrots 4 oz 7% (191,261)
Gerber Squash 4 oz 5% (141,127)
Beechnut Applesauce 4 oz 5% (120,112)
Beechnut Bananas 4 oz 5% (119,339)
Gerber Green Beans 4 oz 4% (112,509)
Beechnut Pears 4 oz 4% (104,233)

Baby Food Meats
For our exclusively breastfeeding babies, only 49% of baby meats were redeemed.

 

Baby Food Meats
Top 5 Baby Food Meats Top Ten Overall Vegetables
Gerber Chicken 2.5 oz 23% (28,686)
Gerber Beef 2.5 oz 19% (23,426)
Gerber Turkey 2.5 oz 18% (23,099)
Gerber Ham 2.5 oz 15% (18,663)
Beechnut Chicken and Broth 2.5 oz 9% (10,931)

Fruits and Vegetables
Fruit and vegetable redemption has been relatively low, but is slowly increasing (78%). To the right is the top ten list from July 2010 for both fresh fruits and vegetables.

Top Ten Overall Fruits:
Bananas
Apples
Grapes
Tomatoes
Strawberries
Watermelon
Cantaloupe
Avocados
Oranges
Mango

Top Ten Overall Vegetables:
Peppers (mixed hot varieties)
Lettuce (Iceberg)
Onions
Carrots
Broccoli
Corn
Bell Peppers
Cabbage
Squash
Cucumbers

The redemption information provided in this article is intended to inform local agencies of what items and brands are being purchased by participants. Staff can use this information when providing counseling. For example, the data on milk redemption indicates the need to continue encouraging the consumption of low-fat (1%) milk.

The state office will continue to look at redemption data with the hope that this information will help us better understand participant purchasing patterns.

 

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WIC Wellness Works: Walk the World with WIC – The Ticket to Fitness!


If you listened closely, you could hear the sound of feet hitting the pavement and heart beats quickening. If you watched closely, you could see bodies getting stronger and faces smiling more brightly. This past year Texas WIC staff from across the state were busy changing their lives as they completed the Walk the World with WIC exercise challenge.

Texas WIC staff completed a six-week global adventure by challenging themselves and other agencies to walk, run, dance, cycle, jump rope, hula hoop or do whatever they could to make it around the world (virtually, that is). Experienced exercisers averaged at least 150 minutes each week and beginning exercisers averaged at least 70 minutes a week to make it around the world.

With Walk the World with WIC, employees had the opportunity to incorporate the healthy habits of exercise into their daily lives while gaining confidence in their own physical abilities. Participating in the exercise challenge allowed WIC staff to improve their own fitness and gain valuable insight into the challenges of becoming more active. How better to be ready to “Pass it On” to their WIC participants?

Global Competition
Some friendly interagency competition took place with 56 agencies and the state office challenging each other to see who, at the end of six weeks, averaged the highest number of exercise minutes per employee. Agencies were divided into four categories based on staff size and agency and clinic coordinators used an online tracking system to register the total number of minutes their employees exercised each week. The top three agencies in each category received a wellness basket with exercise DVDs, cookbooks, magazine subscriptions, pedometers, and a measuring wheel to mark walking paths around the office. One additional bonus winner in each size category was selected at random to receive a wellness basket.

Congratulations to the following winning agencies and to each and every one of the WIC employees who contributed minutes to the agency competition.

 

The Winning Agencies
Large (100+ employees) Agency # Agency WWW Coordinator
033 City of El Paso Joel Olivas
077 UT Medical Branch at Galveston Teresa Garza
054 Tarrant County Public Health Department Laurie Arrington
012 (Bonus) Hidalgo County Health & Human Services Ryan Rios
Medium (25 -99 employees) 035 Denton County Health Department Alva Santos
031 Bell County Public Health District Angela Teague
020 Regence Health Network, Inc. Ginny Rawls
073 (Bonus) El Centro del Barrio, Inc. Teresa Villarreal
Small (11-24 employees) 030 City of Port Arthur Brenda Mullen
107 Community Care Foundation, Inc. Kathy Roden
029 Fort Bend Family Health Center, Inc. Mary Diaz
087 (Bonus) Health Service Region 4/5 North Beth Lloyd
Petite (10 or less employees) 074 Brownwood- Brown County Health Department Juanita Arriaga
060 Matagorda County Hospital District Leisha Hurtado
106 St. Joseph Regional Health Center Karen Sanders
028 (Bonus) Centro de Salud Familiar La Fe Guadalupe Delgado

Walk the World with WIC: Letters from Our Members!

We walk every Wednesday to the DVD or, if it’s not too hot, we go outside. It is a GREAT break from the day. A couple of days ago we jumped roped — oh my! That was a great workout. I still feel it this morning. We bought a few items for the clinic like hula hoops, balls, hand weights, and stretch bands. One of our peer counselors has joined a fitness center and is so competitive she has lost 18 pounds. Awesome! Thanks for such a wonderful opportunity to encourage my co-workers.
—Alva Santos, Denton County WIC

We are doing a variety of activities including walking, aerobics classes, exercise videos, and playing volley ball and basketball. Since we started, some have lost a few pounds, others have lost inches. I and another co-worker have seen a significant drop in our blood pressure and I have seen lower numbers when I test my blood sugar. The results of this competition are very positive and we plan to carry on our exercise routines after this contest is over.
—Brenda Mullin, Port Arthur WIC
   
We do the 10-minute cardio athletic dance routine twice a day. It keeps everyone working out, keeps our energy level up, makes us feel good all day long, and we work better. When we go home I do my Zumba workout which I love, Rosie walks outside with her girls, Nelda walks at home, and Dina walks with her boyfriend out in the country. We know that Walk the World is going to end soon but we will continue to do our exercise so we may look and feel better. We used balloons to make the kickoff fun and colorful and it was an attention getter. We were asked by non-WIC staff members what we were doing and we let them know. We also invited them to join in on the exercises. We had t-shirts for the kickoff embroidered with the Walk the World with WIC logo. After all that we went outside took pictures and let the balloons go. We all had a good time. Thank you so much.
—Sandra Gonzalez, Harris County WIC

We kicked off our event with a LUAU! During our May in-service, our coordinators presented the tour details and reviewed the passport packets. Staff was excited to participate and signed up to embark on this journey.
—Krystle Griffin, Galveston County WIC

When our staff has a free moment, we put our exercise DVDs on. One of our staff members walked the mall to get some fun activity and enjoy the air conditioning. We had a dietician who went to Washington DC. She walked seven miles a day which gave our team an extra 700 minutes — woo hoo! Our breastfeeding peer counselor participated in a Relay for Life cancer event and was scheduled to walk for one hour, but walked three!
—Teresa Kunschik, Karnes County WIC

We had a good time with our global potluck! We got to talk about our cultural differences from around the world. With this program, not only did we have good food but we feel great about ourselves now that we have emphasized daily exercise in our lives. 
—Elizabeth Roach, Dallas WIC

Our staff participated in walking, jogging, cleaning, gardening, and many more exercise activities. We were very involved from the beginning to the end of the challenge. As a first-time nutritionist coordinator, I was concerned that the staff would give up after the first week, but I was amazed and proud that the team followed through the six weeks and found great exercises to participate in. The breastfeeding peer counselor had the greatest number of minutes in exercising and improved her blood pressure levels, lost weight, and felt energized and happy. Many of her minutes came from a family trip to Disney World. She enjoyed walking all day with her children. The rest of the staff commented that they had better self-esteem and had lost weight. Thank you for giving us the opportunity to change our lifestyle and be role models to our families.
—Elizabeth Romero, Hardin County WIC

Walk the World with WIC inspired us to do all sorts of activities besides walking. We ran, scuba dived, biked, mowed lawns, played Wii Fitness, did Pilates, hiked, weight lifted, yoga, hula hooped, did aerobics, jogged with dogs, played volleyball, danced, and gardened. A few staff reported up to a six pound weight loss! Some sites used the program as a team building opportunity and held walks during site meetings at parks, and used work out videos during lunch or break time. There were even text messages sent to encourage activity! Being part of a team gave us motivation to be more active. During our June All Staff Meeting, we scheduled a 20-minute walk before the meeting began. Despite the rainy weather that morning, we walked inside. WIC staff reported that Walk the World with WIC was fun, motivating, a good incentive to walk daily, and helped improve our eating habits.
—Yvonne Martinez, Austin-Travis County WIC

Pass it On!
Why not take another lap around the world and better yet, encourage someone else to go with you? Use your experience and passion to start a friend, family member or WIC participant on their own healthy journey. Share your experiences, successes and challenges with your participants. Here are some tips for passing it on:
✿ Help participants set realistic goals. Realistic goals lead to success and help participants recognize their progress.
✿ Let them know that you will be asking about their progress the next time you see them. Accountability makes participants more likely to stick with it.
✿ Provide strategies for overcoming barriers. How did you find the time to be active? What did you do when it was raining or 103 degrees outside? What did you do when you just didn’t feel like being active?
✿ Encourage participants to keep a log or journal of their progress. Writing it down is a great way to stay focused and recognize success. Provide them with a copy of the Walk the World with WIC map — they can track their progress just like you did. (Your local agency WWW coordinator can provide you with a bi-lingual, black and white copy of the map.)
✿ Help participants identify people they can team-up with on their journey. Social support, team work and even friendly competition are powerful motivators. We all need others to encourage us, push us and sometimes grab us by the arm and say, “come on.”
✿ Be their cheerleader! Acknowledge their willingness to start, their progress and their successes and encourage them to keep going.
✿ Finally, continue to be an example for them to follow.

 

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Participants Are Using the WIC Tools Provided

by Matt Harrington, M.S., R.D.
Nutrition Education Consultant

To mark the six-month, post-new food packages rollout we conducted an online survey to better understand the shopping habits of our participants and their attitudes toward the new WIC food packages.

6,004 participants took the online survey over the week of June 23rd on TexasWIC.org and the results were quite interesting. Here are the questions and participant responses:

1. Do you use your WIC shopping list?
— 96% of our participants report using the shopping list.
2. Do you keep your WIC store receipt to refer to later?
— 93% of the participants keep the shopping receipt to refer to later.
3. Do you buy all of your WIC foods by the end of the month?
— 82% of the participants buy all of their WIC foods by the end of the month.
4. How many different stores do you shop at every month to buy your WIC foods?
— 36% of the participants shop at one store during the month.
— 53% of the participants shop at two stores during the month.
5. Have you checked your WIC food balance at the store before shopping?
— 60% of the participants have checked their WIC food balance at the store.
— Only 14% did not know that they could check their food balance at the store.
6. Do you shop for all of your WIC foods at one time?
— 11% of the participants shop for all of their WIC foods at one time.
7. True or False – You must buy all your WIC foods at one time.
— 97% of the participants know they can buy WIC foods throughout the month.
8. Have you had any problems spending all the money on your WIC EBT card for fruits and vegetables? Each month, do you use all/most of the fruit and vegetable money?
— 61% of the participants responded that they use all.
— 33% of the participants responded that they use most of the fruit and vegetable money.
9. Have you ever been unable to buy WIC foods because you lost your WIC EBT card?
— 92% of the participants have not had a problem buying WIC foods due to a lost WIC EBT card.
10. How do you feel about the amount of food you get with your WIC package?
— Across all food packages, from low-fat milk and cheese to peanut butter and bread our participants tell us that Texas WIC provides just the right amount of food.
11. If your current WIC food package contains baby food, do you buy all the baby food that comes with your WIC package?
— 59% of the participants buy all the baby food that comes with the package.
12. If you currently have a baby, do you make your own (homemade) baby food?
— 25% of the participants make homemade baby food.

The online survey shows that our participants are using the tools that WIC provides (shopping list, store receipt) to shop for their benefits throughout the month. It shows that our participants are happy with the amount of WIC foods they receive.

We will periodically survey our participants to ensure that they are getting the most from their WIC benefits and that we are providing them with finest services possible.

 

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Planning Helps Pave the Way for Successful WIC Certification Specialist Trainings

by The University of Texas at Austin Nutrition Education Group

Attendees at the April 2010 Nutrition and Breastfeeding Conference had the opportunity to participate in a pre-conference workshop to learn about the new WIC Certification Specialist (WCS) Training Program. The workshop included an outline and review of the new training modules, allowing attendees to look through the twelve training modules, practice some of the modules’ hands-on activities, and watch a sample of video vignettes the state agency created that supplement the training modules.

A Q&A panel discussion was the highlight of the session. Panelists were comprised of those who participated in the field and beta testing, including directors, WCS preceptors and some of the WCS candidates themselves from Brazos Valley, Los Barrios Unidos, Amarillo, Laredo, Plainview, San Antonio and Williamson County. Panelists shared their experiences and detailed how they tackled the planning that surrounded implementing a WCS program. One of the more endearing moments of the panel discussion included the WCS candidates themselves. They spoke of how privileged it made them feel to be selected to be a WCS candidate, and how proud they were to share that with their families. The candidates expressed how they were grateful for the opportunity to advance their career, how much more confident they are after completing the training, and how they can already notice the positive impact the training has had in performing their clinic duties and participant interactions.

To ensure the process goes smoothly, LAs should start WCS planning at least three months in advance, and be aware that the WCS Certification and Training Program takes three to nine months to properly complete. LAs should allot more time for their first batch of candidates, so the directors, preceptors and candidates can become acquainted with the material and the time commitment so that any obstacles can be addressed. Timelines can be adjusted for future candidates.
WCS preceptors will have to commit time to each candidate. Factors that can take time away from candidates, such as staffing coverage, registered dietitian’s work load and travel between sites, needs to be considered when planning. Preceptors should initially work with fewer candidates until they are comfortable with the process and material.

LAs considering a WCS program should determine whether they have the appropriate staff for oversight. “For approval, the biggest barrier will be if they (local agencies) have the appropriate oversight. LAs will need a full-time nutritionist or registered dietitian to qualify for the WCS program,” said Tonia Swartz, WIC clinical nutrition specialist.

Once local agencies determine whether they have the appropriate oversight, the next step is candidate selection. Local agencies need to consider who will be a good candidate and whether candidates can succeed with the training. Starting with a candidate who is not prepared or ready for the training will harm the candidate’s chances of successfully completing the training.

Another issue LA director’s should consider is candidate scheduling. For example, local agencies will need to adjust candidates’ schedules to allow time for on-site training, as LA 13 Director, Nora Martinez stated, “At our agency we allotted the first hour of the day for reading modules and completing assignments. Every Monday we held a conference call with the preceptor and staff for questions and concerns. If you budget the time for staff to take advantage of the training, it will work.”

Local agencies will also need to develop plans to ensure candidates have computer access and designated study areas. Candidates will also benefit from both director and other staff support.

“This training works if you have management support. This type of ‘Leadership Buy-In,’ allows your preceptor and staff the support needed to complete the program as intended,” said Nora Martinez.

LAs should think of submitting the application as the final step of the planning process, because applications should not be submitted until LAs understand what they must do to ensure both the candidates and clinics realize the WCS Certification and Training Program’s benefits.

To request an application, contact Tonia Swartz at Texas WIC at 1-512-341-4586 or tonia.swartz@dshs.state.tx.us.

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What You Need to Know About Food Allergy, Intolerance and the New WIC Food Packages

by Cathy Plyler, R.D., L.D.
Clinical Nutrition Specialist

Where could you have gone to sample gluten free cereal, soy milk and play a rousing game of Jeopardy? The Nutrition and Breastfeeding conference session entitled “What You Need to Know About Food Allergy, Intolerance and the New WIC Food Packages,” that’s where! The session provided the opportunity for Texas WIC staff and guests to sample some products available to participants as a result of the new food rules implementation in October 2009. In addition, three topics were covered during the session.

The first topic covered was food allergy and food intolerance. Food allergy is on the rise and the reason for this is not clear. Of the 33 percent of people who believe they have a food allergy, only six to eight percent of infants and children under age 3 and four percent of adults have a true food allergy. This means that it is likely that many individuals are limiting their diets unnecessarily.

A food allergy is defined as an abnormal or exaggerated immune system response to the protein in a food. A food intolerance involves any negative reaction to a food or food additive. Many people confuse the terms and use them interchangeably. True food allergy always involves the body’s immune system. We want participants to be able to benefit from as wide a variety of foods as possible within the confines of any medical limitations they might have. It is important that WIC staff communicate effectively with healthcare providers to obtain information on foods that may need to be removed from a participant’s food package. A revised Texas WIC Medical Request for Formula/Food is now available in clinics and at our www.TexasWIC.org website on the healthcare provider tab. We hope this redesigned tool will improve communication between WIC staff and medical staff to benefit participants with food allergies, intolerances and other medical conditions.

The most common food intolerance world-wide, lactose intolerance, is very rare in infants. But, following a gastrointestinal illness, temporary lactose intolerance may occur. This resolves itself once the lactase enzyme is reestablished in the gut. Lactose intolerance may cause stomach ache, gas, bloating and/or diarrhea. Lactose intolerance is more common in certain ethnic groups, particularly those of east Asian, African and Hispanic ancestry. Some people are able to tolerate small amounts of milk and other lactose-containing foods, particularly when taken with a meal, while others must completely avoid lactose, depending on the remaining lactase activity. Since hard cheese is virtually lactose-free, it can be tolerated by all those who are lactose-intolerant. Alternative foods for lactose-intolerant WIC participants are lactose-free milk, calcium fortified orange juice, soy milk and tofu.

The American Academy of Pediatrics issued relatively new guidelines in 2008 for parents of infants who are at high risk for developing food allergies, which can be found at: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;121/1/183

The second topic discussed during this session was gluten. Gluten is a protein found in grains such as wheat, barley and rye. Medical conditions that may improve in persons who consume a gluten-free diet include celiac disease and wheat allergy (or gluten intolerance). Texas WIC created some new food packages that allow participants to choose gluten-free cereal within their food selections. Rice Chex and Corn Chex are the cereals allowed in the WIC gluten-free food package. A medical request is no longer required for this food package.

The gluten-free diet is challenging in that gluten containing foods and additives are abundant in our food supply. Persons on this diet have to watch for hidden sources of gluten since it is often used as an additive or emulsifier in foods, medications and supplements. Balanced meal planning is important because gluten-free cereals, pasta and bread can be made with rice and potato flours that are not enriched and may be low in fiber, B vitamins, iron and folate. Clients on this diet should be encouraged to choose products that are enriched or made with healthier ingredients such as brown rice, quinoa or flax. Other alternative grains were displayed at the presentation including buckwheat flour, millet, amaranth and teff. WIC gluten-free cereal is an example of an enriched product.

Label reading is also important as gluten is found in many frequently used products and condiments such as salad dressings, ketchup, soy sauce and packaged mixes. There have been some major changes to legislation regarding food labels and allergens which have resulted in the development of rules for the use of the term “gluten-free.”

The third topic covered was vegetarian diets and the WIC soy food packages. The definitions of the different types of vegetarian diets were provided since WIC staff need to know the type of vegetarian they may be working with in order to counsel appropriately and issue the right food packages.

Nutrients of special interest for vegetarians were covered. Attendees learned that some nutrients are not of much concern, like protein and folic acid, because most vegetarians consume plenty of these nutrients. Other nutrients, like vitamin B-12, would be a concern for vegans (a vegan consumes no animal products) because vitamin B-12 is only found in animal products. Lacto-ovo vegetarians (a lacto-ovo vegetarian consumes milk and eggs) can consume adequate amounts of vitamin B-12.

Next, the guidelines for vegetarian and vegan pregnant and breastfeeding women, followed by guidelines for infants were reviewed. Guidelines for pregnant women included using soy, flax, or canola oil in cooking to provide for DHA synthesis. Guidelines for infants included introducing iron-rich fruits and vegetables, like mashed acorn squash and pureed prunes, as good “early foods” when infants are developmentally ready for solids.

The session ended with a review of the new WIC soy food packages. The guidelines for issuing soy toddler formula versus soy milk were reviewed and directives for when to issue soy foods with and without cheese were explained.

At the conclusion, a game of Jeopardy was played using information discussed during the presentation. The game emphasized key points covered such as the differences between food allergy and intolerance. It was emphasized that people with celiac disease and wheat allergy may benefit from a gluten-free diet and challenges faced. Soy foods are important components in the diets of vegetarians and those persons allergic to cow’s milk.

This session was so well received that state staff are planning to provide additional sessions and more information at next year’s conference. Hope to see you there!

 

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WIC Streamlines the Process of Plotting through Growth XP

by Leona Duong, R.D., L.D.
Clinical Nutrition Specialist

Local agencies recently received electronic software that would automate the plotting of the heights, weights, and BMI of infants and children. Rolled out in the summer of 2010, Growth XP software will assist in streamlining the process of plotting for all local agencies throughout Texas.

Current Benefits
Growth XP significantly increases the accuracy of the plotting of the growth charts while decreasing the amount of staff time required for manually plotting. The increased accuracy will instantly be seen in local agencies’ self audits. In addition to this, there should be fewer findings related to plotting during local agencies’ quality assurance monitoring visits. This is due to the reduction of human error associated with the manual plotting process.

This time savings advantage can be observed in a variety of ways. For instance, it allows clinic staff to devote more time to educating participants on the benefits of proper nutrition and breastfeeding. It assists large clinics with improving their clinic flow by moving participants through the certification process quicker.

Future Benefits?
As with any software, there is room for improvement. The state agency is working toward moving Growth XP to a web based system with a centralized database. The goal is to convert the data for storage onto one centralized database. Currently data can be stored on only one computer. After this conversion, all of the data that is recorded for a participant would then be saved on a state agency database. This would allow the sharing of information between all the clinics within Texas. As a result, this would provide our staff the ability to recall historical data for an infant or child’s growth and provide the appropriate counseling to assist with improving nutritional status.

The state agency is discussing software modifications that would make Growth XP more convenient for use in our WIC clinics with the company that created the software, PC Pal. We prioritized our requests due to the many items on our “wish list.” We plan to discuss such items as the plotting of premature infants while accounting for the adjusted age, the ability to search for participants by name and date of birth, and having the height and weight display in the growth chart in inches and pounds. One of the changes we have focused on is to adjust the lower and upper limits on the growth grid from the 3rd and 97th percentile to the 5th and 95th percentile. This change would make the charts more consistent with the paper growth charts, which were previously used in our clinics.

We are very excited to be working with the staff of PC Pal and expect great benefits from using Growth XP.

 

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state agency spotlight: A Warm Farewell for a Friendly Welcome

by Shirley Ellis, M.S., R.D.
Nutrition Education Branch Manager

"Nutrition Services, this is Mary Dell. How may I help you?” For the 17 years Mary Dell Heitkamp greeted callers to the WIC state office with this friendly customer service welcome. Mary Dell welcomed callers to the state office for the last time on July 30, 2010, the date of her retirement.

Mary Dell began working for WIC as a temporary employee hired to help with reconciliation of claims. At the end of her one-year contract she applied for and was selected as an administrative assistant, a position she held until her retirement. During her years with the program she witnessed many changes including numerous advancements in technology. Mary Dell recalls when all processing procedures such as ordering of supplies and distribution of correspondence were done manually without the benefit of computer automation. She has also seen the program transition through several physical changes including two remodelings and one big move from the main health department site to the Howard Lane office in north Austin.

Mary Dell will not miss the 120 mile daily round-trip drive to the office, but she will definitely miss her co-workers and friends. “We have been through a lot together: births, graduations, marriages. We spend more time at work than at home so you really know each other.”

Mary Dell’s tenure with WIC concluded with a retirement party surrounded by both family and friends. Many current and past WIC employees came to wish her good-luck and best wishes. The well-wishers also included several of her coworker’s children, who over the years would stop by to say “Hi” to Mary Dell, and in return would receive one of her generous hugs.

Mary Dell has big plans for her retirement including doing “anything I want to and nothing I don’t want to.” She also plans on spending as much time as possible with the center of her life, her three children, Troy, Amber and Kyle and her grandson, Jorden, all of who honored her by attending her retirement party.

One of the major projects she hopes to accomplish is to organize her photo albums as a gift for her family. Mary Dell states that “as she has gotten older she realizes how important photos are for children to have.” She also plans on catching up with old friends. She recently reestablished contact with a friend she has not seen in 20 years. She will now have time to get together and visit with her friends and not have to worry about needing to get up early for work the next day.

Mary Dell plans to stay in touch with her WIC colleagues and even had her own Ex-WIC Employee “retirement” business card printed with her personal contact numbers — encouraging her friends to stay in touch.

 

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state agency spotlight continued

DarrellGrimm

When Darrell Grimm retired after almost 22 years with WIC and a total of 26 years state service, he already had a busy agenda waiting for him. Tops on his list of things to do was moving, traveling, and church and volunteer work. But Darrell also made sure to include some of his favorite things on his list like fishing, hiking and photography.

As Database Administrator at WIC, Darrell maintained databases that contain WIC local agency and clinic information. He generated reports from the data, did security work for the MS Access application and support work for staff concerning this information.

“To me this has been an ongoing accomplishment, helping to provide support to the WIC local agencies, in some way, to provide good client services to the public,” said Darrell, who was also the recipient of the TALWD (Texas Association of Local WIC Directors) Award in October 2009.

When asked if he could recall any one event or moment that stood out over the past 22 years at WIC, Darrell immediately thought of the WIC staff and how much he enjoyed the Christmas parties and Thanksgiving lunches every year.

BarbaraPark

WIC Financial Analyst, Barbara Park, put a successful career at DSHS and WIC behind her to enter the world of fishing, reading and crossword puzzles.

Barbara Park retired from state service in August 2010. During her 20 years at WIC, she participated in many projects, including Farmers’ Market, EBT and WIN Evolution. She also worked on WIC history stats and graphs, audits of federal reports and analysis, projections, and forecasts of trends for rebates, participation, food and administrative expenditures.

Her many accomplishments in WIC consist of preparing and submitting the first Advanced Planning Document for the new TXWIN System in the 90s and reporting participation when Texas WIC hit the MILLION! She is especially proud of the completion of WIC’s Financial History from the beginning of WIC in 1974 to 2010.

Barbara’s daughter, Chelsea, was born in 1985. A proud mom, Barbara saw Chelsea, as a child, act in two WIC PSA’s, and now as an adult, Chelsea works for WIC EBT.

“It’s a family affair and I’ve had the unique honor of working with my daughter during my last year at WIC. This only makes it harder to leave my extended WIC family,” said Barbara.

About that retirement. Barbara definitely plans to spend more time with her husband, Richard, and Chelsea and her husband, Arthur. She even plans to go to the golf course with Richard. Who knows, she may even take up golf again.

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Dallas County Shows Off EBT to Out-of-State WIC Staff

by Patti L. Fitch, R.D.
Clinical Services Manager

Joe Williams, the vice president of Regulatory and Member Services with the Texas Retailers Association, hosted the first “By Retailers, For Retailers” trade and technology event. The event, called the National eWIC Symposium, was designed to show how online and offline WIC Electronic Benefits Transfer (EBT) electronic cash register and point of sale systems work, their similarities and differences, the pros and cons of each, their costs and more. WIC authorized vendors, State and Indian Tribal Organization WIC representatives and staff from U.S. Department of Agriculture, Food and Nutrition Service were in attendance. Clinic Services staff from the Texas state WIC office were invited to attend the conference and to accompany several out-of-state WIC staff to our Dallas clinics to see an “up close and personal” view of EBT in the clinic setting.

Attendees were able to watch how clinic flow occurs with the issuance of the EBT card, and how the PIN number is used for security. They also had the opportunity to go to a store and actually observe the purchasing process with an EBT card.

Paula Kanter, Program Specialist on Food Packages/Approved Foods, said the staff from the other states enjoyed the opportunity, “I went to Northwest Dallas clinic and the supervisor, Cassie Shockey-Holguin, did a marvelous job demonstrating the clinic system to state staff from Alabama WIC and Oregon WIC. The out of state staff also observed clients purchasing their WIC foods at the "WIC only" store around the corner from the clinic.”

Cassie had this to say about the visit, “It was great to be a part of the tour. Texas is fortunate to have already gone through the experience of the EBT transition. I was pleased to calm some fears, answer questions, and enlighten the other states on the benefits EBT has to offer.”

Kristi Miller of North Dakota commented, “Thanks again for getting me there on time and for coordinating the week. The meeting was great and I learned so much and appreciate all the time you all spent on taking care of us and sharing all your wonderful information. It was great to meet the other Texas staff and I look forward to coming back for the next meeting!”

Ellen Larkin, WIC state program specialist, said, “The Oak Cliff clinic staff were extremely helpful and knowledgeable. The visitors from Arizona and New Mexico had lots of questions and were very complimentary when speaking about EBT and the Oak Cliff clinic.”

A really big thanks goes to John Hanneman, Shey Walley, Duane Grabarschick and Brian Whitfield as the organizers and tour leaders from the state office.

John Hanneman and Brian Whitfield were at site 25 (Southwest Dallas Clinic) with USDA Regional staff from Boston. John said, “The clinic staff were very friendly and accommodating. A tour of the clinic was provided as well as allowing parts of the certification process to be observed. The most involved part was the certification data entry and issuance of benefits. Regional staff had many questions. Clinic staff explained what they were doing and answered questions as they worked. The clinic supervisor, Joyce Devereaux-Walls, asked a participant if she would allow us (six of us — USDA and Texas staff) to accompany her on her shopping trip to the ‘WIC only’ store, which was two doors down. Once she purchased her WIC food items, the USDA staff graciously carried the participant’s groceries to her car. The participant was very nice, patient and surprised with the help she received. She also answered our visitors’ questions. I feel they got a good idea of how Texas EBT works as well as many questions answered.”

 

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Last updated December 07, 2010