Georgia State Plan for Program Operation in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC)

Georgia's WIC 2011 State Plan Table of Contents

Chapter 1

Public Health Overview A. Department and Division Capacity B. WIC Capacity C. Data Sharing D. Public Comments

Chapter 2

WIC and Nutrition Office Overview A. Policy Unit B. Nutrition Services C. Program Development Unit D. Financial Management Unit E. Systems and Information F. Vendor Management Unit G. Compliance Analysis Unit

Chapter 3

Goals and Objectives A. FFY 2010 Objectives / Performance Measures B. FFY 2011 Objectives / Performance Measures

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Georgia's WIC 2011 State Plan Chapter 1: Public Health Overview
A. Department and Division Capacity

The Department of Community Health (DCH) is the umbrella health agency for the state of Georgia. DCH was created in 1999 to serve as the lead agency for health care planning and purchasing issues in Georgia. The General Assembly created DCH by consolidating four agencies involved in purchasing, planning and regulating health care. In 2009, the Divisions of Public Health (DPH) and Emergency Preparedness and Response transitioned to DCH.

DCH has five divisions and several enterprise functional areas. The divisions are DPH, Health Care Facility Regulation, Medicaid, State Health Benefit Plan, and Emergency Preparedness and Response. The enterprise functional areas are: Communications, General Counsel, Information, Operations, Finance, Inspector General, Legislative & External Affairs, and Health Information Technology & Transparency.

The mission of DCH is to champion: Access to affordable, quality health care in our communities Responsible health planning and use of health care resources Healthy behaviors and improved health outcomes

The DCH Initiatives for 2011 are:

Continuity of Operations Preparedness

Customer Service

Emergency Preparedness

Financial & Program Integrity

Health Care Consumerism

Health Improvement

Health Care Transformation

Public Health

Workforce Development

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DPH is the lead division entrusted by the people of the state of Georgia with the ultimate responsibility for the health of communities and the entire population. At the state level, DPH is divided into two deputy areas of Administration, and Programs & Services. At the local level, DPH functions via 18 health districts and 159 county health departments.

The deputy area of Administration contains Field Operations, State Operations, and DCH Enterprise Coordination areas. The Programs and Services Deputy area contains seven programs; they are Health Promotion & Disease Prevention, Maternal & Child Health (MCH), Infectious Disease & Immunization, Environmental Health, Epidemiology, Vital Records, and State Health Laboratory.

The MCH Program contains seven offices: Business Operations, Title V Integration & Grant Development, Performance Management & Support Services, Epidemiology, Child Health, Women, Infants, and Children (WIC) & Nutrition, and Community Health Services. Georgia's WIC has strong collaborations with the MCH programs and services located within these offices, especially Comprehensive Child Health, Children and Youth with Special Needs, Family Planning, Womens' Health, Oral Health, and Epidemiology.

All of the DPH deputy areas, programs, sections, offices and units work together to provide, refer and optimize services to the women, infants, and children through out the state.

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B. WIC Capacity

Georgia's WIC 2011 State Plan

Georgia administers the nation's fifth largest Special Supplemental Nutrition Program for Women, Infants and Children (WIC). During FFY 2009, Georgia's WIC provided benefits to an average of 323,355 clients each month for a total of 531,000 unduplicated clients for the year and contributed approximately $354 million to the State's economy. This funding amount is composed of $289.7 million in food and $64.3 million nutrition education, breast feeding peer counseling, breastfeeding, and administrative funds.

For FFY 2010, Georgia's WIC plans to provide benefits to approximately 329,867 clients each month for a total of 480,000 unduplicated clients for the year and contribute approximately $337.4 million to the state's economy. This fund amount is composed of $255 million in food and $70 million in nutrition education, breast feeding peer counseling, breastfeeding, and administrative funds. Based on seven months of data, Georgia's WIC has provided benefits to an average of 312,837 clients each month, which is a three percent decrease from FFY 2009. This decrease is not specific to Georgia and is occurring nationwide. To assist with increasing participation, Georgia's WIC has developed a statewide media campaign that includes flyers, bill boards, Public Service Announcements (PSAs), and bus and mass transit signs.

For FFY 2011, Georgia's WIC plans to provide benefits to approximately 325,641 clients each month for a total of 480,000 unduplicated clients for the year and contribute approximately $334 million to the state's economy in approximately the same categories as in FFY 2010.

During FFY 2009, there were 236 clinic locations providing services, with clinic sizes varying greatly as illustrated in the table below. This stratification is based on average monthly participation for the year. As the table illustrates, 150 clinics or 63.56 percent are serving less than 1,000 participants with 81 clinics or 34.32 percent of these being very small and serving less than 500 participants.

Clinic Size
< 200 201-500 501-1,000 1,001-3,000 3,001-5,000 5,001-7,500 7,501-10,000
>10,000 Totals

Number of Clinics
29 52 69 61 15
3 6
1 236

Percentage of Clinics Cumulative Percentage

12.29 22.03 29.24 25.85
6.36 1.27 2.54
0.42 100.00

34.32 63.56 89.41 95.76 97.03 99.58
100.00

During FFY 2010, WIC services are being provided through 18 health districts and two contract agencies. Services are provided at over 223 clinic locations including: 174 health departments, 29 community health centers, 13 hospitals, five military bases, and two Division of Family and Children Services (DFCS) offices. Of these locations, 99 sites provide WIC and other services during a WIC visit; 98 provide other services by referral within the same location; and 26 provide other services by referral to another location. Most locations have extended hours with no location providing home visit certifications.

As of June 28, 2010, there were 1,618 authorized vendors that were participating in the WIC food delivery system who were redeeming approximately one million vouchers each month.

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Georgia's WIC 2011 State Plan In FFY 2009, the WIC and Nutrition Office was created by combing two previously separate Sections and Unit entities. The WIC and Nutrition Office contain five units: Nutrition Services, Vendor Management, Program Development, Policy, and Systems and Information. The Compliance Analysis staff function under the Deputy Inspector General, and the Financial staff function under the Administration's Budget Section Director.

Georgia's WIC State Office Positions

Georgia's WIC funds 74 positions at the State WIC Office, 21 or 28% of which are vacant. The major filled position categories are: a Director, one legal officer, 19 vendor program specialists, nine program specialists, nine automated data processing specialists, five registered dietitians, three general administrative support, two financial specialists, one breastfeeding peer counseling coordinator, one epidemiologist, one nutrition administrative support, and one information technology specialist.

District/Local Agency Positions

As of April 2010, services are provided at the Districts/Local agency levels by 64 Registered Dietitians/Licensed Dietitians (RD/LD) for high risk nutrition education, 485 Certified Professional Authorities (CPA), 519 clerks, and 97 District/local agency management staff.

Staffing standards were developed and recommended for Clinic and District/local agency levels in 2007. Staffing recommendations are included in the Georgia's WIC Procedures Manual, Certification Section. Staffing standards are assessed during each District/local agency Program Review, and statewide each year for October and April. The results of the October 2009 and April 2010 reports, and plans for October 2010 are listed in the table below.

Standard
1 RD/LD per 5,000 Participants 1 clinical CPA per 1,000 Participants 1 Clinical Clerk per 800 Participants 1 District or Local agency Staff per 2,500 Participants

State Met the Standard as of October 2009
Yes
Yes
Yes
No

Number of Districts/local agencies Who Met the Standard as of October 2009
11
12
13
8

State Met the Standard as of April 2010
No
Yes
Yes
No

Number of Districts/local agencies Who Met the Standard as of April 2010
8
18
15
5

State Plans to Meet the Standard as of October 2010
Yes
Yes
Yes
No

Number of Districts/local agencies Planning to Meet the Standard for October 2010
11
19
16
5

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Georgia's WIC 2011 State Plan In October 2009, every District/local agency met at least one of the 2007 Recommended Staffing Standards; two Districts met all four standards; and the State as a whole met three of the four standards. Statewide, 55 % of the standards were met (44 of 80) at the District/local agency level.

In April 2010, there was improvement in the clinical and clerical capacity, but a decreased capacity in RD/LDs and management staff at the District/local agency level. Every District/local agency met at least one of the 2007 Recommended Staffing Standards; three District/local agencies met all four standards; and the State as a whole meeting only two of the four standards. Statewide, 58 % of the standards were met (46 of 80) at the District/local agency level.

In October 2010, plans indicate that there will be a significant improvement in the RD/LD capacity; only slight improvements in CPA and clerical capacity; and maintenance capacity in management staff at the District/local agency level. 18 of the District/local agencies plan to meet at least one of the 2007 Recommended Staffing Standards, with four District/local agencies planning to meet all four standards, and the state as a whole planning to meet three of the four standards. Statewide, 64 % of the standards were met (51 of 80) at the District/local agency level.

Management Information System

Georgia's WIC has four front end data collection systems (AEGIS, Mitchell and McCormick, Netsmart, and HealthNet2) and a contract with CSC Covansys Corporation for all back end data processing, banking and reports. Georgia's WIC is currently working to complete a Planning Advanced Planning Document (PAPD) that will research, assess and define alternatives for a new WIC clinical system. The goal of Georgia's WIC in conjunction with the DCH Office of Information Technology is to coordinate the planning activities that will ultimately provide the state of Georgia with a modern clinical information system that is:
Cost effective to maintain Flexible enough to adapt to changing legislation Client and case centric Facilitative towards standardized financial management Comprehensive and meets the needs of WIC at the Federal, State and local levels Moving to move to Electronic Benefits Transfer (EBT)

Performance Management

Georgia's WIC utilized ten participant performance measures in FFY 2009 to assess whether its operation at the State and District/local agency levels has the capacity to serve the potential population and was providing services in a system that was improving the health and nutritional status of participants. These measures are also being used for FFYs 2010 and 2011.

As the table illustrates below, the March 2010 monthly data indicates that the State has made progress in the enrollment of prenatals in the first trimester, with an increase to 64% from 55%. Other data is not showing improvement or is not available as this date. The State began the collection of secondary and high risk nutrition education contacts electronically January 1, 2010. A FFY 2010 performance measure report for the missing data has been drafted and expected to be completed by the data processing contractor by late summer.

The FFY 2010 progress section identifies many of the accomplishments and activities being implemented at both the State and local agency levels to improve performance for these measures; it also includes some of the challenges to their attainment. The plan section identifies some of the activities the State plans to implement in FFY 2011 to accomplish these measures.

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Georgia's WIC 2011 State Plan

FFY 2009

FFY FFY 2009 FFY FFY

2009

2009 2010

FFY 2010

FFY 2010

FFY 2010

FFY 2011

State Performance Measure
Average Monthly Participation Average Monthly Prenatal Participation Average Monthly Infant Participation Percent of Prenatals Enrolled in 1st Trimester Percent of Infants Enrolled in 1st Six Weeks of Life Percent of Infants Who Initiate Breastfeeding Percent of Infants Who Breastfeed for at Least Six Months Percent of Children Within Normal Weight

State Result
323,355

State Goal
314,535

Percentage of State
Goal Met
1.0280

Numb er of Distri cts/loc
al agenci
es Meeti ng the Goal
14

State Result
for March or Six Months
313,166

State Goal
329,867

Percent age of State Goal Met
0.9493

Numb er of Distri cts/loc
al agenci
es Meeti ng the Goal
1

State Goal
325,641

25,773 24,131 0.9363

5 23,023 24,372 0.9446

19 24,614

79,429 84,404 0.9411

3 80,223 75,997 0.9473

0.5460 0.6100 0.8951

13 0.6420 0.6000 1.0666

1 81,018 7 0.6000

0.8586 0.8200 1.0471 0.5633 0.5700 0.9882 0.1079 0.2500 0.4316 0.6080 0.8800 0.7727

16 Report 0.9000 Report Report 0.9000

Not

Not Not

Avail-

Avail- Avail-

able

able able

13 Report 0.6000 Report Report 0.6000

Not

Not Not

Avail-

Avail- Avail-

able

able able

0 Report 0.2500 Report Report 0.2500

Not

Not Not

Avail-

Avail- Avail-

able

able able

0 0.6028 0.8000 0.7535

0 0.8000

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FFY 2009

Georgia's WIC 2011 State Plan

FFY FFY 2009 FFY FFY FFY

2009

2009 2010 2010

FFY 2010

FFY 2010

FFY 2011

State Performance Measure
Percent of Participants receiving Secondary Nutrition Education Percent of High Risk Participants receiving High Risk Nutrition Education

State Result
Results Avail-
able only by District Results Avail-
able only by District

State Goal

Percentage of State
Goal Met

0.9000 Report Not Available

Numb er of Distri cts/loc
al agenci
es Meeti ng the Goal
2

State Result
for March or Six Months
Report Not
Available

0.9000 Report Not Available

0 Report Not
Available

State Goal
Report Not
Available

Percent age of State Goal Met
Report Not
Available

Numb er of Distri cts/loc
al agenci
es Meeti ng the Goal Report
Not Avail-
able

Report Not
Available

Report Not
Available

Report Not
Available

State Goal
0.9000 0.9000

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C. Data Sharing

Georgia's WIC 2011 State Plan

It is recognized that certain public organizations housed in the Division of Public Health as well as the Georgia Department of Community Health and the Georgia Department of Human Services share a common mission: to promote, protect and improve the health and safety of all people in Georgia.

Identifying information of WIC applicants and participants is confidential. 7 C.F.R. Section 246.26(d). However, Georgia's WIC and its local agencies, pursuant to Federal WIC regulations, may disclose confidential WIC information to public organizations for use in the administration of their programs that serve persons eligible for WIC benefits, provided the required steps are followed. 7 C.F.R. Section 264.26(d)(2)(ii).

The steps required for use and disclosure of confidential WIC applicant/participant information for non-WIC purposes are:

1) The State Health Officer must designate in writing the permitted non-WIC uses of the confidential WIC applicant/participant information and the names of the organizations to whom such information may be disclosed;

2) Notice must be provided to the WIC applicant/participant at the time of application or through subsequent notice that the State Health Officer may authorize the use and disclosure of information about their participation in WIC for non-WIC purposes only in the administration of those programs that serve persons eligible for WIC;

3) Include in the State agency's State plan a list of the designated organizations with which it has executed or intends to execute a written agreement for use and disclosure of WIC applicant/participant information for non-WIC purposes; and

4) Execution of the written agreement that must specify the receiving organization may use the confidential WIC applicant/participant information only to establish eligibility, conduct outreach; enhance health, education or well being; streamline administrative procedures; and/or assess and evaluate responsiveness of the State's health system. The written agreement must also contain the receiving organization's assurance that it will not use the information for any other purpose or disclose it to a third party. 7 C.F.R. Section 246.26(h).

The State Health Officer for Georgia designated in writing on July 12, 2010, that confidential WIC information may be disclosed for non-WIC purposes to establish eligibility, conduct outreach, enhance health or education or well-being, streamline administrative procedures, and/or assess and evaluate responsiveness of the State's health system, based on a written agreement between WIC and designated public organizations.

Georgia's WIC provides the required notice to WIC applicants/participants that the State Health Officer authorizes the use and disclosure of information about their participation in WIC for non-WIC purposes to designated organizations on the WIC Certification Form.

Georgia's WIC FFY 2011 State plan includes the list of designated organizations.

Effective October 1, 2011, Georgia's WIC will have executed the required written agreements with: Maternal

and Child Health Program, Infectious Disease & Immunization, Epidemiology, Environmental Health, Health

Promotion and Disease Prevention, Medicaid, State Health Benefit Plan, Emergency Preparedness and

Response, Division of Emergency Preparedness, and Division of Family & Children Services (see Agreement

for Disclosure of WIC Information.

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Georgia's WIC 2011 State Plan Effective October 1, 2011, provided the written agreements have been timely executed, confidential WIC information may be disclosed to the following designated public organizations:
DIVISION OF PUBLIC HEALTH Maternal and Child Health Program: Newborn Hearing Screening, Newborn Metabolic Screening, Childrens 1st, Babies Can't Wait, Children's Medical Services, Oral Health, Family Planning, Babies Born Healthy, Epidemiology, MCH Director's Office, Perinatal Hepatitis B Prevention
Infectious Disease & Immunization: Immunization
Epidemiology: PRAMS, OASIS/OHIP
Environmental Health: Lead
Health Promotion and Disease Prevention: Tobacco, Obesity, Adolescent Health
DEPARTMENT OF COMMUNITY HEALTH Medicaid: Medicaid, Peachcare for Kids
State Health Benefit Plan
Emergency Preparedness & Response: Injury Prevention
Division of Emergency Preparedness (in execution of a disaster response)
DEPARTMENT OF HUMAN SERVICES Division of Family & Children Services

D. Public Comments

Three different public comment surveys were created in Survey Monkey in early 2010 to solicit input from WIC participants, WIC vendors, and WIC advocates. An announcement was made via radio broadcast and newspaper advertising the Georgia's WIC 2010 annual Public Comment Survey and providing the dates the survey would be open.

The survey methodology used for each population is below:

WIC Participants Each of the 21 Georgia's WIC District/local agencies were mailed an introductory letter which included survey implementation instructions. Each District/local agency also received printed paper copies of the WIC Participant Public Comment Survey (English and Spanish versions) for distribution and a flyer for advertising the WIC Participant Public Comment Survey (English and Spanish versions). Paper surveys were marked with the District's identification code listed so that completed surveys could be identified by each District /local agency for analysis purposes. All WIC clinics were asked to hand surveys out to all WIC participants that came into their clinic beginning June 14, 2010 through July 14, 2010 and to provide a box labeled "Public Comment Survey" for anonymous submission of completed paper surveys.

WIC participants were given the option of either handing in a completed paper survey or going to a website to

complete the survey via Survey Monkey. All completed paper surveys were to be placed by the WIC participant

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Georgia's WIC 2011 State Plan into a box marked "Public Comment Survey". Clinics were asked to mail completed surveys to their District /local agency office on a weekly basis, District/local agency offices mailed surveys to the Georgia's WIC office weekly to allow Georgia's WIC staff to begin data entry. Over 24,000 completed surveys were received by Georgia's WIC by August 10, 2010.
Data for our annual 2010 Participant Public Comment Survey Summary will only come from data collected from completed paper surveys hand entered by Georgia's WIC staff. The online WIC Participant Public Comment Survey via Survey Monkey will be a pilot. We will look at this pilot data to determine how many WIC participants will respond to an online WIC Participant Public Comment Survey and to determine if the demographic characteristics of those WIC participants differ from those WIC participants who completed the paper survey.
The Table below includes the number of completed surveys submitted by each District/local agency compared to the WIC monthly participation numbers for the previous five months.

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Georgia's WIC 2011 State Plan

Table: Number of completed surveys submitted by District/local agency.

Rome Dalton Gainesville Cobb Fulton Clayton Gwinnett Dekalb Lagrange Dublin Macon Augusta Columbus Valdosta Albany Savannah Waycross Athens Southside Grady Total

WIC participation by month and district

19,016

18,849

18,690 18,218 17,849

17,900

17,766

17,731 17,473 17,177

20,036

19,821

19,880 19,382 19,084

21,544

21,492

21,714 21,356 20,562

15,192

15,146

15,145 14,907 14,885

8,964

9,140

9,486 9,598

9,645

30,650

30,440

30,236 29,767 29,882

24,847

24,569

24,921 24,790 24,797

20,949

20,800

21,089 20,876 20,027

5,341

5,386

5,261 5,224

5,115

19,348

19,408

19,160 19,397 18,631

15,101

14,980

14,639 14,699 14,449

16,245

16,174

16,232 16,124 15,619

11,029

10,670

10,069 10,778 10,348

14,470

14,297

14,152 13,926 13,511

20,436

20,346

19,993 19,871 19,453

16,693

16,700

16,436 16,134 15,694

10,777

10,599

10,597 10,252 10,216

3,425

3,368

3,268 3,291

3,105

6,004

5,840

5,421 5,652

5,541

317,967 315,791 314,120 311,715 305,590

Average monthly WIC participation
18,524.4 17,609.4 19,640.6 21,333.6 15,055.0
9,366.6 30,195.0 24,784.8 20,748.2
5,265.4 19,188.8 14,773.6 16,078.8 10,578.8 14,071.2 20,019.8 16,331.4 10,488.2
3,291.4 5,691.6 313,036.6

Number of surveys
completed 1,107 1,151 951 2,438 435 738 835 767 5,224 695 1,738 1.193 1,544 1,055 2,070 622 655 490 818 306 24,832

WIC Vendors WIC Vendors received an introductory e-mail on June 14, 2010, asking them to complete the online WIC Vendor Public Comment Survey. We used WIC vendor e-mail addresses collected during the most recent shelf price survey. The e-mail directed WIC vendors to a website, via Survey Monkey, where they could complete the WIC Vendor Public Comment Survey. The online survey was available for completion from June 14, 2010 through July 14, 2010. Two reminder e-mails were sent to all WIC vendors (June 30, 2010 and July 7, 2010) in hopes of increasing the number of survey responses received.

WIC Advocates We partnered with the Georgia Academy of Family Physicians and the Georgia Academy of Pediatricians for distribution of our WIC Advocate Public Comment Survey. WIC advocates received the WIC Vendor Public Comment Survey by two different methods. We received an annual list of our WIC advocates from all our Georgia's WIC District/local agencies. An introductory letter and a copy of the paper survey were mailed to these WIC advocates. These WIC advocates were given the option of either completing the paper survey or mailing it to the State WIC office or going to a website, via Survey Monkey, to complete the survey online.

To ensure we reach all our WIC advocates, we asked our partners, the Georgia Academy of Family Physicians and the Georgia Academy of Pediatricians, to e-mail the WIC Advocate Public Comment Survey to their members as well. Two reminder e-mails were sent to all members of the Georgia Academy of Family Physicians and the Georgia Academy of Pediatricians (June 30, 2010 and July 7, 2010) in hopes of increasing the number of survey responses received.

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Georgia's WIC 2011 State Plan The WIC Advocate Public Comment Survey was available for completion from June 14, 2010 through July 14, 2010. We do understand that some of our WIC advocates may have received both a letter as well as an e-mail regarding the survey.

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Georgia's WIC 2011 State Plan
Chapter 2: WIC and Nutrition Office Overview A. Policy Unit This Unit is responsible for:
Monitoring statewide clerical clinic operations. The Unit provides technical assistance and training to the Districts and clinics. In addition, the Unit oversees the drafting, review and finalization of the yearly Georgia's WIC Procedures Manual for submission by August 15, 2010 to the United States Department of Agriculture (USDA) for its approval
Interpreting Federal rules and regulations for the Districts, local agencies and State WIC office. Developing and reviewing the distribution of all clerical policies that are utilized by the Districts and
local agency WIC clinics Distributing all WIC policies to the Districts for distribution to the local agency staff. Collaborating with the Districts and WIC clinics to conduct quality assurance program reviews to
evaluate clinic operations, one of the USDA requirements. Prior to a review, the Unit staff reviews reports and contacts the District office for a number of issues. This Unit serves as the team lead for all program reviews. After a review is conducted, the Unit is responsible for ensuring that the review process is closed and an annual Summary of Corrective Action report is developed for State use and USDA audit purposes Coordinating all potential Civil Rights complaints from the Georgia's WIC hotline. The Unit handles all phone calls from the Georgia's WIC hotline. In addition, the Unit handles the yearly public announcement and public comments period Developing and distributing the WIC ID card Updating and distributing the annual food pantry book to the Districts Coordinating with the Secretary of States office on voter registration issues Monitoring whether the processing standards are being met by each District/clinic monthly. In addition, it reviews and processes all requests for processing standards extensions. Conducting patient flow analysis of clinic locations
B. Nutrition Services This Unit is responsible for:
Ensuring, promoting, and influencing statewide nutrition related policies, practices, and system development; including breastfeeding
Administering the nutrition portion of Georgia's WIC and assists in the coordination of the continued development of Georgia's WIC goals across all Districts and local agencies
Collaborating with the internal Policy Unit, Districts, and local agencies to conduct quality assurance program reviews of Georgia's WIC implementation to assure compliance with USDA mandates
Providing support to other WIC units such as Systems Development and Vendor Management Assisting in the development and updating of the Georgia's WIC Procedures Manual and the State Plan. Facilitating the development, approval, and dissemination of the Georgia's WIC Approved Foods List Providing District and local agencies with training on WIC food packages and approved foods list. The
Unit also assists Districts and local agencies with interpretation of Federal regulations and policies in the development of food packages Designing food packages that meet Federal regulations and policies based on USDA certification type, age, and feeding methods Providing support for nutrition education and breastfeeding promotion within Georgia's WIC by working with internal units and external partners, such as the American Academy of Pediatrics, to promote applicable nutrition science

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Georgia's WIC 2011 State Plan Increasing workforce competency through the operation of our Commission on Accreditation for
Dietetic Education accredited Dietetic Internship Providing training and educational resources such as continuing education for current staff, new staff,
and training on Georgia's WIC specific updates such as the recently implemented Value Enhanced Nutrition Assessment (VENA) and food packages Providing technical assistance to Districts and local agencies relating to nutrition education contacts, medical documentation, nutrition-related client complaints, food packages and formulas. Implementing the national risk criteria through policies, procedures, technical assistance, training and program reviews Operating the special infant formulas ordering system by reviewing, approving, ordering, tracking and processing special formula orders when not available from local vendors Managing the provision of metabolic formulas through a contract with Emory's Genetics program

Breastfeeding Support
This Unit is responsible for:
Developing, implementing and evaluating the State promotion, education and support plan. Periodically reviewing and evaluating the plan, and making appropriate revisions
developing guidelines for District/local agency promotion, education and support plans. Review each Plan and provide feedback
Monitoring the progress of District/local agency promotion, education and support through on-site programmatic reviews visits
Developing and implementing a plan to provide training and technical assistance for Competent Professional Authorities (CPAs), paraprofessional, and clerical staff
Coordinating, promoting, educating and supporting activities with related programs and professional groups such as hospitals, private medical organizations and other breastfeeding support groups
Managing and coordinating Peer Counselor Services. Promotion of breastfeeding is not enough; to be successful, mothers may need many hours of support that is skilled and is provided when needed. Peer Counselor services are a core Georgia's WIC service to provide the needed additional time and skilled help
Providing technical assistance and training to the District/local agencies

C. Program Development Unit
This Unit is responsible for: Leading efforts to increase the performance in both quantity and quality of services provided, planning and evaluation. Developing, tracking, and evaluating the performance measures for Georgia's WIC services and responsibilities. Georgia's WIC performance measures are complimentary to other MCH and PH initiatives.
Planning, including the development of the State Office and District/local agency annual templates and creating the annual Georgia's WIC plan based on these submissions. Status reports are submitted and reviewed at least twice a year to track progress and identify if technical assistance, training or revisions are needed. Each District/local agency receives feedback on their annual plan.
Coordinating data requests, reports and evaluation activities.

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Georgia's WIC 2011 State Plan Providing technical assistance and consultation to the Districts/local agencies to improve performance
by assessing data and performance measures to identify areas that need implementation of best practices or targeted interventions.
D. Financial Management Unit
This Unit is responsible for: Managing and accounting for program funds and expenditures Allocating grant funds to the 18 Districts and two contract local agencies Monitoring of expenditures Assisting with financial reporting to state and Federal agencies Preparing the annual operating budget Working with the DCH Office of Financial Services for fiscal information requirements
E. Systems and Information
This Unit is responsible for: Providing technical assistance and advice to develop, implement and improve clinic information systems and back end data processing. Planning, coordinating, and evaluating testing procedures for all proposed system changes; recommending policies and procedures for the development and implementation of system changes statewide; and monitoring system changes for compliance with State and/or Federal guidelines through reports and on-site visits. Collaborating with the internal Policy Unit, Districts, and local agencies to conduct quality assurance program reviews of Georgia's WIC implementation of system changes to assure compliance with USDA mandates Serving as the database administrator (DBA) for in-house developed applications. Activities include formulating best practices for data capture, input, and reporting; assisting with developing policies and training for automated processes; and producing user manuals
Working with all Units to facilitate automation of functions and processes Coordinating data reports in response to requests
Overseeing the equipment inventory control processes for Georgia's WIC by ensuring that purchased equipment is accounted for at all levels; clinic, District and State
Providing software and hardware support to both Georgia's WIC and local agency staff Serving as the liaison between staff who use the Vendor Integrity Profile System (VIPS) and the back
end data processing contractor. The Unit coordinates problem resolution associated with batching and reports

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Georgia's WIC 2011 State Plan reconciling the Cumulative Unmatched Redemption (CUR), Bank Exception and Critical Error Reports.
Unit staff import data on a monthly basis from text files into the CUR database. In addition, the Unit coordinates manual reconciliation of vouchers to comply with Federal Regulations and standards by entering manual reconciliations into CUR database to show true reconciliation rate. The unit corresponds with local agencies and data processing contractor in the reconciliation process.

The FFY 2009 and FFY 2010 reconciliation rates are included in the table below:

Voucher Reconciliation Rates for FFYs 2009 and 2010

Total

Un-

Un-

Manually

Total

FFY Vouchers matched matched Recon- Unrecon-

Year Produced Original

Final

ciled

ciled

(CUR 1

and 2)

2009 12,414,216

50,975

13,780

7,104

6,676

2010* 6,875,205

68,840

11,184

6,593

4,543

Totals 19,289,421 119,815

24,964

13,697

11,219

* First six months

Total Reconciliation Rate
99.9462% 99.9339% 99.9418%

Total Unreconciliation Rate
0.0538% 0.0661% 0.0582%

F. Vendor Management Unit
Vendor Relations This Unit is responsible for:
Selecting, authorizing, training, and monitoring Georgia's WIC vendors to ensure access to WIC approved foods by participants and to reduce vendor incidents of fraud and abuse
Managing the application processes of all currently authorized and prospective vendors, including selection criteria, business integrity, and inventory and pricing assessments
Managing the operational processes of all currently authorized vendors, including payment consideration for returned vouchers, assessment and implementation of sanctions, termination for noncompliance, preparations and testimony for administrative hearings, communications, complaints and monitoring
Monitoring covertly the inventory of a minimum of five percent of the vendors to ensure compliance with program rules and regulations
Conducting all mandated training for new, prospective and current vendors on an ongoing, annual and triennial basis
Determining cost competitiveness of WIC vendors and assuring their compliance with cost guidelines through above-50%-vendor assessments and shelf price collection. Activities include new and annual assessment of food sales data, and assisting in the annual process of determining cost neutrality

Farmers' Market Nutrition Program (FMNP)
This Unit is responsible for: Providing checks to the Districts in the form of a set of checks to be distributed at local WIC clinics for participants to purchase locally grown, unprepared fruits and vegetables. WIC participants receive these FMNP benefits in addition to the regular WIC food package
Interpreting federal regulations and developing State operational manuals, policies and procedures. All FMNP policies and procedures are sent to the Districts and local agencies for distribution to clinic staff

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Georgia's WIC 2011 State Plan Conducting management evaluations of District and local agencies; and providing technical assistance
and training Developing the State Plan, market development, increasing public awareness, education and training
throughout the State to State and local agencies, educational institutions, farmer organizations and community groups Authorizing all farmers and farmers markets Managing the statewide FMNP database and oversee overall management and operation. The District staff and the Market Specialist train the farmers and submit paperwork to the State for processing and authorization
G. Compliance Analysis Unit
This Unit is responsible for: Assessing compliance of Georgia's WIC vendors by performing an onsite covert investigations on a minimum of five percent of vendors to deter potential abuse and to ensure the appropriate delivery of WIC approved foods Investigating vendors under the guidance of the DCH Office of Inspector General and clinics when WIC vouchers are reported missing or stolen Investigating potential dual participation and evaluating and analyzing system reports related to fraud and abuse Participating in District/local agency quality assurance reviews to assess voucher accountability and security Conducting covert investigations to assess whether authorized vendors are in compliance when redeeming vouchers of participants for foods based on program regulations and guidelines Assessing vendors found guilty of violations by issuing a sanction, disqualification, or awarding a civil monetary penalty.
Investigations are performed based on the following indicators: Analysis of computerized vendor profile reports that provide a score based on vouchers redeemed by each vendor. Five percent of authorized vendors will be selected using this report. The high risk score will be utilized first to identify high risk vendors, and then a lesser score in descending order is used to identify the number of vendors to be investigated Complaints regarding the misuse of vouchers at a specific store Clinic Reviews: Assessments of the security of vouchers, and voucher issuance materials in clinics during issuance, staff breaks, and the close of business Missing Vouchers: Vouchers reported missing or stolen from clinics will be investigated by Districts or local agencies in conjunction with staff from this Unit. Investigating agencies may include the local police department. Districts may be subject to corrective action(s) and/or financial penalties if WIC regulations are not being followed Reports Analysis: Semi-annual reviews of Dual Participation Reports that may lead to the investigation of participants. Financial penalties may be assessed to participants found guilty of violations. Other System reports, including system-generated reports, manual reports, and ad hoc reports are also analyzed

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Chapter 3: Goals and Objectives

2011 State Plan

Goal: To provide quality services to assure that Georgians are eating healthy, breastfeeding infants, physically active, and accessing complementary services to improve their nutritional status.

A. FFY 2010 Objectives / Performance Measures Accomplishments to Date: a) Status of measure as of March 31, 2010 or later b) Best practices used to meet the measure c) Challenges to meeting the measure

1. Increase Average Monthly Participation

Target: 329,867

Data source: Close out total participation

a. State Based on six months of data, the average is 313,166; 95% of the target is being met

Districts/local agencies Based on March monthly data, only one District, Clayton, is meeting the target

b. State 1. Developed new WIC food packages client DVD to be used in health department waiting areas to promote the benefits of the new food packages 2. Developed new WIC food packages and medical documentation DVD for medical providers and distributed throughout the state to be used to increase knowledge and referrals 3. Presented and exhibited at Georgia Chapter of the American Academy of Pediatrics, Georgia Academy of Family Physicians, and several pediatric nursing organization events to promote WIC and discuss the benefits of the new WIC food packages 4. Developed a media campaign that includes bill boards, Public Service Announcements (PSAs), movie theatre, bus and mass transit signs 5. Sharing District/local agency and state staffing standards results 6. Implementation of Personnel Accounting System (PARS) 7. 98% (163 of 180) of WIC clinics are meeting processing standards based on monthly telephone calls to assess whether clinics are meeting processing from October 2009 through June 11, 2010 8. No Districts or clinics met the processing standards based on eight program reviews and five revisits due to inadequate documentation

Districts/local agencies 1. Most clinics have hours of operation and appointments in the early morning, evening and/or Saturdays 2. Most clinics have same day appointments for walk-ins 3. Many clinics contact participants who have missed voucher pickup and certification appointments 4. Some Districts/local agencies have increased staff based on gaps identified by the staffing standards and PARS 5. One District/local agency (Cobb) has established a WIC service standard of two hours and a one hour for the largest and medium size clinics respectfully and monitors the clinics against this standard monthly 6. Several Districts/local agencies expanded outreach activities, with one District/local agency (Columbus) having implemented extensive outreach activities (postcards with income guidelines, PSAs, newspaper articles, school calendars) 7. One District/local agency (LaGrange) implemented a centralized appointment and reminder call center

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2011 State Plan 8. One District/local agency (Columbus) moved to a 100% WIC funded staffing model

c. State 1. Decreased participation is a national trend, and not unique to Georgia 2. Organizational challenges related to vacant positions and leadership changes

Districts/local agencies

1. Many clinics have facility limitations 2. Many clinics have a high turnover and staff shortages 3. WIC food package is not a top priority to WIC participants who are receiving SNAP benefits since SNAP benefits have increased 4. HIPAA, disconnected phone numbers, incorrect addresses, transportation issues 5. Loss of jobs and families relocating or moving in with family members 6. One District/local agency (Southside) needs a computerized appointment system 7. Aegis front end system still needs to make some corrections to the system 8. Several Districts had longer waiting periods in October due to Aegis system not being fully functional

2. Increase Average Monthly Prenatal Participation

Target: 24,372

Data source: Close out total participation

3. Increase Enrollment of Prenatals in the First (1st) Trimester

Target: 60%

Data source: Number of 1st trimester prenatals certified/Number of prenatals

certified

a. State Based on six months of data, the average prenatal participation is 23,023; 94% of the target is being met Based on March monthly data, 64% of prenatals were enrolled in the first trimester; exceeding the target by 7%

Districts/local agencies Based on March monthly data, nineteen Districts/local agencies were meeting or exceeding the target prenatal participation Based on March monthly data, seven Districts/local agencies were meeting or exceeding the target for enrolling prenatals in the first trimester

b. State 1. All clinics provide services to prenatals and infants on a priority basis 2. New food packages that contain increased forms and variety of foods that are ethnically and culturally diverse 3. Developed new food packages client DVD to be used in health department waiting areas to promote the benefits of the new food packages 4. Developed new food packages and medical documentation DVD for medical providers and distributed throughout the state to be used to increase knowledge and referrals 5. Contracts with Georgia Chapters of the American Academy of Pediatricians (AAP) and Academy Family Physicians (AFP) to provide information and outreach and to encourage referrals 6. Presented and exhibited at Georgia AAP and AFP, and several pediatric nursing organization events to promote and discuss the benefits of the new food packages 7. Developed a media campaign that includes flyers, bill boards, Public Service Announcements (PSA) s, movie theater, bus and mass transit signs 8. Sharing District/local agency and State Staffing Standards results

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2011 State Plan 9. Implementation of Personnel Accounting System (PARS)

Districts/local agencies 1. Most clinics provide services to prenatals and infants on a walk in basis 2. Many clinics provide WIC services during the family planning visit in which a woman is notified of a positive pregnancy test or a same day appointment 3. Some clinics provide Perinatal Case Management (PCM) and WIC services during the same visit 4. Most Districts/local agencies have contacted their OB/GYN and family physicians, and pregnancy counseling centers to provide information and encourage referrals 5. One District/local agency (Albany) implemented Centering Pregnancy sessions in Dougherty County to increase enrollment of prenatals in the first trimester of pregnancy. Prenatals residing in Baker, Calhoun, Mitchell and Worth counties are eligible to participate in these sessions 6. New food packages have increased interest 7. Some Districts/local agencies have increased staff based on gaps identified by the Staffing Standards and PARS 8. One District/local agency (Columbus) monitors presumptive Medicaid eligibility enrollment and ensure WIC enrollment or provides WIC information to client

c. State Organizational challenges related to vacant positions and leadership changes

Districts/local agencies

1. Many clinics have facility limitations 2. Many clinics have a high turnover and shortage of staff 3. WIC food package is not a top priority to WIC participants who are receiving SNAP benefits since SNAP benefits have increased 4. Transportation issues in rural counties 5. Prenatals waiting for Medicaid to be approved before seeking prenatal care and WIC services 6. OBs not providing services to prenatals until after eight to 12 weeks 7. High cost of pregnancy tests in clinics

4. Increase Average Monthly Infant Participation

Target: 80,223

Data source: Close out infant participation

5. Increase Enrollment of Infants in the First Six (6) Weeks

Target: 90%

Data source: Number of infants certified by six weeks/Number of infants certified

a. State Based on six months of data, the average is 75,997; 95% of the target is being met Infant enrollment by six weeks report is not available

Districts/local agencies Based on March monthly data, only the Clayton District, is meeting or exceeding the target Infant enrollment by six weeks report is not available

b. State 1. Contracts with Georgia Chapters of the American Academy of Pediatricians (AAP) and Academy Family Physicians (AFP) to provide information and outreach and to encourage referrals

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2011 State Plan 2. Presented and exhibited at Georgia AAP and AFP, and several pediatric nursing organization events to promote WIC and discuss the benefits of the new WIC food packages 3. Developed a media campaign that includes flyers, bill boards, Public Service Announcements (PSA) s, movie theater, bus and mass transit signs 4. Sharing District/local agency and State Staffing Standards results 5. Implementation of Personnel Accounting System (PARS) 6. New food packages with added baby fruits and vegetables

Districts/local agencies 1. Most clinics provide services to prenatals and infants on a walk in basis 2. A few Districts/local agencies provide WIC services in hospitals to new mothers and infants 3. Several Districts/local agencies met with women and child health services staff and reemphasized referrals to WIC 4. Most Districts/local agencies have contacted pediatricians, OB/GYNs and family physicians, hospitals, day care centers, and Early Head Start centers to provide information and encourage referrals 5. Many clinics are educating prenatals during the 3rd trimester and the last voucher pick up on breastfeeding and enrolling their infant on WIC within one week of delivery 6. Some Districts/local agencies have increased staff based on gaps identified by the Staffing Standards and PARS

c. State 1. Decreased participation is a national trend, not unique to Georgia 2. Organizational challenges related to vacant positions and leadership changes

Districts/local agencies 1. Many clinics have facility limitations 2. Many clinics have a high turnover and shortage of staff 3. Hospitals eliminating or not allowing WIC services to be provided on site due to revenue loss and/or lack of space 4. Transportation issues in rural counties 5. Some participants have difficulty missing work 6. Cultural issues with moms not wanting to bring babies out 7. Breastfeeding moms who do not want to enroll infants 8. New medical documentation form

6. Increase Percentage of Infants who Initiate Breastfeeding Target: 60% Data source: Number of infants certified who ever breast fed/Number of infants certified

7. Increase Percentage of Infants who Breastfeed for at least Six Months Target: 25% Data source: Number of one year olds breast fed for six months and greater/Number of one year olds who ever breast fed

a. State and Districts/local agencies Revised breastfeeding reports for initiation and duration are not available

b. State 1. Loving Support Through Peer Counseling Program expanded from seven Districts/local agencies to 15 2. Developing incentives for Districts that reach beyond their initiation goals

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2011 State Plan 3. Duration rates are expected to increase due to the increased number of Districts/local agencies with the "The Loving Support Through Peer Counseling Program" 4. Breastfeeding Education Committee is developing a breastfeeding continuing education component to the WIC Online Nutrition Program. Four activities will focus on "Getting started with breastfeeding", "Myths and Facts", "Going back to work or school", and "WIC breastfeeding Food Package" 5. Began work on implementation of The Loving Support Through Peer Counseling Program in the remaining five Districts (1-1 Rome, 3-2 Fulton, 5-2 Macon, 8-1 Valdosta and 8-2 Albany) 6. Clarified breastfeeding data collection questions and revising duration calculation to be calculated from initiation and termination dates instead of number of weeks breastfeeding to increase accuracy of data 7. New enhanced food package for exclusively breastfeeding moms and baby meats added for infants
Districts/local agencies 1. WIC services provided in hospitals to new mothers and infants 2. Many clinics are educating prenatals during the third trimester and the last voucher pick up on breastfeeding and enrolling their infant within one week of delivery 2. All clinics educate CPA's and Nutrition Assistants annually on current breastfeeding topics 3. Many Districts/local agencies share breastfeeding reports with each county 4. Many Districts/local agencies follow up with breastfeeding mothers at voucher pickup 5. Breast pump program, including electric breast pumps available for moms that meet criteria 6. Some Districts/local agencies employ or train nutritionists as Certified Lactation Counselors (CLC) s 7. Many Districts/local agencies have a comprehensive breastfeeding plan 8. Several Districts/local agencies have implemented breastfeeding friendly policies and environment in county health departments, schools, businesses, hospitals, churches, physician offices 9 One District/local agency (Gwinnett) provides breastfeeding orientation to all new staff 10. Peer counseling program in all clinics 11. Many Districts/local agencies participate in a community or hospital coalition, including initiative hospital initiative to meet new Joint Commission breastfeeding performance goals 12. One District/local agency (Macon) is creating a certificate for moms who breastfeed six and 12 months
c. State Accurate data collection has been a challenge
Districts/local agencies 1. District/local agency staff's limited time to give appropriate breastfeeding support and education to clients 2. Cultural, social and family beliefs related to breastfeeding 3. Many clinics have a high turnover and shortage of staff 4. Breastfeeding moms who do not want to enroll infants 5. Lack of home, work and community support 6. Many moms are returning to work before six weeks and do not understand the importance of breastfeeding for a short period of time
8. Increase Percentage of Children within Normal Weight Target: 80% Data source: Number of children within normal weight / Number of children recertified
a. State 1. Based on six months of data, only 60.28% of children are within normal weight; only meeting 75% of the target

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2011 State Plan Districts/local agencies Based on six months of data, no Districts/local agencies were meeting the target
b. State 1. Nutrition Education (NE) Committee has identified the lack of appropriate obesity nutrition education materials in the Districts despite overweight and obesity being among the most common nutrition risks identified among participants 2. The NE Committee has made it a priority to develop new NE materials on childhood and postpartum obesity prevention and the promotion of weight management for statewide use; will also identify any existing resources 3. Positive changes in the food packages which includes fruits/vegetables, whole grains, lower fat milk choices, less cheese, less juice, etc
Districts/local agencies 1. Most Districts/local agencies provide annual NE updates so that staff can stay abreast of cutting edge interventions 2. Most Districts/local agencies are providing and incorporating activity programs into NE sessions 3. Most Districts/local agencies provide specific NE sessions, including activity programs for children at risk and overweight 4. Fit WIC initiative implemented in some clinics 5. Many Districts/local agencies expanded the use of videoconferencing for NE sessions 6. Several Districts/local agencies refer extreme obese participants to RD for high risk counseling
c. State Organizational challenges related to vacant positions and leadership changes
Districts/local agencies 1. Low literacy and retention rate of parents concerning nutrition topics discussed 2. Cultural and family beliefs related to weight 3. Monetary issues of clients 4. Lack of safe walking and play areas for families and children
9. Increase Percentage of Participants Receiving Secondary Nutrition Education Target: 90% Data source: FFY 2009 Number of Secondary NE/Number of clients recertified
10. Increase Percentage of High Risk Participants Receiving High Risk Nutrition Education Target: 90% Data source: FFY 2009 Number of High Risk NE/Number of High Risk Clients recertified
a. State Reports for secondary and high risk nutrition education are not available
Districts/local agencies
Reports for secondary and high risk nutrition education are not available
b. State 1. Preparing to pilot test new web-based secondary NE service to provide statewide online low-risk secondary NE alternative for clients

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2011 State Plan 2. Kiosks have already been acquired and delivered to clinics to provide access to web-based secondary NE service in waiting areas 2. Filled one vacancy and hired one additional staff member to assist in providing Districts with technical assistance and training 3. Converted secondary NE contact documentation from paper to electronic, which is improving secondary NE documentation rates

Districts/local agencies 1. Nutrition Assistants in some counties provide low risk NE contacts; if the CPA is unable to see high risk clients, the nutrition assistant provides a low risk secondary NE contact and reschedules them to see CPA for high risk contact 2. Most Districts/local agencies provide annual NE updates 3. Some Districts/local agencies monitor and provide a monthly report to clinic employees/supervisors on NE rates for secondary and high risk contacts 4. Implementation of interactive and client focused NE 5. One District/local agency (Clayton) identifies the ID cards of high risk clients with a customized label so that high risk NE sessions are provided 6. One District/local agency's (Dekalb) computer system notifies CPAs of high risk client status based on risk criteria during certification and clerks during voucher pick up that high risk NE session required

c. State and Districts/local agencies 1. Decreased numbers of RDs, LDs, nutritionists to provide services 2. Decreased RD, LD, and nutritionist salaries that are not competitive 3. State level organizational challenges related to vacant positions and leadership changes 4. A few Districts/local agencies experienced computer system reporting problems 5. Lack of participant time and interest in NE

11. Distribute State Procedures Manual and Plan Electronically to the Local Agencies

Target: 100%

Data source: Date distributed / Oct 1

a. State 1. Target not met, manual and plan were completed and distributed early November 2009

b. State 1. Plan developed early with all the steps, responsible staff, and due dates included 2. Early and frequent meetings with Georgia's WIC staff to ensure completion 3. Conducted monthly discussions with Georgia's WIC and District/local agency staff on revisions to the Manual 4. All WIC advocates, participants and vendors were offered the opportunity to provide comments during the public comment period

Districts/local agencies 1. All Districts/local agencies had staff participate and provide input into the revisions of Georgia's WIC Procedures Manual

c. State and Districts/local agencies 1. Organizational challenges related to vacant positions and leadership changes

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2011 State Plan

12. Conduct Program Reviews and Re-Reviews of Local Agencies

Target: 100%

Data source: Number completed / 14

a. State 1. Conducted thirteen program reviews or 92% of target; the remaining review is scheduled during September

Districts/local agencies 1. Most Districts/local agencies are on schedule to complete internal reviews of clinics 2. Review reports discussed with clinics and revised reviews conducted of clinics who are not meeting requirements 3. Most Districts/local agencies provide annual training to all staff on deficiencies identified 4. A few Districts/local agencies have dedicated monitoring team

b. State and Districts/local agencies 1. Annual calendar developed early and monitored 2. One District/local agency (Dekalb) reviews each clinic twice per year

c. Districts/local agencies 1. Clerical portion of review is very lengthy and a lot of details even though it has been condensed from last year.

13. Develop Patient Flow Analysis (PFA) Standards for Services and Wait Time

Target: Yes

Data source: Yes or No

a. State 1. Conduct four PFAs, randomly selecting two clinics in two different Districts in order to determine state standards of service and wait times 2. Develop and conduct training for each District one day prior to the PFA being conducted 3. Review all PFA data to determine the state's strengths and weaknesses

b. Districts/local agencies 1. Many Districts/local agencies have performed clinic PFAs. 2. One District/local agency (Clayton) tracks electronically all WIC services using the beginning and ending times

14. Expand WIC Farmers Market (FM) to allow Farmers to Accept WIC Fruit and Vegetable Vouchers

(FVV)

Target: Yes

Data source: Yes or No

15. Increase the Number of Farmers who Participate in WIC FM.

Target: 5%

Data source: Number of farmers / 136; target is six

a. State and Districts/local agencies 1. Implementation planned for July 1, 2010 2. Farmers have increased in several Districts/local agencies

b. State and Districts/local agencies 1. Revised FMNP Policies, Procedures Manual and forms to include FVV 2. Conducted statewide training for District staff and Market Specialist 3. Developed Farmer Training PPt and distributed to Districts/local agencies to train farmers

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2011 State Plan 4. Georgia's WIC staff attended Fort Valley State Conference in February to promote and market program to farmers 5. Georgia's WIC staff attended meeting with SNAP EBT staff to discuss and promote FMNP to EBT Farmers Markets 6. Most Districts/local agencies are including FVV tips into client NE sessions, i.e., seasonal produce; how to maximize purchase

c. State and Districts/local agencies Some areas have a limited number of farmers to recruit from

16. Automate Client Forms in the Front End Computer Systems

Target: 50%

Data source: Number of forms automated / 54, target is 27

a. State 1. Identified forms that need to be automated based on discussions with District/local agency staff

b. Districts/local agencies 1. A few Districts have computerized and automated client forms 2. One District/local agency (Athens) has already computerized 27 forms in their system; six of which are automatically completed and printed, others are printed on demand

17. Provide Input, Clarification, and Recommendations to Assist with the Infant Formula Rebate

Contract that will be Effective Oct 1, 2010

Target: Yes

Data source: Yes or No

a. State 1. Drafted Infant Formula Rebate (IFR) Request for Quote (RFQ) 2. Meet with various stakeholders for review and input and made revisions 3. Submitted final RFQ draft to Department and USDA for approval 4. Contract awarded and announced July 7, 2010

18. Streamline Vendor Selection and Authorization Process

Target: Yes

Data source: Yes or No

a. State 1. Began assessing the vendor application process for weaknesses

b. State 1. Began best practice research of comparable state WIC application processes 2. Electronic vendor application has been drafted and testing started

19. Monitor Vendors to Increase Compliance

Target: 5%

Data source: Number of monitored / 1,618; target is 81

a. State 1. Performed 130 or 160% of target 2. These visits resulted in 97 vendors being in compliance, 33 vendors found in violation of having stale dated food or insufficient inventory 3. Eight vendors have been disqualified 4. One administrative hearing held with decision to uphold the decision

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2011 State Plan

20. Investigate vendors to decrease fraud and abuse

Target: 5%

Data source: Number of monitored / 1,618; target is 81

a. State 1. Performed 34 or 42% of target 2. These investigations resulted in the identification of ten vendors overcharging, two vendors substituting unauthorized foods, 14 vendors with other violations, and ten vendors with no violations 3. Disqualified ten vendors due to non-compliance 4. Referred ten vendors to the Food Stamp Program for program disqualifications 5. Testified in eight vendor appeals

21. Improve Communication on Disqualified Vendors Target: 100% Data source: Number of notices sent to the Districts/number of disqualified vendors from both Vendor Management and Compliance Units

a. State 1. Vendor Management and Vendor Compliance Unit staff have developed a plan that includes the identification of vendors that have been disqualified; and sending an e-mail twice a month to the District/local agency Nutrition Services Directors entitled "Update: Georgia's WIC Disqualified Vendors". If there are no updates, no e-mail will be sent.

Districts/local agencies 1. A few Districts/local agencies stated that they received feedback

c. Districts/local agencies 1. A few Districts/local agencies stated that they received no feedback

22. Expend Food Funds

Target: 97%

Data source: Expended funds/Allocated funds

a. State 1. The state is on track to expend 97% of the state's allocated food funds 2. A financial statement will be submitted monthly to the State Office of Nutrition and WIC and will include total projected expenditures, projected budget, and a running expenditure ratio comparing projected NSA and food expenditure percentages

Districts/local agencies 1. All Districts/local agencies educate clients about the importance of maximizing the amount and redeeming vouchers

23. Implement Personnel Activity Reporting System (PARS)

Target: 100%

Data source: Number of clinics implemented/Number of clinics

a. State 1. All Districts and local agencies have implemented PARS to capture the accountability of WIC expenditures at the local agency

Districts/local agencies 1. All Districts/local agencies have implemented PARS and reviewing reports

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2011 State Plan

b. Districts/local agencies 1. Most Districts/local agencies are reviewing monthly reports to identify issues and providing information to staff/supervisors 2. Most Districts/local agencies are providing clarification and training to staff to ensure compliance and accuracy

c. Districts/local agencies 1. System is not user friendly

24. Improve FNS-798 Reporting

Target: 100%

Data Source: Yes/No

a. State 1. Monthly reports will be discussed by Chief, Nutrition and WIC Services and other team members

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2011 State Plan B. FFY 2011 Objectives / Performance Measures Activities Planned to Accomplish this Objective/Performance Measure

1. Increase Average Monthly Participation

Target: 325,641

Data source: Close out total participation

State 1. Implement media campaign that includes bill boards, PSAs, movie theatre, bus and mass transit signs 2. Continue contracts with AAP and AFP to strengthen referrals 3. Continue to monitor whether clinics are meeting the processing standards

Districts/local agencies 1. Many Districts/local agencies plan to increase staff 2. Most District/Local agencies plan to increase hours of operations, including alternative hours 3. Many Districts/local agencies are investigating facility expansions, renovations, and/or relocations, including mobile units 4. Most Districts/local agencies plan to increase outreach activities, especially to SNAP clients 5. A few Districts/local agencies plan to target outreach activities to Hispanic communities, e.g. newspaper articles 6. Most Districts/local agencies plan to call and/or send post cards to all participants who have not picked up vouchers or kept appointment 7. One District/local agency (Gainesville) will be piloting the calling of participants after an appointment to assess "how we are doing" and to remind them of their NE goal 8. One District/local agency (LaGrange) plans to continue using a centralized telephone system for appointments, calling clients with missed appointments or voucher pick up 9. One District/local agency (Columbus) plans to partner with Car Seat Safety Education staff to increase referrals 10. A few Districts/local agencies plan to conduct customer service training

2. Increase Average Monthly Prenatal Participation

Target: 24,614

Data source: Close out prenatal participation

3. Increase Enrollment of Prenatals in the First (1st) Trimester
Target: 60% Data source: Number of 1st trimester prenatals certified/Number of prenatals certified

State 1. Implement media campaign that includes bill boards, PSAs, movie theatre, bus and mass transit signs 2. Continue contracts with AAP and AFP to strengthen referrals 3. Continue to monitor whether clinics are meeting the processing standards

Districts/local agencies 1. Many Districts/local agencies plan to increase staff 2. Several District/Local agencies plan to increase hours of operations, including alternative hours 3. Many Districts/local agencies are investigating facility expansions, renovations, or relocations 4. Several Districts/local agencies plan to meet with clinic staff (children and women's health) to provide data, encourage referrals, and develop a plan for meeting the targets 5. Most Districts/local agencies plan to meet with local physicians and encourage referrals 6. One District/local agency (Gainesville) plans to call missed appointments at least twice

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2011 State Plan 7. One District/local agency (Cobb) plans to obtain list of positive pregnancy tests and contact those clients who have not requested or received WIC services

4. Increase Average Monthly Infant Participation

Target: 81,018

Data source: Close out infant participation

5. Increase Enrollment of Infants in the First Six Weeks

Target: 90%

Data source: Number of infants certified by six weeks/Number of infants certified

State 1. Implement media campaign that includes bill boards, PSAs, movie theatre, bus and mass transit signs 2. Continue contracts with AAP and AFP to strengthen referrals 3. Continue to monitor whether clinics are meeting the processing standards

Districts/local agencies 1. Many Districts/local agencies plan to increase staff 2. Several Districts/local agencies are investigating facility expansions, renovations, or relocations 3. Several Districts/local agencies plan to meet with clinic staff to provide data and develop a plan for meeting the targets 4. Many Districts/local agencies plan to meet with local physicians, hospitals and encourage referrals 5. Most Districts/local agencies plan to call and/or send post cards to all participants who have not picked up vouchers or kept appointment 6. Several Districts/local agencies plan to meet with hospitals to encourage referrals, include WIC info in birthing packets, and advertise on in-house TV 7. Several Districts/local agencies plan to explore the re-establishment of hospital based clinics 8. One District/local agency (Gainesville) plans to call missed appointments at least twice 9. One District/local agency (Gainesville) plans to call all mothers within three days of EDC if not recertified

6. Increase Percentage of Infants who Initiate Breastfeeding Target: 60% Data source: Number of infants certified who ever breast fed/Number of infants certified

7. Increase Percentage of Infants who Breastfeed for at least Six Months Target: 25% Data source: Number of one year olds breast fed for six months and greater/Number of one year olds who ever breast fed

State 1. Expand Peer Counseling services to include all 20 Districts/local agencies 2. Provide breastfeeding specific training to all District/local agency staff that provide services 3. Create a strong media campaign focusing on initiation and duration

Districts/local agencies 1. Most Districts/local agencies plan to continue distributing breast pumps 2. Most Districts/local agencies plan to continue to provide training and updates to staff, WIC and non-WIC paid staff 3. One District/local agency (Gainesville) plans to have peer counselors contact all prenatals to encourage breastfeeding 4. One District/local agency (Gainesville) plans to have peer counselors contact all prenatals within three days of EDC to encourage breastfeeding

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2011 State Plan 5. Several Districts/local agencies plan to continue and/or enhance their hospital based programs 6. A few Districts/local agencies plan to explore the re-establishment of hospital based clinics 7. One District/local agency (Clayton) provides E-ZONE priority services to mostly and exclusively breastfeeding moms 8. Most Districts/local agencies plan to offer CLC training to staff 9. Most Districts/local agencies plan to continue participating in a community or hospital coalition 10. One District/local agency (Augusta) plans to implement the "Breastfeeding Employee Support Policy" in additional county health departments 11. One District/local agency (Waycross) plans to implement "Business Case for Breastfeeding" in additional locations, particularly schools

8. Increase Percentage of Children within Normal Weight Target: 80% Data source: Number of children within normal weight / Number of children recertified

a. State 1. Improve staff competency by improving the evaluation of state provided training by evaluating the impact of training on knowledge, skills and attitude using methods directed at a correlation between training activity and staff performance 2. Create online VENA training modules for each of the four core competencies: rapport building, critical thinking, goal setting and motivational interviewing. Training modules will include assessment of trainee and evaluation for feedback from trainee on the use of the system and modules.

Districts/local agencies 1. Most Districts/local agencies plan to incorporate more physical activity exercises and healthy eating habits into NE sessions 2. Several Districts/local agencies plan to implement or expand Fit WIC initiative 3. Some Districts/local agencies plan to expand Farm to Fork initiative into NE sessions 4. One District/local agency (Cobb) plans to conduct an "Obesity" audit to assess provision of NE services and referrals

9. Increase Percentage of Participants Receiving Secondary Nutrition Education (NE) Target: 90% Data source: Number of Secondary NE/Number of clients recertified

10. Increase Percentage of High Risk Participants Receiving High Risk Nutrition Education Target: 90% Data source: Number of High Risk NE/ Number of High Risk Clients recertified

a. State 1. Implement online Georgia's WIC participant NE statewide with evaluation of participant utilization of system as well as evaluation of client attitudes towards online NE 2. Establish monthly data tracking reports for online NE to allow District/local agency, and State level monitoring of NE secondary and high risk contact rates 3. Increase utilization of videoconferencing technology to improve quality and geographical reach of NE provided to WIC clients by Registered Dietitians and CPAs

Districts/local agencies 1. Many Districts/local agencies plan to expand use of videoconferencing and DVDs for NE sessions 2. Many Districts/local agencies plan to increase RD, LD, nutritionists, and other CPA staff

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2011 State Plan 3. One District/local agency (Dekalb) plans to conduct client survey to determine NE topic preferences 4. A few Districts/local agencies plan to schedule secondary and high risk NE sessions monthly until completed 5. Several Districts/local agencies plan to increase use of Nutrition Assistants and/ or LPNs for low risk NE sessions

11. Distribute State Procedures Manual and Plan Electronically to the Local Agencies

Target: 100%

Data source: Date distributed / Oct 1

State 1. Plan developed early with all the steps, responsible staff, and due dates included 2. Early and frequent meetings with Georgia's WIC staff to ensure completion 3. Conduct monthly discussions with Georgia's WIC and District/local agency staff on revisions to Georgia's WIC Procedures Manual 4. All WIC advocates, participants and vendors will be offered the opportunity to provide comments during the public comment period 5. Receive written approval from USDA 6. Send approved manual and plan to the contracted agency for conversion to a PDF searchable format 7. Distribute 25 CD's to the Districts/local agencies

12. Conduct Program Reviews and Re-Reviews of Local Agencies

Target: 100%

Data source: Number completed / 14

State 1. Meet with State staff to develop a calendar of dates for program reviews and re-reviews 2. E-mail the final calendar out to the Districts after negotiating with the Nutrition Services Directors for dates 3. Conduct program reviews and re-reviews

Districts All Districts/local agencies plan to continue conducting clinic reviews

13. Increase Number of Clinics Participating in WIC FM

Target: 100%

Data source: Number of clinics added / 10; Total of 65

State 1. Discuss with currently participating District/local agency WIC Coordinators to gain support for increasing the number of clinics participating 2. Contact non-participating Districts/local agencies to gain support for participating

14. Maintain WIC FM Redemption Rate

Target: 95%

Data source: Vouchers redeemed / vouchers issued

State 1. Review Check Summary Report weekly to monitor agency and statewide redemption 2. Identify and share strategies in annual training sessions to assist Districts/local agencies with low redemption rates to improve their rates

Districts/local agencies All Districts plan to increase information on redeeming and maximizing FVV and FM vouchers as part of NE sessions

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15. Automate Client Forms in the Front End Computer Systems

Target: 100%

Data source: Number of forms automated / 27

1. Meet with appropriate staff to develop business rules 2. Develop drafts, distribute for review and finalize

Districts/local agencies 1. One District/local agency (Athens) plans to continue to automate forms in their system

16. Improve Voucher Reconciliation Processes

Target: 100%

Data source: Yes or No

a. State 1. Follow up by e-mail with Districts/local agencies whose reports are late 2. Enter data into database to calculate total reconciliation rate 3. Track District/local agency compliance with reporting 4. File reports 5. Conduct training for local agencies if needed

17. Train Vendors Using the Accordant System

Target: 100%

Data source: Number of Vendors trained via Accordant system

State 1. Meet with appropriate staff pertaining to utilizing the Accordant system for authorization and reauthorization training, and annual and cashier training 2. Develop training via Accordant system 3. Implement all training modules via Accordant system

18. Monitor Vendors to Increase Compliance

Target: 10%

Data source: Number of vendors monitored / 1,618; target is 162

State 1. Revise criteria for monitoring to include redemption high risk indicators, complaints, and authorization date 2. Expedite monitoring process 3. Assess the benefits of and ability to conduct vendor audits 4. Implement vendor audits 5. Begin to create system of collaboration with Compliance Analysis Unit to prevent fraud

19. Implement a Web-Based Application for Vendor Selection and Authorization

Target: Yes

Data source: Yes or No

State 1. Develop a web-base application in which vendors can initiate the application process 2. Test web based application 3. Implement complete the application package in its entirety, including electronic signatures

20. Improve Communication on Disqualified Vendors Target: 100% Data source: Number of notices sent to the Districts/number of disqualified vendors from both Vendor Compliance and Management Units

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State 1. Communicate with Districts/local agencies, contract bank and the DCH Office of Investigative Services on clinic and vendor investigations

21. Investigate Vendors to Decrease Fraud and Abuse

Target: 5%

Data source: Number of monitored/1,618; target is 81

State 1. Provide guidance and assistance to Districts/local agencies and vendors 2. Monitor food purchasing practices and compliance with voucher redemption 3. Investigate high risk vendors 4. Develop and implement new guidelines and regulations from USDA

22. Expend Food Funds

Target: 97%

Data source: Expended funds/Allocated funds

State 1. The State plans to expend 97% of the allocated food funds 2. A financial statement will be submitted monthly to the State Office of Nutrition and WIC and will include total projected expenditures, projected budget, and a running expenditure ratio comparing projected NSA and food expenditure percentages

Districts/local agencies Most Districts plan to increase information on redeeming and maximizing vouchers as part of NE sessions

23. Re-establish Financial Management Unit

Target: Yes

Data source: Yes or N

State 1. The Unit will be reorganized with adequate infrastructure to ensure planning, monitoring, appropriate utilization, auditing and reporting of expenditures

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