Gti HgCJb .n Sf F6 ICj'1b GEORGIA DEPARTMENT OF HUMAN RESOURCES DIVISION OF PUBLIC HEALTH STATE WIC OFFICE Georgia State Plan for Program Operation in the Special Supplemental Food Program for Women, Infants, and Children (WIC) Fiscal Year (October I, to September 30, Submitted in accordance with USDA Food and Nutrition Service Federal Regulations 246.4 - State Plan August, TABLE OF CONTENTS State WIC Office Staff. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. i HI. IV. Projected Fiscal Yearl!:\S\5 Participation V. Local Agencies in Order of Need VI. Process for Applying to Operate a WIC Clinic VII. Special Populations . VIII. Outreach/Coordination , X. Food Delivery System . . .. . . ..... a8 38 ~P: ~g ................. ~ XIV. Fair Hearings and Administrative Appeals ~~ XVI. Public Notification . XVII. Public Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . p ~... ATTACHMENTS A. WIC Income Guidelines. . . B. Flagged Voucher by Vendor Per District Average C. Voucher Variation Report . D. Voucper Redemption Fluctuation Report . STATE WICPLAN - ........ $9 ............ gl ........... Q2 STATE WIC OFFICE ATTACHMENTS E. Vouchers by Day Cashed . F. Vendor Voucher Deviation Report G. Vendor FPC Compare and VC Compare Report H. Vouchers Cashed by Clinic 1. Cumulative Vendor Totals. . J. Georgia WIC Program Organizational Chart K. Public Meetings . L. Indirect Cost Agreement M. Potential Population N ~~ O. New WIC Logo . . . . . . . . . . . . . . .. . _. P. Federal Fiscal Yeart~g Food Allocation Formula Q. AutomatedData Processing Update. . . Ri . . . . . . . . . STATE WIC PLAN- STATE WIC OFFICE STATE WIC OFFICE Director's Office Director - Lynda D. Pittman-Cotton, R.N., M.S.N. Medical Epidemiologist -;By,~g~9$ll' Coordinator Special Projects - LuVera Howell Human Service Program Specialist II - Gen Hunter Administrative Assistant - PENDING Vendor Management Unit Vendor Manager (Operations Analyst)Operations Analyst - Mamie D Operations Analyst Associate - Alisha Brooks Operations Analyst Associate - Lorane Brown Operations Analyst Tech . Administrative Clerk - SenAidomr Sineicsrtreatatirvye-C~!le!r~k~f-!~tli~Nijli#i~~i\m Clerk Transcriber II - Barbara Woods Quality Improvement Unit Quality Improvement Manager (Operations Analyst Principal) - Nina Murray Operations Analyst - Vernon Lawton Operations Analyst - Sonia Jackson Operations Analyst Associate Compliance Investigator - Compliance Investigator Senior Compliance Investigator Compliance Investigator - STATE WIC PLAN- STATE WIC OFFICE Systems Information Unit Database Coordinator (Acting Manager) - ~~G!~NW Senior Systems Analyst (Manager) - VACANT Operations Analyst - James Laraby Systems Analyst - Joan Gregory Operations Analyst - Tonya Miller Principal Clerk - Modesty Williams Data Processing Specialist - Ronnie Currie Program Management and Review Unit Unit Manager (Human Services Program Services II) - Lynn Flen Human Services Program Specialist I - j:i.~~m~$~ Operations Analyst - Samuel Sims Operations Analyst - . Operations Analyst Tech. - Senior SecretMy - Angela Lawson Financial Management Unit Fiscal Analyst Principal (Mana er Fiscal Analyst - Operations Analyst - Jim Campbell Administrative Clerk - ~~tc!iWg~ Administrative Support Unit Principal Secretary (Office Manager) - Cindy Woods Secretary/Typist - Mimi Benton Senior Clerk - VACANT STATE WIC PLAN- STATE WIC OFFICE I. INTRODUCTION The mission of the Department of Human Resources (DHR) is to assist Georgians in achieving their highest levels of health, development, independence and self-sufficiency. The Division of Public Health emphasis is on an integrated service system that assures comprehensive health services in an environment which fosters personal ~ignity and promotes optimal attainment of individual ability. The goal of The Maternal and Child Health Branch is to assure women of child bearing age, and their children access to early comprehensive health services which promote healthy behavior and healthy life styles. The WIC Program serves as a gateway to comprehensive health services for maternal and child health clients. Therefore, the goal of the Georgia WIC Program is to provide comprehensive health and nutrition services, that encourage wellness, healthy life styles, and preventive health care to as many low-income women, infants, and children as possible. The implementation of programs directed toward improving access to prenatal care and family planning service enhances the Division's efforts to reduce infant mortality. The reduction ofinfant mortality rate continues to be a driving force for the Division of Public Health program initiatives and services. The Georgia WIC Program contributes to the Division efforts by 'targeting interventions to certify pregnant women during the first trimester.. This client-oriented approach to service delivery enables Local Agencies to' develop and implement program interventions which are suitable to the needs of the local community. The WIC Program continues to: expand the implementation of innovative initiatives which will increase certification of prenatal participants during the first trimester of the pregnancy; collaborate with immunization programs for purposes of increasing the number/percentage oftwo year olds who are fully immunized; decrease the number/percentage of subsequent teenage pregnancies; and streamline the application process for enrolling in WIC via the Georgia Common Access Form. The State Plan outlines strategies for administering the WIC Program in Georgia. The plan is divided into three parts. Part one summarizes progress for FY objectives and lists objectives for FY 12. Part two for delivery service to WIC clients. isgith~:ejnia~r1riat~i.vieiwith!i!cfh~mtie~t!h~oid~i.z!e~sJjr~oir;ajm&;~st!rjal!~Ie~s~ Q;!:iiig!~li}!ij~!&giiRl!jjThe narrative includes program strategies for caseload management, food fund management, local agency selection and ranking needs, certification and rights of program participants, public notification and comments and data management initiatives. The third part is the Procedure Manual which provides guidance to local agencies in operating the Program. The Procedure Manual is developed in a separate document. STATE WIC PLAN- STATE WIC OFFICE II. OBJECTIVES A. SUMMARY OF FFY '95 OBJECTIVES The Objectives Summary provides an update ofthe State's efforts to complete FFY i,2) Program Objectives. The State WIC Office, Office of Nutrition, Local Agencies, and WIC Coordinators worked collectively to implement FFY objectives. This summary presents the objective accomplishments in accordance with program function. The following Program functions are included: Programmatic Administration; Quality Improvement and Food Instrument Accountability; System Information Management, Vendor Management; Financial Management and Certification and Nutrition Services. FOOD FUND MANAGEMENT FOOD FUND MANAGEMENT - OBJECTIVES I, II, AND ill STATE WIC PLAN- 2 STATE WIC OFFICE CASELOAD MANAGEMENT CASELOAD MANAGEMENT - OBJECTIVES IV AND V STATE WIC PLAN- 3 STATE WIC OFFICE OUALITY IMPROVEMENT QUALITY IMPROVEMENT - OBJECTIVES VI, VII, AND VIII STATE WIC PLAN - 4 STATE WIC OFFICE PROGRAMMATIC ADMINISTRATION PROGRAM ADMINISTRATION - OBJECTIVES IX, X, XI, XII, xm, XIV, XV, XVI, XVII, AND XVIII Prowam benefits to unserved infants and children under foster care, parents. protective services. or child welfare authorities - Objective XII Improve access to WIC Pro~ram and Health Care Services for Mi~rants Objective XIII STATE WIC PLAN- 5 STATE WIC OFFICE Interagencv Network for Information and Resources Sharing to Provide and Improve Program Services for Women ofChild Bearing Age and their ChildrenObjective XVI Cessation Intervention Program for WlC STATE WIC PLAN- 6 STATE WIC OFFICE SYSTEMS INFORMAnON MANAGEMENT SYSTEMS INFORMATION MANAGEMENT - OBJECTIVE XIX, STATE WIC PLAN- 7 STATE WIC OFFICE VENDOR MANAGEMENT VENDOR MANAGEMENT - OBJECTIVE XX Special Application, Handbook and Trainin~ Format for Pharmacies - Objective XXI PROGRAM INTERVENTION PROGRAM rNTERVENTION - OBJECTrvE xxr AND XXII STATE WIC PLAN- 8 STATE WIC OFFICE 16 B. FEDERAL FISCAL YEAR OBJECTJYES FOOD FUNDS MANAGEMENT OBJECTIVE I: By January 1,~QQ complete the first year ofa three year cost contaimnent initiative in the form ofrebates on purchases of infant formula thereby reducing the overall food package cost and increasing caseload participation. EVALUATION DESIGN: E Signed contract with successful quoter, which guarantees a specific amount to be returned to the State WIC Office for each can of iron fortified concentrate, powdered or ready to feed formula purchased, and Action Steps ActivitieslMethods Ii provide technical assi~tance and training, as needed, to Districts regarding infant formtlla contract changes, if required. Resources SWO,OON Milestones 2) Continue to monitor ADP Contractor for appropriate food package change and reports, if required. SIU, SWO, OON Contact period will be from January 1, 1996 to ~~~~#!lc~ri~!jt~!~7; STATE WIC PLAN- 9 STATE WIC OFFICE FOOD FUNDS MANAGEMENT OBJECTIVE II: By lifP9~'~jt~iiiii, Districts will issue m\l!<~~~ontract formula to forWIC. of the infants certified EVALUATION DESIGN: A specified amount of rebate to the State WIC Office for each can offormula purchased. Action Steps ActivitieslMethods Resources Milestones 1. Implement new statewide policy concerning utilization of sole source milk based infant formula for all well WIC infants. SWO January 1996 2. Monitor Concentrate .Rebate Compliance Report. SWO, SMI, OON Monthly 3. Review trend ffilalysis of Compliance Report as needed. SMI,OON As Needed 4. Educate parents and health care providers on change in policy. OON, SWO, SIU Georgia Chapter American Academy of Pediatrics On-Going STATE WIe PLAN- 10 STATE WIC OFFICE FOOD FUNDS MANAGEMENT OBJECTIVE ID: By September 30, ~g2 the Statewide accuracy of monthly food obligations to expenditures will be maintained at 98% or greater. EVALUATION DESIGN: The accuracy will be assessed monthly by comparing projected food costs for each month (issue month) with the final expenditures for the month (closeout). Action Steps ActivitiesfMethods Resources Milestones I. Calculate, review and submit monthly food obligations to DHR for submission to USDA Regional Office. SWO-Systems Information Unit, Financial Management Unit 1O/31/QS thru 9/30/g~ 2. Maintain monthly table which summarizes percent of accuracy. Financial Management Unit Monthly STATE WIC PLAN- II STATE WIC OFFICE CASELOAD MANAGEMENT OBJECTIVE IV: By September 30, iligg{!, at least ofWIC participants served will be in Priorities I, II and III resulting in targeting of benefits to the highest risk participants. EVALUATION DESIGN: The Systems Information Unit report which includes priority information will be reviewed monthly and percent of total participation classified as Priorities I-III will be assessed. Action Steps ActivitieslMethods Resources Milestones I. Assess which local agencies were below the Statewide percentage of high risk clients served in FFY '96. Systems Information Unit(SWO) 1/3l/Q6 ,2. Monitor and provide technical: assistance to those local agencies whichhave not maintained the established standards/caseload. Systems Information Unit & Program Management Review Unit (SWO) On-Going 3. Assist local agencies in developing strategies to target high risk clients. Program Management and Review Unit On-Going 4. Assist local agencies in developing strategies to maintain participation for high risk clients. Program Management and Review Unit On-Going STATE WIC PLAN - 12 STATE WIC OFFICE CASELOAD MANAGEMENT OBJECTIVE V: By September 30, !lim, increase the percentage of prenatal WIC participants certified in the first trimester from 52% to 58%. EVALUATION DESIGN: The quarterly Trimester of Enrollment Report, will be reviewed and percent of total prenatal WIC participants certified in the first trimester will be assessed. Action Steps ActivitieslMethods 1. Review Local Agency referral system for reaching private providers 2. Assist local agencies in developing strategies to increase early enrollment in prenatal care'and WIC. Resources Milestones Office of Nutrition, 12/31/95 SWO- Program Management and Review Unit (PM&R). Program Management and Review Unit (PM&R) (SWO),OON 2/3 1/9~ 3. Provide technical assistance to local agencies who have difficulty enrolling prenatal women early in pregnancy. 4. Provide a forum for local agencies to discuss successful strategies for increasing first trimester enrollment. 5. Develop public employer and physician awareness campaign concerning WIC Program and use of referral form. 6. Explore the expansion of WIC Services to community health centers, health maintenance organizations, private obstetricians, migrant and rural health centers. Same as #2 On-going Same as #3 6/Q~ SWO, OON, Department 2/2~ of Medical Assistance, District Coordinators, Department of Labor, DRR. SWO, OON, DMA, Georgia On-going Primary Care Association, Medical Association of Georgia, Georgia Academy of Pediatrics, Migrant and Rural Health Association, HMO Affiliates. STATE WIC PLAN- 13 STATE WIC OFFICE QUALITY IMPROVEMENT OBJECTIVE VI: By September 30, il~ complete q6:!~I~!~iqfflpm~n~~~r4ltIl6!~..iiii!lc!cornplian.ce investigations on 10% of active WIC Vendors. EVALUATION DESIGN: Comparison of High Risk Vendors designated for investigations and reports of completed investigations will be reviewed and evaluated. Action Steps ActivitieslMethods Resources Milestones I. IdentifY High Risk Vendors to be targeted for compliance investigations. SWO, Vendor and Quality Improvement staff 2. Begin compliance investigations. Same as #1 3. Complete 10% active WIC Same as #1 9/30/96 4. STATE WIC PLAN- 14 STATE WIC OFFICE QUALITY IMPROVEMENT OBJECTIVE Vll: Continue to enhance Quality Improvement guidelines and procedures in addressing potential program abuse. EVALUATION DESIGN: By September 30, IQQ, the Quality Improvement Plan will be updated, based on obtaining new information which would enhance current regulations. Action Steps ActivitiesfMethods Resources Milestones I. Continue to research other state agencies to evaluate quality improvement strategies. SWO Quality Improvement Unit 2. Forward updates to Coordinators "for comments. Results presented at Coordinator's meeting. Same as #2 3. Provide technical assistance and training regarding implementation of updated plan to local agencies, as needed Quality Improvement Unit, Program Management and Review Unit (SWO) On-going STATE WIC PLAN- 15 STATE WIC OFFICE QUALITY IMPROVEMENT EVALUATION DESIGN: G9mP!,!~j:(!!tgg9W~j),~;ffl~lt%QfjlQg~!&1\nQ.t1~~~!;I!Yi Action Steps ActivitieslM ethod Resources 1. Confer with local agency to verifY incident 2: Milestones 4. STATE WIC PLAN- 16 STATE WIC OFFICE PROGRAMMATIC ADMINISTRATION OBJECTIVE IX: By April I, ![Q~, implement revised WIC eligibility guidelines simultaneously with the implementation of State income eligibility guidelines for the Medicaid program. EVALUATION DESIGN: The WIC Program will notifY Local agencies of income guideline changes and implement revised guidelines as policy by April I, 1996. Action Steps Activities/M ethods Resources Milestones I. Receive official USDA notification of new income poverty guidelines. Program Management and Review Unit 3/15/96 2. Send memorandum to Districts notifYing them of the revised WIC income poverty guidelines based on the revised guidelines issued by DIillS. Program Management arid Review Unit (SWO) 4/1/96 3. Send memorandum to Department of Medicaid Assistance (DMA) informing the agency of the revised WIC income poverty guidelines. Same as #1 4/!/96 4. Revise Georgia WIC Resource Booklet to reflect income poverty update. Program Management and Review Unit 4/25/29 STATE WIC PLAN- 17 STATE WIC OFFICE PROGRAMMATIC ADMINISTRATION OBJECTIVE X: By September 30, I!~[it ~~;!t\tQ) Local Agencies will have been reviewed to ensure their progr~~tif~o~pliance with Federal Regulations and State Policies and Procedures. The remaining \1!~yii1:~~i local agencies will be offered training and technical assistance by State Agency staff. EVALUATION DESIGN: TeIi(fQ) Local Agency programmatic and financial reviews will be conducted by Sept. 30, 1996. Action Steps ActivitieslMethods Resources Milestones 1. Finalize Local Agency review schedule for FFY '96. SWO, Office of Nutrition (OON), WIC Nutritionist Local Agencies 2. Complete eleven (11) Local Agency. reviews/technical assistance. Same as #1 3. Prepare Local Agency reviews/technical assistance reports and submit to Local Agency. SWO,OON On-going 4. Analyze and summarize FFY '96 Local Agency reviews/technical assistance sessions flow sheets and submit to Program Directors. SWO,OON 5. Close all FFY '96 Local Agency reviews. SWO,OON STATE WIC PLAN- 18 STATE WIC OFFICE PROGRAMMATIC ADMINISTRATION OBJECTIVES XI: By August IS, ~~. the Federal Fiscal Year ~j;!2 State Plan and Procedures Manual will be revised as needed and submitted to the USDA Regional WIC Office. EVALUATION DESIGN: The Federal Fiscal Year 1996 State Plan and Procedures Manual will be submitted on time. Action Steps ActivitiesIMethods 1. Receive final USDA approval ofFFY '96 State Plan and Procedures Manual. 2. Contract with private agency to index Plan and Manual. Resources USDA, SWO, OON Private Vendor SWO,OON Milestones 10/1/95 10!l/g~ - 11115/2$ 3. Print and distribute Procedures Manual to Local Agencies, Clinics, and others as requested. DOAS, SWO 4. Develop and distribute policy memos throughout FFY '96 as necessary. 5. Mail public comment letters notifying participants and advocacy groups of statewide regional public hearings. Program Management and Review Unit (SWO), Nutrition Consultant (OON) Program Management and Review Unit (SWO) On-going 4/30/j;! 6. Mail Local Agency comment letters. 7. Conduct statewide regional public hearings. 8. Compile and analyze public comments to include FFY State Plan and Procedures Manual as appropriate. Program Management and Review Unit (SWO) Same as #1, Local Agencies. Same as#1 STATE WIC PLAN- 19 STATE WIC OFFICE PROGRAMMATIC ADMINISTRATION OBJECTIVE XII: By September 30, i~)?, continue to ensure that program benefits are provided to unserved infants and children under the care of foster parents, protective services, or child welfare authorities, including infants exposed to drugs perinatally. EVALVATION DESIGN: Coordinate WIC services with Department of Family and Children Services (DFACS) and distribute WIC literature. Action Steps ActivitieslMethods Resources Milestones I. Continue to notifY all DFACS agencies and personnel ofWIC Program provision. Program Management and Review Unit (SWO) On-going 2. Continue to provide DFACS agencies and personnel with WIC Program infomlation. . Program Management and Review Unit On-going 3. Continue to instruct WIC Local agencies to document origin of DFACS referral in "Special Use" field on turnaround document. Systems Information Unit, (SWO), Local Agencies, Viking, Inc. On-going 5. Monitor montWy Viking report of number ofDFACS infants and children receiving WIC program benefits. Systems Information Unit (SWO) On-going STATE WIC PLAN - 20 STATE WIC OFFICE PROGRAMMATIC ADMINISTRATION OBJECTIVE xm: Continue to improve access to WIC Program and health clinic services for migrants. Action Steps ActivitieslMethods 1. Monitor migrant encounters and provide technica agimciesas increase enr Resources Milestones 3. 4. STATE WIC PLAN- 21 STATE WIC OFFICE PROGRAMMATIC ADMINISTRATION OBJECTIVE XIV: Continue to encourage local agencies to adopt the "Athens model" (or comparable prototype) or other district specific strategy to enhance the coordination of WIC services with the district immunization programs. EVALUATION DESIGN: Twenty-one local agencies will have implemented the Athens model or other district specific models for coordinating WIC with Immunization. Action Steps ActivitiesfMethods Resources Milestones 1. Provide technical assistance to local agencies which will implement the coordinated program (Athens model). State Immunization Program & Program Management and Review Unit On-going 2. Develop and distribute WIC/ Immunization Integration Survey (or information included in a comprehensive survey.) SWO - PM&R UNIT, Systems Information Unit, Immunization Program. 3. Compile results SWO - PM&R UNIT, Systems Information Unit, Immunization Program. STATE WIC PLAN- 22 STATE WIC OFFICE PROGRAMMATIC ADMINISTRATION OBJECTIVE XV: Disseminate referral infonnation ofFood Assistance Programs for WIC applicants/participants when caseload is at full capacity. EVALUATION DESIGN: By November I, ;l~Q, distribute a listing of local agency referral resources for food assistance programs for participants/applicants to the Local Agencies. Action Steps ActivitieslMethods Resources Milestone I. Include statewide listing of local food assistance programs into State WIC Resource Booklet for typesetting. DOAS, SWO 8/95 - 9/95 2. Continue to design and disseminate information about other local fooe assistance programs. Local Agencies On-going 3. Develop a process for reviewing and revising local food assistance program listings. Local Agencies On-going STATE WIC PLAN- 23 STATE WIC OFFICE PROGRAMMATIC ADMINISTRATION EVALVATION DESIGN: Collaborate and attend meetings with other agencies communicating ideas and coordinating resources to foster working relationships and to enbance program efforts. AgencieslPrograms include Migrant Health and Education Program, Georgia Department of Education, Even Start, Head Start, Medicaid, Weed and Seed, Council on Children & Youth, Children Medical Services, Expanded Food and Nutrition Education Program (EFNEP), DMA, and other appropriate agencies. Action Steps ActivitieslMethods Resources Milestone 1. Contact various agency representatives to receive 1995/96 meeting schedules. SWO, Staff of responsible agencies 11/96 2. Attend meetings with collaborating agencies. SWO, Staff of responsible agencies 3. Provide and share technical support and information to collaborating agencies. SWO, Staff of responsible agencies On-Going STATE WIC PLAN- 24 STATE WIC OFFICE PROGRAMMATIC ADMINISTRATION OBJECTfVE XVll: illJl, By September 30, the Georgia WIC Program will continue to encourage implementation of a comprehensive smoking cessation intervention program for WIC prenatal participants. EVALUATION DESIGN: WIC prenatal participants will have a decrease in percentage of prenatal WIC women who smoke (white prenatal to 28%; black prenatal 5% ). Action Steps ActivitieslMethods Resources Milestone I. Continue previously developed smoking cessation initiative for prenatal participants. SWO, OON, Women Health, PSC Local WIC Program staff On-going 2. Monitor smoking cessation initiatives implemented by Local Agencies. SWO (Systems Information Unit) Quarterly 3. Evaluate/review prenatal smoking statistics via Armis. SWO, Sill, OON Quarterly' STATE WIC PLAN- 25 STATE WIC OFFICE PROGRAMMATIC ADMINISTRATION OBJECTIVE xvm: By July 31,JQQ, the Georgia WIC Program will develop guidelines for establishing and improving linkages with local community health centers (CHC) and health maintenance organizations for the expansion ofWIC service to these facilities. EVALUATION DESIGN: The development of procedures and guidelines for establishing andlor expanding WIC service sites. Action Steps ActivitieslM ethods Resources Milestones I. Convene a work group to explore and develop strategies for expansions. SWO, OON, Local WIC Agencies, Local IState Hospital Representatives State HMOs, CHCs 2. Draft program strategies and procedural guidelines. SWO, OON, Local WIC Agencies, Local/State Hospital Representatives State HMOs, CHCs 3. Expand Pre-Application information and develop L.A. selection criteria, application form and other related documents. 4. Finalize procedural guidelines. SWO, WIC Coordinators, District Staff SWO, WIC Coordinators, District Staff 7/1S/6c STATE WIC PLAN - 26 STATE WIC OFFICE SYSTEMS INFORMATION MANAGEMENT EVALUATION DESIGN: The Systems Information Unit will make site visits to determine the accuracy of the download in FFY'96. Action Steps Activities/Methods L The data processing Will download da to each'individual c Resources Milestone 2, Select test site(s) and begin receiving data. from contractor: 3. Begin to download files 10 individualclinic:s 4. STATE WIC PLAN- 27 STATE WIC OFFICE VENDOR MANAGEMENT Action Steps ActivitieslM ethods 2: 3. 4. Resources Milestone STATE WIC PLAN- 28 STATE WIC OFFICE ActionSteps Activities/Methods 1: Resources 2. Milestones STATE WIC PLAN- 29 STATE WIC OFFICE 4. STATE WIC PLAN- 30 STATE WIC OFFICE Rep. STATE WIC PLAN- 31 STATE WIC OFFICE PROGRAM INTERVENTION XXI: EVALUATION DESIGN: A progress summary of researched infonnation including possible strategies for implementing an EBT System for the Georgia WIC Program. Action Steps ActivitiesIM ethods Resources Milestone I. Continue participation in EBTIWIC Task Force. Director SWO and designated staff On-going 2. Continue participation in EBT-WIC Task Force with FNS and DHR. Food Stamps EBT Task Force. SWO EBT Task Force, FNS, DFACS On-going 3. Continue participation in Georgia WIC EBT Task Force with Southeast Region EBT Task Force. SWO EBTTask Force, S.E. Region EBT Task Force SAS (Southeast Alliance of States). On-going 4. Attend national/ regional/state EBT conferences. SWOEBT Task Force On-going STATE WIC PLAN- 32 STATE WIC OFFICE OBJECTIVE XXII: By January I, ~QQ, improve access to WIC Program for participants and prospective applicants who are employed or reside in rural areas. EVALUATION DESIGN: By November 30, 1995, local agencies will develop for implementation, plans for modifYing clinic schedules to accommodate employed applicants/participants and those participants/applicants residing in rural areas. Action Steps ActivitieslMethods Resources Milestones I. Assess clinic hours oflocal agencies to identifY clinics with flexible or extended hours to accommodate participants/applicants with special needs. 2. Local agencies to identifY/estimate the percentag~.of working participants in respective areas. 3. Local agencies to review identified needs and present system of scheduling appointments and develop a plan to accommodate participants/prospective applicants who work or reside in rural areas. SWO 10/15/96 Local Agencies 04/30/Q,g Local Agencies 08/3 STATE WIC PLAN- 33 STATE WIC OFFICE L 2. Attachment S lists the summaries and objectives for each District. mi CASELOAD MANAGEMENT Program Philosophy The Goal of the Georgia WIC Program is to provide WIc benefits to as many eligible wome.n, infants, and children as possible. The provision of nutrition education and nutritious WIC approved foods, referrals to agencies/facilities, and the promotion of access to health care are justifications for ensuring that applicants/participants receive WIC benefits for as long as financial and categorical status permit. With infant mortality rates being exceedingly high; rampant childhood poverty, hunger and homelessness; pregnant women having difficulty accessing prenatal care; high unemployment rates; and as the number of young children growing up without adequate immunizations increases in Georgia, the WIC Program maintains a philosophy of providing WIC services to those most in need for as long as possible. Determining Caseload Participation During FFY '94, USDA contracted with Sigma One for purposes ofupdating the WIC estimated population. This information was based on 1989 income level and determined that in all WIC categories the Georgia estimated population at or below 185% of poverty totaled 262,251. Assuming that if 81% ofall income eligibles would be fully eligible (due to nutritional risk factors), USDA revised the Georgia WIC estimated population to be 255,946. Due to the disparity between the State Agency estimated eligibles (367,346) and USDA most current estimated eligibles (243,878), the State Agency has requested that USDA re-examine their data and methodology. Independent of this request, the State Agency entered into a contract with Georgia State University, Policy Research Center for pur oses of calculating the estimated WIC Po ulation durin FFY'95 J Attachment R) USDA has entered into a contract with Mathmatica, who will analyze the Signa One report and recalculated these estimated STATE WIC PLAN - 34 STATE WIC OFFICE population fi Additional factors considered when determining caseload participation include: current Medicaid totals ofpregnant women and children served, most current Georgia birth data, Division ofPublic Health initiatives (early enrollment of prenatal women), teenage pregnancy rates, EPSDT and immunization unduplicated data, infant mortality rates, unemployment information, anticipated business layofflclosing information, military population, special population data (migrant, refugee, homeless), previous caseload history/trends, current year participation, federal grant awards (projected, actual, current and succeeding year(s)), and rebate funds (projected, actual, current and succeeding year(s. WlC Allocation Advisol)' Committee The WlC Allocation Advisory Committee is charged with assisting the State Agency, and Division of Public Health with developing an acceptable methodology for allocating federal grant funds to Local agencies. Since'.FFY '90 the Georgia WIC Program has been allocating administrative funds based on the methodology described in the Financial Management Section of this document. This Georgia WlC approved funding formula has been well accepted by local agencies due to its accuracy and fairness. Additionally, the Georgia WlC Allocation Advisory Committee makes recommendations to the State AgencylDivision of Public Health concerning caseload management strategies; these recommendations are considered and modified if necessary. The committee is chaired by a District Health Director and other members of the committee include representatives of smal~ medium and large WIC clinics in the capacity of District WIC Coordinator, District Program Manager, and District Health Director. Each category (coordinator, manager, director) has one representative from a small, medium, and large size clinics. The committee meets two(2) times per year, first in January or after the federal grant award notification; and in July or August to reallocation and the succeeding year's caseload strategies. ~l)a;;n~lill~ll.~~!$;Committeemembers rotate every two years. To ensure committee continuity and integrity, one member from each category becomes a member ofthe succeeding rotation. Calculating Caseload Participation Determining caseload participation is an on-going process. The ideal planning process projects participation over a three to five year period. This long term process forecasts current and future participation, and enables the State and Local Agencies to potentially stabilize participation patterns from year to year. However, some STATE WlC PLAN- 35 STATE WlC OFFICE uncontrollable factors which directly impact this forecasting process result in unpredictable caseload fluctuations. Some of these factors include: food price inflation, expansion of Medicaid eligibility for women and children, United States military activities natural disasters which devastate communities, birth and pregnancy rates, unemployment, congressional allocation, reallocation of funds, the time of the year which impacts pregnancy rates and immunization appointments, the local agency capability to handle caseload expansion, food package costs, rebate revenue, and previous participation trends. Nonetheless, these factors must be considered when projecting caseload participation. In general, every August, the State Agency begins projecting the next fiscal year's participation direction, either expansion or reduction. In order to project realistically, the above mentioned factors are incorporated into the projection analysis. The primary contributing factors which are considered include current participation trends; projected rebate revenue; average food package costs; and projected FNS State grant. The amount of "projected available" food funds actually determines the preliminary direction for the succeeding years caseload. The projected year end participation and the current year participation trend patterns (by women, infants and children), and available funds are used as the base for projecting program.caseload direction. On a montWy basis, participation reports and funds are analyzed and appropriate adjust.ments to caseload direction are modified as appropriate. All the above mentioned calculations and analysis are shared with the WIC Allocation Advisory Committee prior to implementing statewide policies concerning participation, expansion, stabilization or reduction. As a general rule, all Local Agencies (Districts) adhere to the caseload policies established by the State Agency. In the event that Local Agencies are unable to maintain caseload strategies as designated by the State Agency, the WIC Allocation Advisory Committee and/or the State Agency develop(s) a plan for assisting the local agency(ies) with adjusting funds to accommodate an acceptable caseload plan. STATE WIC PLAN- 36 STATE WIC OFFICE 1be Caseload Management and Financial Forecasting Report is a combination of Projected and Actual Data. On a monthly basis, after receipt of previous month's statistics from the data processing contractor, the following steps are used to re-<:alculatelupdate monthly figures. PART I Step 1: The latest USDA Food Grant is used. Step 2: Projected Rebate - Calculated total (part II of this Report) Step 3: RoD Forward ~ (FOOD FUND) This is the amount which remains unspent from previous old Fiscal Year (up to 1% of USDA Food Grant) (ADMIN) 1bis is the amount which remains unspent from the previous fiscal year (up to 1% of total administrative grant) Step 4: Total Available is the sum ofLhe USDA Grant, Projected Rebate and Roll Forward. Step 5: Projected Expenditure ~ Automatically calculated from Part II of this report. Step 6: Difference is the indication of overspending (negative figure) or underspending (positive figure) from subtracting the Projected Expenditure from the Total Available. PART II This section requires the following reports from Viking: 1. Participation Summary by District/Unit - Participation Totals for Issue Month -30 Day ~ Clos~ut 2. Food Expenditure Report - Issue Month ~ 30 Day - Closeout 3. Infant Fonnuia Rebate Report ~ District/County 4. Food Cost Projection - Obtain from ARMIS (Automated Reporting Management Infonnation System) the current cost ofWomen~ InfantChildren Average Food Package. 5. Establish Participation Figures - To establish participation figures for each remaining month: Post closeout month participation for Prenatal, Non-Breastfeeding, Breastfeeding, Infant and Children participatioon count. b. 3Q-day month - Review previous 12 months to determine the average difference of PNBIC from 30 day to closeout and either add or subtract that figure to/from the present 30 day month to arive at a projected closeout month figure. Issue month - Review previous 12 months to determine the average difference of PNBIC from the Issue month to 30-day month and either add or subtract that figure to/from the present Issue month to anive at a projected 30-day month figure. Unknown WIC Type are added to children. For months remaining beyond aJrrent issue month, add projected monthly increase/decrease for each WIC Type to arrive at projected participation figures. NOTE: During periods of unusual activity such as adding or removing large numbers of participants use only the most recent months. STATE WIC PLAN- 37 STATE WIC OFFICE Projected Rebate - Using current Redeemed Month (same as Issue Month) multiply the total number of redeemed cans from the Infant Formula Rebate - District/Unit/County Summary Report times the per can rebate for that type (Concentrated/Powdered/Ready to Feed), add the three figures then deduct I %. Post this figure in the Issue Month Row. Divide the average rebate for the previous four months by the average number of infants served for that period to arrive at an average rebate per infant. Multiply the remaining months of PROJECTED infant participation by that figure to determine the Projected Rebate for the remainder of the year. (This process may be modified during times when rebate amounts change.) Projected Expenditure - For the Closeout Month - Post Closeout figures For the 30 Day Month - Use current Viking system projections, however raise or lower to assume new participants. For the Issue Month - For each month newer than the Issue the system calculates as follows: Using AVG FOOD PACKAGE of Women, Infant and Children the spreadsheet calculates by multiplying the number of Women, Infant and Children by their respective food package cost. The cost by WIC type are added together and multiplied by the current cash rate of approximately.95. PROJECTED FISCAL YEAR 1995 PARTICIPATION Emphasis continues to be placed on early enrollment of pregnant women and infants. Due to the disparity between the Georgia WIC estimated potential and the USDA figures, the Georgia WIC Director has requested that USDA reexamine the original Sigma One research calculations. In addition, the Georgia WIC Program has contracted with a reputable Atlanta Georgia demographic/statistical vendor to independently reassess the Georgia WIC estimated population. However, regardless of which figures are used in the final analysis, a minimum of 98 % of the total caseload will be in Priorities I, II, and III. LOCAL AGENCIES IN ORDER OF NEED Ranking districts according to need is done by exammmg key demographic information that relates to WIC. This includes potential population, percent of WIC compared to the total district population, infant mortality rate, infant death rate, low birth weight rate, and teenage pregnancy rates. The following is a brief description of the formulas used. Potential Population STATE WIC PLAN- 38 STATE WIC OFFICE To determine the number of potentially eligible women, pO~lltiilL.illfill1r ~qi~tiJ;~~i~!B at or below 200 % of Poverty level is multiplied by 1.2S. This formula was suggested by USDA in order to account for fifteen (IS) months [assuming nine (9) months of pregnancy and six (6) months postpartum]. Therefore, the' formula for determining Potential Population is: (e) (% Children 0-4.$. 200% pov., 1980 X # children 0-4, 1991) (1) (% Children 0-4.$. 200% pov., 1980 X # live births, 1991) (y.l) + (Number live births> 200% pov 1991 X 1 2S) POTENTIAL POPULAnON Other Fonnu1as 1) % WIC Compared to the Total Population Potential PopulationrTotal Population &1 Low Birth Weight (Total Birth Weights .$. 2,SOOgrTotal Live Births) X 1,000 9) Infant Mortality (Total Infant DeathsrTotal Live Births) X 1,000 19 Teenage Pregnancy Rates Total Live Births - Mothers age 10 - 19 Total Spontaneous Abortions - Mothers age 10 - 19 Total Induced Abortions - Mothers age 10 - 19 STATE W1C PLAN- 39 STATE W1C OFFICE Total Pregnancies - Mothers age 10 - 19 (rotal Pregnancies of Mothers age 10 - 19rrotal Female Population age 10 - 19) X 1,000 The need ranking process consisted of determining the mean (average) of the indices, the standard deviation from the mean of each district index, and a calculation to produce comparable data. This final calculation is called the Z Score. It is determined by subtracting the mean of district indices from the value of the individual district index, and dividing the result by the standard deviation for the particular index, as follows: Zi = (Xi - x) I 0 9J Total Z Score (Z1 + Z2 + Z3 + Z4) STATE WIC PLAN- 40 STATE WIC OFFICE RANKING OF DISTRICTS BY NEED RANKING OF DISTRICTS BY NEED APRIL POTENTIAL % RANK PARTICIPATION POPULATION SERVED FULTON (03-2)* 24,111 29,781 80.96% SAVANNAH (09-1) 8,417 11,918 70.63% MACON (05-2) 16,572 21,529 76.97% COLUMBUS (07-0) 14,332 20,225 70.86% ALBANY (08-2) 12,703 21,370 59.44% DEKALB (03-5) 15,754 18,367 85.77% AUGUSTA (06-0) 15,003 21,151 70.93% CLAYTON (03-3) 6,870 . 6,622 103.74% VALDOSTA (08-1) 9,043 12,922 69;98% DUBLIN (05-1) 5,046 6,612 76.32% WAYCROSS (09-2) 14,120 18,607 75.89% BRUNSWICK (09-3) 9,583 9,811 97.68% LAGRANGE (04-0) 12,323 22,249 55.39% GAINESVILLE (02-0) 9,852 15,360 64.14% ATHENS (10-0) 7,689 16,993 45.25% ROME (01-1) 12,541 20,117 62.34% COBB (03-1) 8,558 12,914 66.27% DALTON (01-2) 7,621 10,824 70.41% GWINNETT (03-4) 8,800 10,684 82.37% TOTAL 218,938 308,056 71.07% *INCLUDES SOUTHSIDE HEALTHCARE, INC AND GRADY M & I STATE WIC PLAN- 41 STATE WIC OFFICE C. Local WIC Agencies The following table lists all local agencies, their address, counties served, and the number of clinic sites. LOCAL WIC AGENCIES DISTRICT/ADDRESS COUNTIES SERVED #ofWIC CLINIC SITES District 1, Unit I (Rome) C.Wade Sellers, M.D., M.P.H. Dade, Walker, 13 District Health Director Catoosa, Polk, Gary Marcum Chattooga, Program Manager Gordon, Rosemarie Newman Floyd, Bartow, WIC Program Coordinator Paulding,Haralson Coosa Valley Health District NW GA Regional Hospital 1305 Redmond Road . Rome, GA 30191 (706) 295-66611GIST 231-6661 District 1, Unit 2 (Dalton) Joy Benson, M.D. Whitfield, Murray, 7 District Health Director Gilmer, Fannin, VACANT, Program Manager Pickens, Cherokee Sandy Akins WIC Program Coordinator Northwest Health District Bry-Man's Plaza North III Bryant Crossing Suite AA Dalton, GA 30720 (706) 272-2342/GIST 234-2342 STATE WIC PLAN- 42 STATE WIC OFFICE DISTRICT/ADDRESS District 2 (Gainesville) Melody A. Stancil, M.D. District Health Director Deputy Program Director Jean Mejorado WIC Program Coordinator North Health District District Health Office PO Box 1295 Gainesville, GA 30503 I 131 Vine Street Gainesville, GA 30501 (404) 535-5743/GIST 261-5743 District 3. Unit I (Cobb) Virginia Galvin, M.D. District Health Director V.ACANT Program Manager Beverly Demetrius WIC Program Coordinator Metro West Health District (CobblDouglas) 1650 County Farm Road Marietta, GA 30060 (404) 514-2389 District 3. Unit 2 (Fulton) Michael Green Acting Health Commissioner Ecleamus Ricks Deputy Commissioner of Physical Health Paulette McCray Nutrition Services Manager Fulton Health Dept. COUNTIES SERVED Banks, Dawson, Forsyth, Franklin, Habersham, Hall, Hart, Lumpkin, Rabun, Towns, Stephens, Union, White C6bb, Douglas Fulton Atlanta, GA 30303 (404) 730-4050 STATE VlIC PLAN- 43 # ofWIC CLINIC SITES 13 6 25 STATE WIC OFFICE DISTRICT/ADDRESS District 3, Unit 3 (Clayton) COUNTIES SERVED Carlton W, Sargent, M,D, District Health Director Paula Sherrer Program Manager Kathy Thomas WIC Program Coordinator Clayton County Health District 675 Forest Parkway Forest Park, Georgia 30050 (404) 363-6780 Clayton District 3, Unit 4 (Gwinnett) James C. Crutcher, M.D, District Health Director Essie Rowser Program Manager Maxine Moore WIC Program Coordinator GwinnettIRockdalelNewton Counties District Health Office P.O. Box 897 Lawrenceville, GA 30246-0897 197 Crogan Street Lawrenceville, GA 30246 (404) 963-0754 Gwinnett, Rockdale, Newton District 3. Unit 5 (Dekalb) District Health Director Alan J, Sievert, M,D" M,P,H" Associate Director for Clinical Servo Carolyn Wetzel WIC Q$!lfA9t Metro-East Health District (Dekalb) Dekalb Co. Board of Health WIC Program 445 Winn Way P.O. Box 987 Decatur, GA 30031 (404) 294-3794 Dekalb STATE WIC PLAN- 44 # ofWIC CLINIC SITES 7 8 STATE WIC OFFICE DISTRICT/ADDRESS District 4. (LaGrange) Lloyd Hofer, M.D. District Health Director Im!~*.ij Program Manager Ili'~~i!~.~~jj WIC Program Coordinator District Four Health Services 122 Gordon Commercial Dr., Suite A LaGrange, GA 30240 (706) 845-4035/GIST 290-4035 District 5. Unit 1 (Dublin) Grady Longino, M.D. District Health Director Jannell Knight Program Manager Wanda Foskey WIC Program Coordinator South Central Health District 2121-B Bellevue Road Dublin, GA 31021 (912) 275-6545/GIST 359-6545 District 5. Unit 2 (Macon) Craig S. Lichtenwalner, M.D. Acting, District Health Director Ollie Askew Program Manager Jacquelynn Nelson WIC Program Coordinator 811 Hemlock Street Macon, GA 31201 (912) 751-6118/GIST 321-6118 COUNTIES SERVED Fayette, Heard, Henry, Butts, Carroll, Coweta, Lamar, Pike, Meriwether, Troup, Spalding, Upson #ofWIC CLINIC SITES 18 Bleckley, Dodge, 10 Laurens, Montgomery, Pulaski, Telfair, Treutlen, Wilcox, Wheeler, Johnson Hancock, Houston, 16 Jasper, Baldwin, Bibb, Crawford, Jones, Monroe, Peach, Putnam, Twiggs, Washington, Wilkinson STATE WIC PLAN- 45 STATE WIC OFFICE DISTRICT/ADDRESS District 6 (Augusta) Frank Rumph, M.D. District Health Director Richmond County Health Dept. VACANT Program Manager Frances Wilkinson WIC Program Coordinator Augusta, GA 30909 (709)&157,4287 District 7 (Columbus) Craig S. Lichtenwalner, M.D. District Health Director I>6h;~Ky(Dee) Cantrell Program Manager Jackie Miller WIC Program Coordinator West Central Health District COUNTIES SERVED Burke, Columbia, Emanuel, Glascock, Jefferson, Wilkes, Warren, Jenkins, Lincoln, McDuffIe, Richmond, Screven, Taliaferro # ofWIC CLINIC SITES Harris, Talbot,Dooly, 23 Quitman, Taylor, Marion, Macon, Crisp, Sumter, Clay, Schley, Webster, Randolph, Stewart, Muscogee, Chattahoochee District 8. Unit 1 (Valdosta) Lynne D. Feldman, M.D. District Health Director Russell Paulk Program Manager Janet McClure WIC Program Coordinator P.O. Box 5147 Valdosta, GA 31603 312 N. Patterson Street Valdosta, GA 3160 I (912) 333-5290/GIST 349-5290 STATE WIC PLAN- Ben Hill, Berrien 12 Brooks, Cook, Echols, Irwin, Tift, Turner, Lanier, Lowndes 46 STATE WIC OFFICE PISTRICT/ADDRESS District 8, Unit 2 (Albany) [;R~M!N~~a!~M,;q; District Health Director Barbara Evans Program Manager Charlotte W, Bedell WIC Program Coordinator Southwest Health District 231 Tift Avenue Albany, GA 31708 (912) 430-4111/GIST 341-4111 District 9, Unit 1 (Savannah) Stephen King, M.D. District Health Director AI Mungin Program Manager Patricia Jackson WIC Program Coordinator East Health District 1321 Bull Street Savannah, GA 31401 (912) 651-2571/GIST 361-2571 District 9, Unit 2 (Waycross) Ted Holloway, M,D, District Health Director Sue ScafTe Program Manager $q~j!,l!jQr~~ WIC Program Coordinator Southeast Health f~!9ig.f!~gf:~m Waycross, GA 31501 WIC Office 1718 Reynolds Street, Suite 100 Waycross, GA 31501 (912) 285-6110/GIST 368-6110 COUNTIES SERVED Terrell, Lee, Calhoun, Worth, Early, Dougherty, Baker, Grady, Mitchell, Colquitt, Miller, Thomas, Seminole, Decatur Chatham, Effingham Appling, Atkinson, Bacon, Jeff Davis, Brantley, Ware, Bulloch, Candler, Clinch, Charlton, Evans, Coffee, Wayne, Pierce, Toombs, Tattnall #OFWIC CLINIC SITES 15 10 23 STATE WIC PLAN - 47 STATE WIC OFFICE DISTRICT/ADDRESS District 9, Unit 3 (Brunswick) B. Brooks Taylor, M,D. District Health Director Billy Griner Program Manager Jo Bishop Manning WIC Program Coordinator Coastal Health District 1609 Newcastle Street Brunswick, GA 31521 (912) 264-3907/GIST 365-7326 District 10 (Athens) Claude A. Burnett, M.D. District Health Director John McKinley Program Manager Vicky Moody WIC Program Coordirrator Northeast Health District 468 North Milledge Ave. Room 101-B Athens, GA 30601-3808 (706) 542-9547/GIST 241-9547 Southside Healthcare, Inc. Dwight E. Jones, M,D. Director Arthur Williams, M.D. Program Manager Laverne Montgomery WIC Program Coordinator Southside Healthcare, Inc. 1039 Ridge Avenue, S.W. Atlanta, GA 30315 (404) 688-1350, Ext. 244 COUNTIES SERVED Bryan, Liberty, Long, McIntosh, Camden, Glynn #OFWIC CLINIC SITES 16 Barrow, Clarke, 15 Elbert, Green, Jackson, Madison, Morgan, Oconee, Walton, Oglethorpe Portions of Fulton and Dekalb STATE WIC PLAN - 48 STATE WIC OFFICE DISTRICT/ADDRESS Grady Maternal & Infant Care Project Lisa Stillman Chief Nutritionist Leigh Ann Feast Senior Nutritionist Maternal & Infant Care Project Grady Memorial Hospital 80 Butler Street #1513E Atlanta, GA 30335 (404) 616-4932 COUNTIES SERVED All #OFWIC CLINIC SITES 3 STATE WIe PLAN- 49 STATE WIC OFFICE MlIJ PROCESS FOR APPLYING TO OPERATE A IDC CLINIC Local agencies must be public or private, non-profit health or human service agencies, in accordance with Section 246.5(d) of the WIC Regulations. The application must demonstrate the agency's ability to operate a WIC Program in accordance with WIC Federal Regulations and State policies. The Georgia WIC Program operates in all 159 counties in the State, and is operated by public health departments and 2 Atlanta based contracted agencies (Grady Hospital and Southside Health Care, Inc.). During FFY '96, Georgia WIC will explore expanding WIC services to additional non-public health agencies/providers. These new WIC sites may include public or private, non-profit: Migrant Health Centers, Health Maintenance Organizations, Community Health Centers, and/or private provider offices. Applications will be accepted for purposes of expanding services in a current Program area. In considering such an application, the State Agency will evaluate the performance of existing programs in the areas in question. An application will be considered for approval if the existing agency/agencies is/are not able to expand the services to the residents/participants of the area and/or are not utilizing all available food/administrative funds. Upon request from an agency interested in operating a WlC Program, the State agency will supply, within fifteen (15) days of inquiry, a pre-application information package consisting of the following documents: 1. A cover letter explaining, at minimum, the overall application process, time frames involved, criteria for selection of agencies, and information concerning the appeal process in the event that the application is denied. 2. A copy of WIC Program Regulations, 7 CFR Part 246. 3. A list of basic requirements for inclusion in the local agency application to operate a WIC Program. This will include staffing, and equipment requirements as well as clinical and nutritional regulatory mandates. . 4. A listing of State and Local Agency resources available to aid the applying agency in formulating an application to operate aWIC Program. 5. A copy of the Memorandum of Understanding between the State Agency and the local agency. (The Memorandum of Understanding is included in Section AD of the Procedures Manual). 6. A copy of the most current State Plan and Procedures Manual, Referral Booklet and Georgia WIC Information Packet. . 7. Examples of nutrition education materials and participant training tapes. STATE WIC PLAN- 50 STATE WIC OFFICE During early FFY '96, State Agency and District representatives will convene to formalize the criteria, application form, and other related documents which will be necessary to complete the application process for an agency (See Objective XIX). Funds will be distributed to agencies who are not currently approved to operate a WIC site, if they can demonstrate an ability to serve priority applicants/participants most in need as identified in the Affirmative Action Plan, Section V of the State Plan. Selection criteria for local agencies will be consistent with the requirements of 7 CFR 246.5. [246.7 (M)] Applications will also be reviewed for assurance that at "minimum: 1. The local agency has corrected all past substantiated civil rights problems and/or non-compliance situations. 2. The Civil Rights Assurance is included in the State/Local Agency Agreement. 3. Civil rights complaints are being handled in accordance with procedures outlined in Section XIII of this Plan. 4. Clinic sites; certification offices, vendors, and other food distribution sites do not deny access to any person because of his or her race, color, national origin, age, sex, or handicap. 5. Appropriate staff, volunteers, or other translation resourCes are avaiiable in areas where a significant proportion of non-English or limited English-speaking persons reside. 6. The description of the racial/ethnic makeup of the service area is included in the application. 7. The agency has the ability to provide appropriate WIC services to applicants and participants in accordance to USDA and State WIC regulations and policies. 8. The agency space availability is adequate to provide WIC services. 9. The agency demonstrates ability to manage financial obligations in accordance to USDA and State regulations and policies. 10. The agency will demonstrate the ability to ensure the security of WIC vouchers at all times. 11. The agency agrees to have all agency staff attend all required meetings and training. 12. The agency agrees to comply with all USDA and Georgia WIC reporting and documentation requirements. 13. The agency demonstrates the ability to comply with all WIC Program STATE WIC PLAN- 51 STATE WIC OFFICE automated data processing requirements. 14. The agency agrees to make all documents and records available for review and audits. ii,;. were issued; c. 16. of the YU; SPECIAL POPULATIONS A. Migrants and Seasonal Farmworkers Data regarding migrant and seasonal farmworkers in Georgia has proven to be unreliable and represents wide variations. WIC Program local agencies provide services to migrant and seasonal farmworkers based upon known migration and actual service statistics from past years. The State agency continues to identify this population as a top priority and provides information and technical assistance locally as required. The State Agency has identified the period from late February to late October of each year, as the time when migrant farmworkers are estimated to reside in Georgia. Beginning in South Georgia with the preparation and shipment of seedlings, migrants are concentrated in the Tifton area and begin moving northward by late May. The State Agency coordinates outreach efforts with the Migrant Education Project, DHR Migrant Health Project, the Migrant and Seasonal Farmworkers Association, Georgia Legal Services, and the Children's Foundation. These outreach efforts will continue in FY '96. The State agency will use the following definition to identify migrants: "An individual (and his/her family) whose principal employment is in agriculture on a seasonal basis (as opposed to STATE WIC PLAN- 52 STATE WIC OFFICE year-round employment), who has been so employed within the last twenty-four (24) months, and who establishes for the purpose of such employment a temporary abode. " Local agencies are instructed to honor VOC cards from other states and within Georgia to serve migrants as the highest priority. The VOC card used in Georgia is discussed in Section CT of the Procedures Manual. Services to migrants are reported year-round and will continue to be reported as a special population. Bilingual materials are available to all local agencies through the State agency. Local agencies have also developed materials for use in outreach with the migrant population. Special clinics are not routinely arranged at migrant camps. However, large camps with significant numbers of women and children will be considered for special on-site clinics. The State agency provides consultation and technical assistance for migrant activities upon request. B. SQutheast Asians . Several local agencies serve Southeast Asian refugees. Local arrangements for interpreters are handled using a network of agencies, religious organizations, and sponsors. The State Agency contracted with a Local Agency to develop an outreach brochure which is available statewide for use with the Southeast Asian population. These participants are concentrated in the Atlanta metropolitan area and the coastal Savannah area. C. Native Americans Although Georgia does not have an identified community of Native Americans, local agencies are instructed to make every effort to outreach to this population. The State agency assists local programs with the outreach effort, as needed. D. Hearing-Impaired Individuals The WIC Program will assist Hearing-Impaired Individuals/families in receiving WIC Services. Local agencies may contact the State Rehabilitation Program for Interpreters. OUTREACH/COORDINATION A. Outreach STATE WIC PLAN- 53 STATE WIC OFFICE "WIC WORKS WONDERS" will continue to be the "motto" for statewide outreach activities, along with a new (currently un-named) theme to coincide with the new Georgia WIC logo. (See Attachment 0) In 1991, when the "WIC WORKS WONDERS" campaign was launched, promotional materials were developed and are still being used by the Georgia WIC Program. A list of the promotional materials can be located in the Outreach Section of the Procedures Manual. Other promotional materials not listed in the Outreach Section of the Procedures Manual are listed below: I. Plastic Drawstring Bags 2. Stickers 3. Balloons Local agencies are provided with general descriptive and nutrition education materials. They distribute these materials to referral agencies within their program areas. The State agency supplies some of these materials and the local agencies add their names, addresses, and telepiJpne numbers. Many refeJ-ral services are housed in county health departments such as family planning, prenatal, immunization, and child health clinics. Posters and printed materials about the WIC Program are also displayed in reception areas. The new Georgia WIC logo (Attachment 0) was specially designed to enhance outreach efforts to private providers, agencies, other health organizations. The WIC HOTLINE continues to be available for outreach. The WIC HOTLINE was installed to give vendors, clients, staff and the general public direct access to the State WIC Office at no cost. This toll-free number, 1-800-228-9173, is available on printed materials and is provided during radio and television interviews. The twenty-one (21) local agencies are encouraged to communicate regularly with agencies providing services to mothers and children. These agencies are inclusive of governmental, quasi-governmental, and private not-for-profit organizations; and citizen participation groups. Examples of agencies, offices and organizations which should be contacted regarding the outreach, referral, and coordination of WIC services include: alcohol/drug abuse counseling centers, family planning, maternal and child health programs, EPSDT, child abuse counseling centers, health and medical organizations, hospitals and clinics, welfare offices, unemployment offices, social service agencies (EFNEP, Medicaid, AFDC), Atlanta's Community Health Program for the.Homeless, religious and community organizations in lower income areas, and private providers. STATE WIC PLAN- 54 STATE WIC OFFICE Other methods of outreach include: 1. The distribution of the Georgia WIC Referral Guide which is a resource booklet to inform clients of other Programs. 2. The Georgia Common Access Application which is an application process to connect clients with WIC and health and social services programs. 3. Presumptive Eligibility which enables the client to qualify for Medicaid at an early stage of their pregnancy. B. Coordination/lntegration of Services Integration of WIC services with other health clinic services has been a major thrust for the State WIC Office and the Division of Public Health. All districts have taken positive steps toward decentralization and the integration of WIC with existing services. The Georgia WIC "Program will continue to interact with other Maternal an~ Child Health Branch Programs at the State level such as Child Health, Dental Health, Genetics, Children's Medical Services, Immunization, Women's Health, and Family Planning, and other Division of Public Health Programs (Migrant Health, Rural Health, Refugee Health and State Legislation Impact Assistance Grant Programs). Staff of other Public Health Programs participate in WIC meetings in order to demonstrate support for the WIC Program. The State WIC staff encourages interaction of all programs on the local level, including WIC. 1. WIC/Medicaid Coordination To date several measures have been implemented Statewide to address the coordination of the WIC and Medicaid Programs. a. The WIC intake form includes a section to indicate if a new applicant is participating in the Medicaid Program and provides a space for their Medicaid number. b. The State of Georgia "Right From The Start", program makes Medicaid available to more pregnant women, infants and children up to age nineteen (19). The program is operated jointly by county Departments of Family and Children's Services (DFCS) and the Division of Public Health. DFCS has been provided with a complete schedule of caseworkers to maximize their effectiveness in reaching the target population as they come in for WIC services. Effective July I, 1993, Medicaid coverage options for pregnant women and STATE WIC PLAN- 55 STATE wrc OFFICE infants expanded to 185 % of federal poverty guidelines; while also expanding coverage for children up to age 19 in families at 100% of federal poverty. c. The Child Nutrition and WIC Reauthorization Act of 1989 (P.L. 101-147) require state agencies to provide information. about and referrals to Medicaid at the time of initial .application and reapplication of such individuals who appear to be Medicaid eligible but are not participating. Implicit in the law is a mandate for greater coordination between programs. To satisfy the requirements of the law, representatives from WIC; the Division of Public Health, Maternal and Child Health Branch; the Division of Family and Ch ildren Services; and the Department of Medical Assistance, Department of Health and Human Services (DHHS) elected to develop a joint, single page Multi Service application form. The ultimate goal of this joint application form is to improve service delivery and access to services for potential participants by integrating/coordinating the application/eligibility process; thereby eliminating or greatly. reducing the duplication of services. d. As an on-going effort, the Georgia WIC Program has on staff a medical epidemiologist who is currently collecting and analyzing data on birth outcomes for WIC participants. This will enable the State agency to fully assess the impact of WIC/Medicaid coordination on infant mortality. Further, an association between early prenatal WIC enrollment and prenatal care is being investigated. C. Information and Referral WIC is designed to provide for the nutritional care of participants. However, some clients seeking WIC services may have other medical or social service needs. To assist in addressing the needs of WIC participants and applicants seeking WIC services, referrals are made to other available resources. Intraagency services and programs are sources of referrals for local WIC Programs, as well as, local and state inter-agency programs. Referrals are essential for the coordination and the maximization of services and resources. It is an on-going effort for local WIC Programs to maintain referral information for the enhancement of WIC services. As the number of applicants seeking WIC services increases, and the number of waiting-list clients increases, the need for referral to other food assistance resources is inevitable. Applicants not eligible for WIC services, and participants who are affected by WIC caseload .adjustment strategies are referred to otl1er resources for assistance. Information concerning food assistance resources incorporated into a Food Assistance Resource STATE WIC PLAN - 56 STATE WIC OFFICE Guide during FFY !~.?,. Referral systems are influenced by available resources, therefore referral services vary from location to location. A referral may be formal or informal, this depends upon the reason for the referral. Other food assistance programs and services that are common referral resources for local WIC Programs include: Food Stamp Programs; Food Banks; Food Cooperatives; Churches/Synagogues Food Pantries; Salvation Army; General Assistance Funds and other community organizations such as fraternities, sororities, and clubs, etc. Updating referral resources is an on-going process to maintain current referral information. Local agencies review and revise resource information periodically. The state WIC Program will review local agencies' referral mechanism during monitoring visits. ~~. CERTIFICATION OF PARTICIPANTS Forms and procedures for certifying WIC applicants are found in Section CT of the Procedures Manual. Progral1) .benefits are provided until the certification period expires, or until a participant is no longer categorically eligible. Pregnant women are certified from the date eligibility was determined until six (6) weeks after the termination of the pregnancy. Postpartum women shall be certified within six (6) weeks postpartum in order to prevent a lapse in WIC benefits. If these women are not certified within six (6) weeks, they may reapply for benefits as long as they are categorically eligible. Non-breastfeeding postpartum women are certified for up to six (6) months. Breastfeeding women are certified in six (6) month intervals [plus or minus thirty (30) days] up to the infant's first birthday. Infants less than six (6) months of age must be certified at Program entrance for up to one (I) year of age. A mid-certification assessment should be performed between five (5) and seven (7) months of age. Infants greater than six (6) months of age must be certified at Program entrance and at six (6) month intervals [plus or minus thirty (30) days]. Children over twelve (12) months of age, must be certified at Program entrance and at six (6) month intervals [plus or minus thirty (30) days]. STATE WIC PLAN- 57 STATE WIC OFFICE All applicants will be certified in accordance with any priority policy which may be in effect. A. Health Criteria The entire WIC Assessment/Certification Form must be completed for every applicant. For each criterion checked on the form, supporting documentation must be available in the health record of the applicant. In accordance with State policy and Federal Regulations, only nutritionists, physicians, registered dietitians, physician's assistants, nurses, or other certified health officials that have been trained by the State or local agency may certify that applicants are eligible for WIC Program benefits. These persons are called Competent Professional Authorities (CPAs). Clerical staff may record information but cannot determine the applicant's nutritional risk status or eligibility. This data is gathered through medical examination and/or review. B. Income Eligibility Criteria Effective October 1, 1980, income screening procedures were implemented uniformly throughout the State. All local agencies are'required to use an income standard at 185 percent of the HHS Income Poverty Level. (See Attachment A, Income Guidelines,) The determination of income eligibility status may be made prior to or following the nutritional risk assessment, depending on how the applicant was referred to the local agency. This information may be determined by clerical staff. Income data, like all certification information, must be updated at the beginning of each certification period. Guidelines about income screening are provided to local agencies and are listed in Section CT of the Procedures Manual. STATE WlC PLAN - 58 STATE WlC OFFICE C. Priority Systems ..'The priority system is based on the nutritional risk status of the participant. During the first of FFY the Georgia WIC Program served participants in Priorities Due to a projected ~m of food funds, Priority VI (non-teenage postpartum women)'!~~J;%::p1~~i1il'!;tll~!Ptqgrwn!!in February 1995. All other participants in Priorities I-VI as well as Post Partum teens were served throughout the year. Local agencies must serve the same priorities as those being served statewide. If a waiting list exists, participants are notified of their status on the waiting list at the same time they are notified of their eligibility for the Program. Assignment of priorities within the system and waiting list procedures are described in Section CT of the Procedures Manual D. Processing and Notification Standards for processing applications for WIC benefits are uniform throughout the State and are listed in Section CT of the Procedures Manual: The State agency assures these standards have been met during monitoring visits to the local agency. Certification data for each applicant/participant must be recorded on the appropriate certification form provided by !l).;State WIC Office, and record entries documented with appropriate date and signatures. The staff member(s) collecting the income/residence/ID data must enter their signature(s) and title(s) (e.g. Clerk, Physical Health Asst., R.N., R.D., etc). An appropriate signature consists of first and last name or first initial and last name. If the person who collects the income information is different from the person determining residency, each must sign the space. The participant, parent/guardian/caretaker, or proxy mnst be asked to read (or have. read to them if they are unable to read) and sign the following statement each time they are certified: I have been advised of my rights and obligations under the Program. I certify that the information I will provide or have provided is correct, to the best of my knowledge. This certification form is being submitted in connection with the receipt of federal assistance. Program officials may verify information on this form. I understand that intentionally making a false or misleading statement or intentionally. misrepresenting, concealing, or withholding facts may STATE WIC PLAN- 59 STATE WIC OFFICE result in paying the State agency, in cash, the value of the food benefits improperly issued to me and may subject me to civil or criminal prosecution under State and Federal law. Due to the content of this statement, clinic staff must ask the participant to read (or have read to them if they are unable to read) the Rights and Obligations Handout prior to requesting the participant/authorized representative's signature. When a clinic serves any non-English speaking persons, this information must be provided in a language that the non-English speaking applicant/participant understands. If the participant/authorized representative is unable to write, he/she will enter hislher mark in lieu of a signature. The staff person will print the person's name next to the mark and initial the mark to indicate that it has been witnessed. .l:lak. The date must be completed by either the participant/authorized representative or a Clinic staff person. N9tification to applicants of ineligibility, termination or placement on the waiting list are also standardized. Notification may be verbal or written, depending on the following circumstances: I. Written Notices a. Persons found ineligible at the time of certification must be notified in writing of their ineligibility, including the reasons and their right to a fair hearing. Deadlines for this notification are part of the processing standards. b. Persons terminated during a certification period must be notified at least fifteen (I5) days prior to termination of the reasons for termination and their right to a fair hearing. Deadlines for this notification are part of the processing standards. c. Persons terminated during a certification period must be provided a list of the participant priority categories. The list must include definitions of each category. d. Persons placed on a waiting list must be given reasons for such placement, the date their certification/eligibility ends, and.notified of the availability of nutrition education within twenty (20) days after STATE WIC PLAN - 60 STATE WIC OFFICE the request for benefits. 2. Written or Verbal Notices a. Information notifying an applicant/participant of their right to a fair hearing is printed on the Notice of Termination/Ineligibil~tylWaiting List Form. The applicant acknowledges that Rights and Obligations have been read by signing the back of the WIC Assessment/Certification Form. b. Notice of the end of a certification period is given at least fifteen (15) days prior to expiration. This notice is usually given at the participant's last voucher pick up before certification expires. c. An explanation of how the food delivery system operates is given prior to or at the time of receipt of the participant's first vouchers. d. The participant is informed of other health services at the time of certification or at the time the food delivery system is explained. E. Transfer of Certification Written verification of certification, through the use of a Verification of Certification (VOC) card, provided by the State agency, must be given to all participants who are members of migrant households and to those individuals who are likely to relocate during the certification period (e.g. military personnel) . When similar written verification is provided to the local agency by a Program applicant, that person must be placed on the WIC Program for the remainder of their certification period, under the following circumstances: 1. Automatic placement if no waiting list exists. 2. During a waiting period, regardless of priority status, the transferring participant must be placed on the program. X. FOOD DELIVERY SYSTEM The State of Georgia has a contract with an off site electronic data processing firm to operate the Georgia WIC Program data collection and food instrument reconciliation process. STATE WIC PLAN- 61 STATE WIC OFFICE A. Vouchers 1. Printing and Shipping In Georgia, an automated system generates uniform negotiable food instruments (vouchers). Vouchers and accompanying issuance registers are generated twice each month. The State agency made provisions for bimonthly issuance effective August, 1986. This thereby increased the maximum number of vouchers available from four (4) to eight (8) as a cost conserving, efficiency and participant convenience measure. Each voucher has a maximum value printed on the face specific to the value of foods listed on that voucher. The system calculates a maximum value for vouchers based on two (2) standard deviations of the average voucher price. A report of the current maximum value and the value at two (2) standard deviations is submitted to the State WIC Office. The report is reviewed by State wrc Office staff and maximum voucher prices are adjusted, when necessary. 2. Issuance, Redemption, and Local Banking Processes After vouchers are printed, they are shippeP to district offices and/or local clinics for issuance. Vouchers are produced with sequential serial numbers for each local agency. All vouchers damaged in printing or shipping are logged and replaced by the Contractor. Local agency clinics issue vouchers to eligible participants. The redemption of vouchers by participants is described in the Georgia WIC User Manual. After a participant has received the foods listed on the voucher face and the voucher has been properly signed and stamped according to the procedures, the vendor may deposit it in his/her local bank. The local bank presents vouchers for payment to the central WIC bank, which transfers funds to the vendor's account at his/her local bank. .If there is an irregularity on the voucher face (missing program stamp, missing vendor stamp, pre-dated, stale dated, amount of purchase exceeds allowed maximum amount, signatures) the voucher will be rejected for payment. These are called "Bank Rejects". 3. Central Bank Processing Each month the central WIC bank receives a tape from the data processing contractor which lists all vouchers issued and the "not to exceed" price for each voucher type by serial number and date of issue. The bank processes each payable voucher against this tape and returns any vouchers to the STATE wrc PLAN- 62 STATE WIC OFFICE vendor which exceed the price ranges or date limits. All vouchers that are within the price ranges and date limits are then processed through the bank where they are microfilmed and recorded on a magnetic tape of banking ti'ltnsactions. This tape is sent to the data processing contractor and contains the actual amount paid, date paid, vendor number and the serial number for each voucher. Vouchers received by the local agencies may not be issued to participants for a variety of reasons: the food package may be inappropriate for the participant (these vouchers are stamped "Void ") or the participant may fail to keep his or her issuance or certification appointment (these vouchers are stamped Currently, "Void" vouchers are forwarded to the central WIC bank where they are sorted, microfilmed and added to the transaction tape. "Bank Rejects" are not added to the bank transaction tape. Replacements for lost or stolen vouchers are not made except in circumstances outlined in the Georgia WIC User Manual. 4. DHR Accounting Process The central WIC bank provides inforIJ1ation to the Department of Human Resources (DHR), Office of Financial Services and to the data processing Contractor. On a weekly basis, DHR Financial Services receives a printout of paid vouchers. On a monthly basis, the bank balances the WIC account and reports this balance to DHR Financial Services. At the same time, the bank supplies the transaction tape to the data processing Contractor for reconciliation. 5. Data Processing Final Disposition The data processing Contractor compares the bank transaction tape with the issuance tape which records each voucher issued. Information on the issue tape is computer generated from the voucher creation process or supplied by local personnel when issuing manual vouchers. Individual vouchers are placed in one the following categories: paid undistributed (Void) issued-cashed-outdated issued-uncashed-outstanding The only vouchers which do not sort into these categories are those which have improper records and which must be investigated by State and local agency personnel to be manually reconciled. STATE WIC PLAN- 63 STATE WIC OFFICE If vendors deposit vouchers which are more than sixty (60) days old, the automated system will have already placed the vouchers in the "issued-uncashed-outdated" category. Therefore, the vouchers cannot be paid. As a general practice, the State agency will not approve any voucher over sixty (60) days old for payment to any vendor. B. Vendor Procedures WIC foods are supplied through approved retail vendors throughout the State. .. Approved retail vendors" are defined as supermarkets and rolling stores. A rolling store may be a privately owned refrigerated truck or a dairy product operation. Rolling stores may either deliver foods directly to a participants home or park the truck in a designated location allowing participants to redeem their WIC vouchers directly from the vehicle. Rolling stores and other retail vendors (grocery stores) must be approved by the Georgia Department of Agriculture and must meet the approval criteria of the WIC Program as outlined in the Georgia WIC Program Procedures Manual Vouchers are issued to participants during WIC clinic visits. Participants or their authorized proxies redeem the vouchers at approved vendors during the thirty (30) days following the issuance date preprinted on the vouchers. The vendor records the price on the :vouchers before depositing them in the bank. 1. Application for Vendor Certification Any merchant that expresses an interest in participating as a Georgia WIC vendor is given a Pre-Application Booklet which explains the necessary requirements for becoming a wrc Vendor. The merchant is also given an Application for Vendor Certification to complete. The instructions for completion and procedures for approval of the Application are contained in the Section VN of the Procedures Manual. One criterion for approval of a vendor application is that .the vendor's prices must be compatible with the prices of other participating vendors within the state. For the purpose of comparison, compatible is defined as being within 10% of the average price for small stores (peer group) within the state. A report is generated by the data processing system which documents each vendor and the average price per voucher and food package. The Vendor Management Unit of the State WIC Office compares the prices of all vendors with the average for peer group plus 10% to determine if the vendor is over the accepted limit. Food Packages and 404 are the most commonly used food packages in the State and are used for this STATE WIC PLAN - 64 STATE WIC OFFICE comparison. 2. Vendor Agreements The Memorandum of Understanding between the State and local agency requires that local agencies execute agreements with approved vendors in their areas. In the retail grocery system, a standard agreement is used which is periodically updated by the State agency. The State uses the standard agreement approved by the Department of Defense for military commissaries. Copies of the vendor agreements are found in the Section VN of the Procedures Manual. 3. Vendor Training All vendors are trained in WIC procedures at least once per year, and more often as procedures are revised. Vendor training is discussed in more detail in Section VN of the Procedures Manual. 4... Vendor Monitoring and Reauthorization Vendor monitoring and reauthorization procedures are discussed in detail in Section VN of the Procedures Manual. 5. Identification of "At Risk" Vendors The Vendor Management Unit of the State WIC Office utilizes reports generated by the data processing Contractor to identify vendors that are potentially abusing the Program. The following is a brief description of each report and how it is used. a. Flagged Voucher by Vendor Per District Average (Attachment B) This report identifies all vouchers which exceed the District average by more than two (2) standard deviations. It is used to determine possible overcharging by the vendor as well as to indicate the voucher types which should be used in compliance investigations. b. Voucher Variation Report (Attachment C) This report is vendor specific and identifies the number of vouchers STATE WIC PLAN- 65 STATE WIC OFFICE that are cashed at the same amount, or with very little variation in price. It is used to identify potential price fixing or overcharging. c. Voucher Redemption Fluctuation Report (Attachment D) This is a vendor specific report which shows the volume of vouchers cashed by a vendor for a six (6) month period of time. It is used to identify any changes in a vendor's redemption patterns which might indicate trafficking or other activities which would place this vendor in the "At Risk" category. d. Vouchers by Day Cashed (Attachment E) This report is vendor specific and shows when the vendor is depositing vouchers into the bank. This report is used to identify stores that may be buying vouchers. It may indicate a problem with WIC clerical fraud. e. Vendor Voucher Deviation Report (Attachment F) This report is vendor specific and identifies vouchers which exceed the store's own average. This report is used to identify possible overcharges on vouchers as well as possible store employee fraud. Requests for Investigations from the local agency, as well as participant complaints, are also used in the identification of vendors who may be classified as "At Risk". f. Vendor Food Package Compare and Voucher Compare Report (Attachment G) This report is vendor specific and identifies vouchers and food packages which exceed the district average within peer groups. Throughout the year, any vendor who is charging above the allowed limits is warned that prices must be lowered to acceptable ranges. If a vendor does not lower his prices, and continues to be identified on the report, the vendor contract for the next year will not be approved. The report is used for approval of new vendor applications. This report is also used in the vendor contract renewal process. However, during the Renewal Processing Period no warning letter will be rendered to vendors whose prices exceed the allowed limits. Instead, a termination notice will be rendered to those vendors informing the vendor that his/her contract will terminate in thirty (30) days. STATE WlC PLAN- 66 STATE WlC OFFICE g. Vouchers Cashed by Clinic (Attachment H) This report is vendor specific and identifies the clinic where the cashed voucher was issued. The report is used to identify possible trafficking of WIC vouchers. h. Cumulative Vendor Totals (Attachment I) This report is discussed in Section VN of the Procedures Manual. NOTE: The State Agency uses a Vendor Activity Monitoring Profile (V.A.M.P.) System which identifies "High Risk" vendors and targets vendors for investigation. All of the above mentioned reports are included in the V.A.M.P. System. The system, eliminates the need for State staff to manually analyze each report. The State continues to use the reports for reclaims of overcharges and for excessive pricing as it has in the past. The State Agency has also developed a peer grouping system to be used for the V.A.M.P. System. The Flagged Voucher Report will be run by peer groups. As of July 1, 1989, the Food Package Cost (FPC) Compare and Voucher Cost (VC) Compare Report is being run by peer groups. 6. Compliance Investigations Compliance investigations are always coordinated by the State WIC Office; and are performed by WIC paid State investigators and Food Stamp Program investigators. Food Vendors identified as "High Risk" by State WIC V.A.M.P. reporting system are targeted for compliance investigations. Complaints from a participant, vendor, or the general public is acceptable. A Request for Investigations form must be completed by the individual taking the complaint, and the original copy must be submitted to the Quality Improvement Unit. The Local Agencies may request a compliance investigation on any vendor suspected to be in violation of WIC Program Procedures. To initiate an investigation, Local Agencies must complete a "Request for Investigation" form (Attachment QI-18) and mail it to the State WIC Office. The State WIC Office decides when an investigation is initiated, and when an investigation is completed. Local Agencies that would like to conduct "compliance buys" in their stores must contact the State WIC Office for approval. If the Local Agency conducts any compliance investigations, each buy must be documented by completing the WIC Transaction Report (Attachment QI19). The original copy of this form must be submitted to the State WIC Office. State and Federal guidelines must be followed when investigations are conducted. STATE WIC PLAN- 67 STATE WIC OFFICE Vouchers to be used by the State WIC Office in Compliance Investigations, will be generated by the ADP system using a clinic that has been set-up for that purpose. The Local Agency will not be notified when investigations are in progress in their area until after the investigations are completed. ;sa; COST CONTAINMENT INITIATIVE In accordance with the provisions of P.L. 100-460, the Georgia WIC Program is continuing with the cost containment initiative begun on October 1, 1988. Effective Jariua.ryl;l~~$ the Georgia WIC Program entered into a three (3) year contract with Mead JohnSdhffuti'mqi@S as sole source provider of infant formula to Georgia WIC participants. The purpose of this initiative is to provide WIC services to more eligible women, infants and children by reducing the cost of infant formula and applying the savings to the food budget. In order that all companies be offered an opportunity to bid, the State WIC Office contacted the U.S. Food and Drug Administration for a list of all companies in the United States that were approved for the manufacture of infant formula. To' ensure that all products met the provisions of the Food, Drug and Cosmetic Act, Page lOA, Section III of the Georgia WIC Programs' SOLICITATION OF QUOTATION (SOQ) and Page 7, Paragraph 202 A(2) of the contract require certification or documentation "...that the Contractor. . .is in compliance with FDCA and HHS regulations pursuant to the Federal Food, Drug and Cosmetics Act and that its products are in compliance with the Infant Formula Act of 1980 and all amendments thereto... ". To identify and bill for infant formula the Georgia WIC Program issues vouchers which have been imprinted with the Contractor's brand and type of formula. Those vouchers are redeemable for only the brand type shown. Each month the WIC Program's data processing contractor compiles a report identifying the number of vouchers cashed for both contract and non-eontract brands of formula by type (Concentrated, Powdered and Ready-To-Feed). A copy of this report is sent to the State WIC Office and Office of Financial Services which then bills the contractor. The first infant formula rebate contract with Mead Johnson Nutritionals has resulted in a total savings of approximately $55,350,000. The total 3-year contract with Ross Laboratories generat~ an ~J!mi\j:%l $76,000,000 in savings. During FFY the rebate iSptqj~tf4tP generate $g!li? million. FINANCIAL MANAGEMENT The proposed budget for Fiscal Year 1996 will be submitted as an amendment.to the plan no later than thirty (30) days after receipt of Georgia's grant award, including any STATE WIC PLAN- 68 STATE WIC OFFICE negotiated amount from USDA. A. Letter of Credit Drawdowns - Food The Office of Financial Services of the Department of Human Resources makes drawdowns from the Letter of Credit. A reimbursement system is used to assure that withdrawals are not in excess of immediate cash needs. Withdrawals from the Letter of Credit are made semi-weekly. Food reimbursements are determined by the daily clearing from a unique bank account for WIC food vouchers. Since the disbursements are made through a unique bank account, the dollar amount of the food vouchers cleared (representing the actual paid disbursements) is obtained from the DHR bank by telephone on a daily basis. When the draw request is paid and available for state use. the draw represents the previous two (2) or three (3) days expenses. When rebate checks are received from the formula contractor, the WIC programmatic accountant makes a copy of the check and forwards it to the cash manager. The check and deposit information is given to the cashier for recording in DHR accounting records and for depositing in the bank. The cash manager takes the amount of the rebate into Consideration before making any fu.rnre draws on the food Letter of Credit. . B. Letter of Credit Drawdowns - Administration The administrative reimbursement is more complex than the food reimbursement. The Department's annual budget was analyzed to determine the ratios' of the different federal and state funds which comprise each type of expenditure. This is called the funding mix. Disbursements from the Operating, Grant-In-Aid, and the Payroll accounts are entered into a computer program containing the funding mix and the historical check clearing patterns of these three (3) bank accounts. The computer program adds the total funds eligible for reimbursement from the three (3) bank accounts, by day, and stores this information in a program ledger. When reimbursement is requested, the draw represents the projected clearing in those bank accounts for the previous two (2) to three (3) days. Clearing patterns and the funding mix are updated periodically to insure that projections can be as accurate as possible. Near or at the end of each month, it will be determined whether conversion authority exists. If conversion authority exists, the administrative expenditures to date will be compared to the amount of availability on the administrative Letter of Credit. If the Letter of Credit does not have any availability, and conversion authority exists, the WIC programmatic accountant will make an entry in the DHR accounting records to use food funds for administrative costs. A copy of the entry will be given to the cash manager so the cash manager will be aware of the STATE WIC PLAN- 69 STATE WIC OFFICE need to draw the food funds immediately rather than during the reconciliation process. C. Allocation of Administrative Funds I. Initial Allocations The procedure the state agency uses to allocate administrative funds is based on the use of a flat yearly cost per participant. This is determined by the following formula (See Attachment P): a. Determine the maximum administrative monies available for allocation after the program overhead expense has been subtracted. These overhead expenses are costs associated with the data processing mainframe contractor, Office of Nutrition expenses, the State WIC office expenses, and DHR indirect costs. b. Average participation is calculated for the local agencies using the most recent two months closeout participation. c. Divide the total district administrative allocation (as determined in step 1) by the statewide caseload to determine the yearly cost per participant. The individual district allocations are calculated based on the number of persons served by each district as follows: The yearly cost per participant is multiplied by each district's average caseload to determine their allocation. 2. Re-Allocations during the state fiscal year: Reallocations are made whenever funds become available to distribute to the local agencies. This is accomplished as follows: a. Add the new available administrative money to the extstmg administrative total to arrive at the new administrative total. b. The average participation for each local agency must be updated using the most recent two months closeout participation. c. Divide the new administrative total by the updated. statewide participation to calculate the new yearly costs per participant. d. Multiply the new cost per participant by each district's updated STATE WIC PLAN - 70 STATE WIC OFFICE average participation to calculate their new allocation. NOTE: A "hold harmless" rule is in effect during the state fiscal year which prevents a local agency from experiencing a reduction in funding for this period. D. Food Funds Allocation Methodology In the process used to determine food obligations, data from three reports, generated by our data processing contractor, are mathematically projected on a spreadsheet. District participation figures based on October closeout are divided by priority and WIC types, ie. Priority I Women, Priority II Infants, etc. These figures are taken from the Ethnic Participation by Priority Report (EWRR980G) Next, the October district specific food package costs are taken from the Food Package Expenditure Report (EWRR340G) and added to the spreadsheet. Then, using the Food Expenditure Report (EWRR8009), the 12 month forward roJl.ing average redemption rate for each district is computed and added to the spreadsheet. Multiplying a district's participation figure for a single priority times the appropriate food package costs, times the average redemption rate for that district equals the total food allocation projected for that priority. Depending on which priorities are to be served, the dollar amounts can then be added across to determine total district allocation. When food funds are reallocated, it may be necessary to reallocate administrative funds. (See Attachment P) E. Use of Funds The Georgia WIC Program is 100% federally funded and officially operates on the federal fiscal year calendar (October 1 through September 30). However, Georgia DHR fiscal budgets are allocated on the state fiscal year calendar (July 1 through June 30). State WIC Office expenditures and local agency expenditures are reported on a cash basis of accounting. 1. Budget/Expenditure Plan STATE WIC PLAN- 71 STATE WIC OFFICE Local agencies are required to submit administrative budgets for WIC administrative expenditures, client service expenditures, nutrition education expenditures and breastfeeding expenditures to the state agency. The budgets used are classified by line item as follows: 1. direct salaries (including salaries, hourly labor, FICA, retirement, and health insurance); equipment (equipment costing $1000 or more, lease purchases, rental of equipment, and equipment costing less than $1000) 2. other operating expenses (including supplies and materials, repairs and maintenance, utilities, printing, rents other than real estate, insurance and bonding, other operating expense, computer software, travel, building rent, per diem fees, contracts, telecommunications, and postage) 3. intra/inter agency transactions. The local agencies must submit original budgets and revisions for approval before monies may be expended. The state Grant-in-Aid system will not allow reimbursement of expenses incurred without prior approval. The required WIC Administrative Budget is prepared by compiling !JUdgeted amounts submitted bylocal agencies and adding to the budgeted amount for the state agency. Services supported entirely by WIC funds include anthropometric measurement, hematological testing, nutrition counseling and education, and breastfeeding education and support. 2. Local Agency Overhead a. Some districts charge a portion of overhead expenses through the indirect cost allocation plan. The expenses not included in the plan are absorbed by the county providing the service. b. The majority of districts have elected not to charge these costs to the programs and the county providing the service is supporting the activity fully. 3. Monitoring of Local Agency Expenditures The local agencies submit a Monthly Income and Expenditure Report to the Public Health Grant-in-Aid Office and the State WIC Offlce. These reports are monitored by the state agency staff and comparison made to STATE WIC PLAN- 72 STATE WIC OFFICE approved budgetary amounts. During program reviews, expenditures and supporting documentation is checked to ensure program compliance. ~i~mI:IQtIi~:illIMi!i!J'~:!!l~II~!~g~pg!~!i,Wi!_!ggmlimg~ilf~l!y i_~l41~l!ntm.!filRflm1P!~iJw.tn<;mgm;]Pf;Wlli!iiijtA~~iii~~l!t~oo l?lm#11~(if1'lilm!!ll:~I~~~~mt~lptlf:jtg;;~!lp~Ym~ijri . mrmiimgmfPfingigffi!B!I#g#n\lygQggpYilt5!:i~m,l!qlmtiK~np~i~ mt9j,igl1ll1ll1I~;pJJm{!ip,:OClPli!~li!,j'~J~l!ntiil.!f;~y~~m;IBffill~;~!iI~nlfqfm 1~ISY~~m)!:J~f!ntii:i~illWiift!!llI,l'Mlqi{~mijli~jmi(1,P'PvmY iilg;;lifggr%iA; 4. Monitoring of State Agency Expenditures The expenditures of the state agency are monitored by the DHR Office of Financial Services and Division of Public Health, and only allowable costs are charged to the federal grant program. The documentation to support these charges is maintained in the Office of Financial Services. The .Department's Office of Audits and the State Office of Audits conduct regular reviews of financial activity in the WIC program. Indirect costs assessed by the Department and the Division are included in the DHR Cost Allocation Plan approved by DHHS. (See Attachment N) 5. Purchasing, Contracting and Property Management All State agency purchasing, other than supplies from the Department of Human Resources Central Supply, is conducted by the Procurement Office for DHR. Federal Regulations, including 7-CFR 3016, A-90 and A-87 guidelines are complied with by the Procurement Office. Prior approval from FNS must be obtained before the State agency can approve the following purchases: a. Automated management information systems. b. Management studies for State or local agencies. c. Capital expenditures over $5,000. d. Non-major ADP equipment. The Purchasing authority for the Georgia Department of Administrative Services (DOAS) complies with the requirements of 7 CFR .Part 3017. This federal regulation provides guidance for systematic policy and STATE WIC PLAN - 73 STATE WIC OFFICE procedures implementation for nonprocurement debarment and suspension. This regulation applies to all debarments and suspensions of persons, fIrms, or corporations from consideration for award of contracts imposed by the Department of Administration Services, Purchasing and Surplus Property Division. The list of disbarred/suspended vendors is maintained by State Purchasing. The state agency does not conduct business with any debarred or suspended vendor. Contracts for services are initiated and written by the State agency following applicable guidelines. Consultation is provided by the Office of Financial Services and the Division of Public Health Contracts OffIce. Companies which the State agency has m~gf#;gjlt gdii:!gcontracts are with: Viking Computing, Inc. ~qu~IS!qi:cJ1w,j;)1ili@.re,i9ijq; I1ijljgnt!$~~fi!H~~i~I' ... Executive departments and agencies shall participate in a government--wide system for nonprocurement debarment and suspension. A person (vendor) who is debarred or siJspended shall bi:c excludMd from Federal financial and nonfInancial assistance and benefIts under Federal programs and activities. Debarment or suspension of a participant (vendor) in a program by one agency shall have government-wide effect. Each local agency conducts its own purchasing through the District Health Office. The Southside, Inc. and Fulton/DeKaib Hospital WIC Programs purchase through their own internal mechanism. Each local agency has been provided a copy of the Federal guidelines and instructed that WIC purchases must be made in accordance with those guidelines. Policies and procedures for purchases made with State Grant-in-Aid funds are given in the Grant-jn-Ajd Policies and Procedures Manual, and are in compliance with Federal requirements. Local agencies are contractual providers of the state, therefore they are subject to DOAS guidelines for "Debarment or Suspension of Vendors.; DOAS complies with the requirement of 7 CFR Part 3017 and maintains a list of disbarred/suspended vendors. State Agencies shall comply with the requirements governing nonprocurement debarment/suspension in accordance with 7 CFR 3017. For WIC property control procedures in accordance with A-102, see Section AD of the Procedures Manual. The property control procedures are applicable for nutrition education property management, and to the debarment suspension requirements for property management. STATE WIC PLAN - 74 STATE WIC OFFICE 6. Identification of Obligations The FNS-498 Report is prepared by the Office of Financial Services using the following reports: A. UNMATCHED REDEMPTIONS REPORT CEWRR3400G) This report lists Manual Vouchers which have been redeemed but for which: I. No matching issue record has been received by the APP Contractor, or 2. No valid certification exists. B. WIC fOOD COST PROJECTION REPORT CBWWRR40J G) Lists food allocation by District/Unit, shows following information: Food Grant Accumlated Expenditures To Date Calculated Expenditure For Current Month Sub-Total Of Expenditures Remaining Total Projected Expenditure Fiscal Year Available Monthly Grant Remianing Projected End of Year (OverlUnder) Projected Percent Of Grant Expended Fiscal Year Actual Percent of Grant Expended Fiscal Year C. FOOD EXPENDITURES CEWRR800G> Shows number of computer generated and manual vouchers created by WIC Type along with Void. Also includes the same information listed for vouchers codes in Report EWRR900G . D. MONTHLY REPORT OF VOl JCHER EXPEND!TlJRES BY VOUCHER CODE CEWRR900G) Gives following information for each voucher code: U Computer Issues UManual Issues UVoid U Net Issues STATE WIC PLAN- 75 STATE WIC OFFICE # Cashed Value of Cashed Vouchers Average Cost/Voucher # Uncashed Value of Uncashed Vouchers The Office of Financial Services uses the following steps to prepare the FNS-498 Report: a. The food obligation amount is taken from the WIC Director's memorandum which is obtained from the data processing contractor's WIC FOOD COST PROJECTION REPORT, less the estimated amount of rebates provided by the State WIC Office. b. The net amount is equal to the total amount of vouchers that have been cashed for the three (3) months, including the issue month. This amount also equals the "total" line on food outlays for the issue month. c. The food outlay section is completed using the E.QQ!2 EXPENDITURES UNMATCHED REDEMPTION, the RECONCILIATION OF USER, and FACS 2012 reports for manual adjustments. (1) The current month amount is calculated by taking the current amount from the FOOD EXPENDITURES REPORT + Early Redemptions (from Reconciliation of User) + Unmatched Redemptions + Redeemed Late (from Reconciliation of User) + Bank Exceptions (from Reconciliation of User) + Manually issued checks for stale dated vouchers (manual journal vouchers - Accounts Payable file) - refunds (manual journal vouchers - Accounts Payable ftle). NOTE: The stale dated vouchers are included in the current month. Because of the small amount of these in respect to total dollars [less than one (1) percent], we determined that it would not be cost effective to identify the actual month of issue. Also, the original month of issue would have already been closed out on the FNS-498 Report. (2) Prior months are taken from the FOOD EXPENDITURES REPORT and adjusted for the vouchers that were cashed early during that month. Example: The May amount cashed in June STATE WIC PLAN - 76 STATE WIC OFFICE would be adjusted for the June amount that had been cashed early in May since we would have originally reported that under May. d. To ensure that the correct amount is being reported, the total of c above would be compared to what is on the books. These amounts must match exactly. e. The participation information is received from the WIC Director's memorandum which is obtained from the data processing Contractor's ETHNIC PARTfCIPATION BY PRIORITY REPORT CEWRR990G) each month. f. The administrative costs for outlays are taken directly from the Fiscal Accounting and Control System (FACS) which identifies all costs by program based on codes used by WIC. The costs are picked up from a monthly 2012 FACS report and added to the previous monthly outlays. This total is compared to the FACS 4100 report to insure accuracy. Any expenditures covered by converted food funds are arrived at in the same manner because the FACS 2012 is a project report. These costs are recorded on an administrative project and food fund source. When the WIC accountant does the comparison to the FACS 4100 report, he/she must adjust for these costs since the 4100 report is by fund source. g. The administrative costs of unliquidated obligations represents the total from the FACS 2039 report less costs not reportable except one (1) month at a time. For the unliquidated obligations we have been informed by the USDA Regional Office that contract costs can only be claimed for the month that is being reported. Example: The data processing contract is not put on the July report unless we have not paid the July invoice and then it is put on for only the amount or estimated amount of the July invoice. The indirect cost for the first two (2) months of the quarter is an estimated amount and is shown as an obligation since indirect cost is only posted once per quarter. This amount is estimated by obtaining an average for the past four (4) quarters of indirect cost and dividing the result by twelve. This result is used for the first month of a quarter and this result times two (2) is used for the second month of the quarter. There is no estimate used for the third month of the quarter since the indirect cost will be the actual cash expense indirect cost and reported as a cash outlay. STATE WIC PLAN- 77 STATE WIC OFFICE (3) The rebate check is recorded through journal voucher to WIC food. The distribution between the months that the check represents is obtained from VIKING INFANT FORMULA REBATE REPORT CEWYR16MG) This journal voucher is adjusted in the proper months from the amounts calculated in steps I and 2 above. 7. Nutrition Education Expenditures WIC Regulations mandate that nutrition education expenditures equal at least one-sixth (1/6) of the State agency's total administrative and operational costs. Local agencies must budget a minimum of one-sixth (1/6) of their administrative funds for nutrition education, or ensure that equivalent nutrition education is provided by other sources. The State agency will take the following steps to ensure that nutrition education spending is at an adequate level. a. Monthly grant-in-aid reports from local agencies will be monitored to determine nutrition education spending levels. The State agency will then record monthly state and local administrative expenditures and compare nutrition education expenditure percentages to determine whether one-sixth (1/6) of all administrative expenditures are for nutrition education. b. If the one-sixth (1/6) requirement is not being met by an agency, the State will determine the cause and work with the local agency to establish spending patterns at the appropriate level. This may entail shifting funds from administration to nutrition education. c. The State agency will provide technical assistance and consultation to local agencies to assist them in planning nutrition education expenditures. d. If an agency persistently fails to meet the nutrition education spending share, the State agency may reduce that agency's administrative allocation up to one-sixth (1/6), unless documentation is available to justify low nutrition education expenses. At the present time, in-kind contributions are not documented and are not included in the minimum requirement for nutrition education. 8. Breastfeeding Expenditures WIC regulations mandate the amount of the administrative grant that must STATE WIC PLAN - 78 STATE WIC OFFICE be spent on breastfeeding promotion activities. Local agencies must budget the allocation amount on a special program code set up for the breastfeeding promotion program. The State agency will take the following steps to ensure that breastfeeding spending is at an adequate level. a. Monthly grant-in-aid reports from local agencies will be monitored to determine breastfeeding spending levels. The State agency will then record monthly state and local breastfeeding expenditures to ensure breastfeeding expenditures are being reported accurately and are allowable breastfeeding activities. b. The State agency will provide technical assistance and consultation to local agencies to assist them in planning breastfeeding expenditures. c. State and local agency breastfeeding expenditures will be reported on the final 269 report. 9. Client Service Expenditures WIC regulations mandate that Client Service expenditures must be accounted for separately from general WIC administrative expenditures. Client Service expenditures include all those costs expended to deliver food and other client services and benefits. 10. Indirect Costs The state agency operates in accordance with the approved department/division indirect cost allocation plan. This plan details the services provided to the WIC program under this agreement. .The indirect costs are charged by organizational codes to the appropriate programs. There are three levels of costs: statewide, departmental, and divisional. (See Attachment L) Local agencies may charge allowable indirect costs to the WIC program upon submission and approval of an indirect cost allocation plan. These plans are reviewed by state agency staff during on site monitoring visits and by local agency and departmental auditors. Please see the enclosed DHR Indirect Cost Allocation Plan. STATE WIC PLAN- 79 STATE WIC OFFICE E. Local Agency Financial Management System The Master Agreement for the Division of Public Health, paragraph 115 requires that local agencies maintain their financial management system in accordance with 45 CFR Parts 74.60 and 74.61 (Subpart H) and Georgia Code Annotated, Section 31-3-8. The DHR Administrative Policy and Procedure Manual and the DHR Grants to Counties Manual give specific instruction in operation of a financial management system at the local level. The WIC Procedure Manual provides information which is specific to the WIC program. XIll. CIVIL RIGHTS A. Collection of Racial and Ethnic Participation Data Local agency personnel collect racial and ethnic data as a routine part of the certification process. Data shall be maintained under safeguard which will restrict access to records to authorized personnel, and maintained on file for three (3) years. . . Visual identification is used to determine race. If the race cannot be determined using this method, the participant is asked their race. When this occurs the participant is Informed that it will have no effect on the determination of eligibility for Program participation. The data must be entered into the automated system before vouchers can be generated for the WIC participant. A monthly State ADP report of participation shows WIC participants by type and by racial ethnic group, as well as by local agency/district/State totals. This report collects the number of participants for whom vouchers have been generated. Participants records must not be coded nor filed by racial/ethnic origin. The Georgia WIC Program must not allow any coding system on the outside of Medical Records, tickler cards, appointment or any related WIC document which can openly distinguish applicants/participants by race, color, national origin, sex, or handicapped. B. Civil Rights Complaints STATE WIC PLAN- 80 STATE WIC OFFICE The local agency documents any complaint and action taken in the participant's health record. All discrimination complaints are reported to the State WIC Office. C. Civil Rights Compliance Reviews In 1974, DHEW approved the Civil Rights Monitoring Plan for the Georgia Department of Human Resources. This plan detailed the method to be used in monitoring local health departments for civil right compliance. This plan is on file with HHS and with the DHR-Division of Public Health. WIC services are integrated in county health departments, therefore, the WIC Program is included in the annual civil rights monitoring conducted by DHR. This annual civil rights review is under the direction of the Affirmative Action Officer for the Division of Public Health. One hundred percent (100%) of all clinic sites are reviewed annually via a Self-Review Form. A 30% sample of these reviews is pulled and an evaluation is completed by the Division of Public Health Affirmative Action Officer. The Affirmative Action Office is provided with the civil rights subsection of this plan. Confirmation that the annual Civil Rights Compliance Review has been conducted in all health districts throughout the State is provided to the State agency by the Affirmative Action Officer. State WIC staff, as part of their Program Review visits to local agencies, will also monitor for civil rights compliance. The following will be monitored: Documentation of civil rights complaints and actions taken to resolve such complaints. Display of the ...And Justice for All poster. Section MO of the Procedures Manual contains the Local Agency Monitoring Tool, which includes a civil rights section. State review for Civil Rights Compliance is conducted in accordance to lXB.3 (b) of FNS Instructions 113-2. A pre-award and post-award review has not been necessary since there are no plans for local agency expansion. However, if the need arises to add additional local agencies, the State agency will comply with the provision of 113-2, IX, A, 2, A-F. There have been no areas of non-compliance found, therefore no action has been necessary. No lawsuits alleging discrimination in the WIC Program have been filed against the State agency. STATE WIC PLAN- 81 STATE WIC OFFICE mi! FAffi HEARINGS AND ADMINISTRATIVE APPEALS Uniform Fair Hearing and Administrative Appeal procedures are explained in detail in the Rights and Obligations Section (RO) of the Procedures Manual. The use of these procedures and forms is required of all local agencies. To meet the requirements of providing applicants with written notification of fair hearing rights at the time of application, the State agency has devised a separate form which lists these rights and is given to the applicant during the certification process. Vendors are entitled to a fair hearing upon disqualification from the WIC Program. Any vendor requesting a fair hearing must contact the local agency by telephone and contact the State WIC Office in writing within fifteen (15) days of the adverse action. The Vendor Agreement and Vendor Handbook of the Procedures Manual lists these rights and is given to each participating vendor prior to reauthorization or immediately upon signing a Vendor Agreement Contract. If a vendor desires to appeal after an Administrative Hearing has taken place and the decision is in the State WIC Program's favor, the Vendor must follow the provisions of the Georgia Public Health Code (Code Section 31-5-1,31-5-2 and 31-5-3. In addition, the Vendor must reference the Georgia Administrative Procedures Act, Code Section 50-13-16 and 50-13-17. STAFFING AND ORGANIZATION OF STATE AGENCY The Division of Public Health is one of five (5) major divisions within the Georgia Department of Human Resources. The delegation of the WIC Program and its operation is vested within the Division's Maternal and Child Health Branch in two (2) Sections: the State WIC Office and the Office of Nutrition. A. State WIC Office Responsibilities To provide leadership and operational guidance for twenty-one (21) WIC local agencies throughout the State operating in 159 counties. Specific activities of the State WIC Office include: interpreting Federal regulations and developing operational policies, implementing funds allocation, developing the State Plan and Procedures Manual, providing technical assistance and consultation to all project sites, developing and maintaining the Food Delivery System, training and providing in-service education for local agencies, and acting as a liaison with the Federal agency. Monitoring and evaluation of the WIC Program statewide is also a responsibility of the State WIC Office. Supervision and leadership are provided by the State WIC Director. Pursuant to the Drug-Free Workplace Act of 1988, Public Law 100-690. Title V. Subtitle D: and 7 CFR Part 3017, Subpart F. the Georgia WIC Program hereby agrees that it will provide a drug-free workplace in accordance with the STATE WIC PLAN- 82 STATE WIC OFFICE current annual single State/State agency drug-free workplace certification statement that is on file with the U.S.Department of Agriculture. The positions forming the nucleus of the WIC management team are: Vendor Management Unit Manager, Systems Information Unit Manager, Program Management and Review Unit Manager, Quality Improvement Uni~ Manager, Administrative Support Unit Manager, and Financial Management Unit Manager. This team is responsible for maintaining a close working relationship with the State WIC Director, the Office of Nutrition staff and the data processing Contractor for effective operation of the WIC Program in Georgia (See Attachment 1). 1. State WIC Program Director Lynda Pittman-Cotton, R.N., M.S.N. is the administrative and programmatic director of the Georgia WIC Program. Ms. Pittman-Cotton is a registered nurse currently licensed by the Georgia Board of Registered Nurses. She has a Master of Science Degree in Nursing. Her area of specialty is Pediatrics. Ms. Pittman-Cotton received advanced training in the field of lactation, which led to her certification as a Lactation Specialist. The position is supervised by the Director of the Maternal and Child Health Branch and is responsible for the development and implementation of policies and the financial accountability of the Program, except for those areas specifically assigned to the Office of Nutrition. This position is the primary contact person for USDA/FNS and is also responsible for coordinating and interfacing with other sections/offices of the Department of Human Resources, such as the Office of Accounting, Office of Audits, and Management Information System Section. The State WIC Director directly supervises seven (7) positions: Vendor Management Unit Manager, Systems Information Unit Manager, Program Management and Review Unit Manager, Financial Management Unit Manager, Administrative Support Unit Manager, Quality Improvement Unit Manager, and WIC Medical Epidemiologist. 2. Vendor Management Unit Manager This position is the manager and coordinator for all vendor related activities in the State. The incumbent serves, at times, in an acting capacity in the absence of the WIC Program Director and supervises eight STATE WIC PLAN- 83 STATE WIC OFFICE (8) positions: IWQ!*g,j Operations Analyst Associates, Q~I~l, Operations Analyst Technician, one (1) Clerk Transcriber, two (2) Administrative Clerks, one (1).f411!lil~ Analyst, and (1) Senior Secretary. 3. Systems Information Unit Manager This position is responsible for managing the contract responsibilities for data processing services, computer program writing, training, and local agency technical assistance. Si~ig) positions are supervised by this position: Operations Analyst$, one (1) Analyst, 9##'~1, Data Processing Specialist, one (I) Database Coordinator, and one (I) Principal Clerk). 4. Program Management and Review Unit Manager This individual has responsibilities for areas of Program procedures and policy including: Regulations, Program Reviews, the State Plan and Procedures Manual, and Public Meetings. The incumbent serves, at times, in an acting capacity in the absence of the WIC Program Director and supervises five (5) positions: two (2) Operations Analysts, one (I) Hum~ Service Program Specialist I, one (I) Senior Secretary and one (I) Operations Analyst Technician. 5. Financial Management Unit Manager This individual acting in the capacity of unit manager to date has responsibilities for areas of coordinating information related to caseload management, rebate funds, administrative conversion funds, financial management, budgets, procurement, and financial reviews of local agencies. The incumbent serves, at times, in an acting capacity in the absence of the WIC Program Director and supervises three (3) positions: one (I) Administrative Clerk, one (I) Fiscal Analyst, one.(I) Operation Analyst. 6. Administrative Support Unit Coordinator This individual is responsible for personnel, administrative clerical staff and general office management and supervises two (2) positions: one (I) Secretary Typist and one (1) Senior Clerk. 7. Quality Improvement Unit Manager This position is responsible for managing vendor, participant and employee STATE \VlC PLAN - 84 STATE WIC OFFICE investigations of alleged program fraud and abuse, as well as developing policies and procedures relating to programmatic quality improvement. The incumbent serves, at times, in an acting capacity in the absence of the WIC Program Director and supervises four (4) Compliance Investigators one (I) Operations Analyst Associate and two (2) Operations Analysts are supervised by this position. B. Office of Nutrition Responsibilities In March, 1980, the Office of Nutrition was assigned three (3) functions in WIC: Certification, Food and Nutrition Education. FOlod}Riick'ag,esJil'his office has the of providing all nutrition consultation and technical assistance, as well as providing professional nutrition training for WIC. The preparation of the Nutrition Education Plan is the responsibility of the Office of Nutrition. Two (2) nutrition consultants spend 100% of their time on WIC in their respective areas. A third 100% position is split between two (2) nutrition consultants, one (1) at 75 % and the other at 25 %. Supervision and leadership for this office is v.ested in the Chief NutritionistJor the Division who is designated as the Nutrition Coordinator for WIC. State WIC Nutrition Coordinator Frances Hanks Cook, M.A., R.D., L.D. is currently the State Nutrition Coordinator for the Georgia WIC Program. She has a Master of Arts Degree in Foods and Nutrition. Ms. Cook is registered with the American Dietetic Association and licensed with the Georgia Board of Licensed Dietitians. She has !'lWit~l~~l'll1\~) years of public health experience. C. Coordination The State WIC Program Director and the State Nutrition Coordinator meet on a regular basis. The State WIC Office has been designated as the liaison with USDA/FNS. PUBLIC NOTIFICATION The dissemination of information to the public regarding the availability and benefit of the WIC Program is an on-going activity for Georgia WIC Program. Newspaper publications; radio and television public service announcements; and other information and promotional materials are media sources used to bring the WIC Program to notice of the general public. The development of cooperative working relationships with public and private organizations provide another avenue to inform the public of the STATE WIC PLAN - 85 STATE WIC OFFICE WIC Program. An example of such efforts is the placing of WIC information announcements in "mail-outs" of DFACS and Utility Companies. "WIC WORKS WONDERS" will continue to be theme of Georgia WIC public information activities. PUBUC COMMENTS The Georgia WIC Program solicits public concerns regarding the State Plan of operation and administration through a series of regional public hearings. The public meetings also give local citizens an opportunity to comment on how WIC services are provided to them. Correspondence announcing these regional meetings are forwarded to interested individuals and groups. The following listings are examples of local groups notified with regard to the public hearings: Boards of Health, Economic Opportunity Authorities, Community Action Agencies, Migrant and Seasonal Farmworkers Association, March of Dimes, Division of Family and Children Services, Legal Aid Societies, Head Start Programs, Unemployment Claim Centers, hospitals, elected officials, associations of elected officials, choruses, religious groups, special interest health groups, minority groups, grassroot organizations, community health centers, retail vendors and grocers association. In addition to the public hearing, the news media is utilized for public notification of where and how the general public may review and make comments on the Plan for the Georgia WIC Program. District Health Directors, District Program Managers, WIC Program Coordinators, Vendors and WIC participants are sent correspondence encouraging them to comment and express their concern in regards to WIC Program operations. (See Attachment K) A list of locations and contact persons where public meetings were held in FY i'~:p: is attached. Plans are being considered to place copies of the State WIC Plans and Procedures Manuals in public facilities other than the local health departments for review prior to the public hearings. (See Attachment K) WIC Program regulations and guidelines are made available to the. public upon request. This includes the Federal Regulations, the State Plan, the Procedures Manual and the Income Guidelines. When the WIC Program Coordinators give interviews to local media outlets, the statement that participation in WIC is the same for everyone regardless of race, color, national origin, age, sex or handicap is included. Information on where and how the public may review the Plan and Procedures Manual for operating Georgia WIC Programs is also shared. Georgia Department of Human Resources Office of Public Affairs prepares news releases to notify the public of WIC benefits and notices soliciting public comments in regards to WIC operations. The news releases are sent to statewide newspapers annually. STATE WIC PLAN- 86 STATE WIC OFFICE AUTOMATED DATA PROCESSING The current system was developed by EDS in 1985, was enhanced in 1988, and was maintained and operated by EDS from Camp Hill, Pennsylvania until December 31, 1991. In January 1992, Viking Computing of Lenexa Kansas assumed operation of _J. the Georgia WIC ADP system. The WIC System has five subsystems; _ A Client Information System which maintains all of the client information for food instrument creation and informational reporting for more than active clients, and more than 400,000 inactive clients which could be recertified at some future date. A Food Instrument System which provides clinics with preprinted manual food instruments to use for the client's first food package; and, automatically prepares computer generated food instruments for eligible clients. The food instruments are prepared twice monthly, and can produce one or two months supply for a client. A Banking System that pre-edits, clears, and vendor encodes each approved food instrument, and returns rejected food instruments to the vendor's bank. A Reconciliation, Financial, and Participation Reporting System that performs the required one-to-one reconciliation, and creates reports for: expenditures, food cost projections, participation, and other essential reports such as Infant Formula Rebate. A Vendor Analysis and Reporting System that analyses redemption data and develops peer group statistical analyses and measures each vendor performance. The system prints reports which assist in detecting fraud and abuse. This system also contains a subsystem Vendor Activity Monitoring Profile (VAMP) which controls and tracks that state run vendor monitoring program, and accomplishes automated annual reporting to FNS. The Quality Improvement System will expand the ARMIS MIS Scope by adding detailed computer and manual voucher information to the ARMIS Database both at the State WIC Office and the DistrictlUnits. The latter will be for the interim period until the Statewide LAN is implemented, at which time the DIU will be able to inquire into the SWO File Server. The State and the D/U users will be able to view vouchers when they have been processed to a final status of: paid, Void, Lost/Stolen, or Expired. In addition to the various reports provided from these subsystems, the state also has the option of requesting ad-hoc report information from the system through the ADP contractor who uses a variety of utilities such as EASYTRIEVE. ~Qt;Q#l#\iq)~;w~w.li~Y~iili~.~)~!i of automated system install~ for aut0!Uated TAD manual voucher submission. (See Attachment Q) STATE WIC PLAN - 87 STATE WIC OFFICE The ATVS System prints manual vouchers and transfers client information to the ADP contractor by~:~,~ffllri~ig~!it~. STATE WIC PLAN- 88 STATE WIC OFFICE WIC INCOME GUIDELINES WlC INCOME POVERTY GUIDELINES (185%) Effective March 23, 1995 through March 23, 1996 Attachment A Family Size 1 2 3 4 5 6 7 8 Yearly $13,820 $18,556 $23,292 $28,028 $32,764 $37,500 $42,236 $46,972 Monthly $1,152 $1,547 $1,941 $2,336 $2,731 $3,125 $3,520 $3,915 Weekly $266 $357 $448 $539 $631 $722 $813 $904 FOR EACH ADDITIONAL FAMIL Y MEMBER ADD YEARLY I MONTHLY I WEEKLY I $4,736 I $395 I $92. I STATE WIC PLAN- 89 STATE WIC OFFICE Attachment B FLAGGED VOUCHER BY VENDOR PER DISTRICT AVERAGE 'AGE 1 tEl'ORT EWVR720G STATE OF GEORGIA WIC SYSTEM DETAILED FLAGGED VOUCHER LISTING FOR THE MONTH OF JUNE RUN DATE 07/14/9: TENDOR VOUCHER lUMBER NUMBER 0001 0001 0001 0001 0001 0001 05186680 05186909 05187016 10261061 10261215 68775308 0005 0005 0005 0005 0005 05186948 05186950 10580668 68775300 68775337 0006 0006 Ol'A" r 04827425 04828679 05193429 05194096 Ov~3 0013 04820873 10578452 0016 68837563 0019 05191868 0021 0021 0021 0021 0021 0021 0021 0021 0021 04823742 04824933 05190874 05190876 10262666 10263158 10581971 10583839 68005194 0024 0024 0024 05517482 05517488 10265691 0025 68545775 0025 68550098 OG26 0026 0026 0026 0026 04507743 04508924 04824075 05190592 05192552 ('0"2 f 10266206 VOUCHER PARTICIPANT REF LAST FIRST M REDEEMED I D/U/CL AMOUNT 61119394 42831743 54451013 61134841 54850602 42801463 BITT HERRELL NOLAN HYERS BOOD KIMBERLY C SHELLY LAUREN RICIlARD D ALICIA 01/2/112 01/2/112 01/2/112 01/2/112 01/2/112 01/2/112 $8.81 $6.19 $7.14 $6.51 $13.50 $58.24 43545912 61105337 60336575 67505227 35059252 MORRIS 'MORRIS BENNETT BENNETT IlARRI.ANA N BARRIANA N RICHARD A RICHARD A 01/2/112 01/2/112 01/2/112 01/2/112 01/2/112 $7.65 $6.35 $9.89 $8.05 $10.35 54165795 CANO 54777082 TORRES 54165790 BRYAN 43524034 LEBRON DANn:L ROSA S XIM!lERLY D HAR7IN A 0112/286 01/2/286 01/2/286 01/2/286 $9.96 $10.34 $11.37 $9.98 54202090 FLOWERS 54861817 CARREll BRITTANY N 01/2/055 $8.66 'U.KI M 01/2/055 $13.59 60326560 ROGERS DONNA A 01/2/061 $10.08 68116738 RIVERA AN=. B 01/2/155 $11.56 54787220 43586802 42802239 43586810 61131681 61131684 61105872 54459911 43586801 APODACA GUERRERO MCARTBUR MCARTHUR CHANEY FERGUSON DEBORA RAMOS LEONOR 0112/155 $9.79 JESSICA G 01/2/155 $10.92 JEREHY A 01/2/155 $10.01 JEREHY A 01/2/155 $8.28 DAMIEN K 01/2/155 $10.19 TAWANNA 01/2/155 $9.16 MIGUEL J 01/21155 $7.92 DAVID 01/21155 $7.88 01/2/105 $9.26 43624802 MORAVIAN 60331478 MORAVIAN 54169716 SPURLOCK FRANK FRANK TOMHY L 01/2/155 $10.07 L 01/2/155 $7.37 L 01/2/155 $9.06 43499826 AVILA 68121690 LACKEY JUAN SHARON 01/2/155 $6.11 01/2/155 $9.82 67548731 67501476 43553192 4280562 54824058 ARAIZA GARCIA BRUCE LOVE SWAFFORD SERGIO JOSE MEGAN R SEBASTIA A DUSTIN L 01/21155 01/2/155 01/2/155 01/2/155 01/2/155 S7.41 $7.59 $7.05 $10.07 $11.80 42852119 WILCOX AHM'DA 01/2/155 S9.79 EXCESS PERCENT CHARGE EXCESS $3.27 $1.83 $2.78 $2.15 $5.03 $22.40 59.03 41.97 63.76 49.31 59.39 62.50 $3.29 $1.99 $2.50 $2.51 $2.96 75.46 45.64 33.83 45.31 40.05 $2.03 $3.19 $4.22 $2.05 25.60 44.62 59.02 25.85 $3.44 65.90 $3.31 32.20 $2.38 30.91 $2.96 34.42 $3.26 $6.56 $3.48 $3.92 $2.80 $2.63 $3.56 $3.52 $2.73 49.92 150.46 53.29 89.91 37.89 40.28 81.65 80.73 41.81 $2.37 $2.15 S3.84 30.78 41.19 73.56 S1. 75 40.14 $3.29 50.38 $3.05 $3.23 S2.69 S3.54 $5.27 69.95 74.08 61.70 54.21 80.70 $2.40 32".48 DATE DATE ISSUED REDEEMED 06/03/93 05/13/93 06/03/93 06/10/93 06/10/93 OS/27/93 06/30/93 06/08/93 06/18/93 06/30/93 06/29/93 06/09/93 06/03/93 06/03/93 06/17/93 OS/26/93 OS/20/93 06/15/93 06/29/93 06/23/93 06/02/93 06/07/93 04/21/93 05/19/93 06/02/93 06/02/93 06/11/93 06/25/93 06/],1/93 06/17/93 05/18/93 06/14/93 06/15/93 06/28/93 06/11/93 06/22/93 06/02/93 06/07/93 05/17/93 05/17/93 06/07/93 06/07193 06/07193 06/14/93 06/16/93 06/16/93 OS/24/93 06/22/93 06/15/93 06/09/93 06/15/93 06/30/93 06/30/93 06/29/93 06/18/93 06/15/93 05/17/93 06/17/93 06/21/93 06/25/93 06/02/93 06/11/93 06/08/93 06/16/93 05/18/93 06/03/93 05/11/93 05/03/93 05/17/93 06/07/93 06/03/93 06/01193 06/02/93 06/15/93 06/09/93 06/24/93 06/07/93 06/09/93 STATE WIC PLAN -~QQ 90 STATE WIC OFFICE VOUCHER VARIATION REPORT Attachment C ~U.T[ ()l' HC~GI~ oIIC ~Y~T{II \'OJ(U{1l \'~QI~ll~ 1l[Pl)'lT 10;; We IIO~'" 01 AlJGlJ~ 1 O/J pI,c:r O'" Ill!" 01,' OQtlllQl \'{x:>o~ 23 10."1 t (0.1"11" lf1111 (00 lllII 0l,T I I H~ .r.vrlll,G 1011.1. SID O{V PIlICE ('{(lJIl PIlIC Ol!'l PIlI([ OCClJIl PRI( O(ClJIl PRIC O(Cl!'l ~1 n.12 000033 0.1,0 S7.LT 2 H.27 8 $7.17 5 S7.07 5 $6.'17 5 31 S7.12 000033 0.1,0 SO.OO 37 S9.62 00002' 1.55 Sl1.55 0 SO.OO 2 S9.25 0 SO.OO 2 SO.OO (I sa.OO 0 sa.OO 0 SO.OO 0 SO.OO 0 0 3 $4.37 000033 0.28 $4.75 2 $.4.67 2 $4.65 2 $4.35 2 $4.27 5 39 $4.~ 000033 0.28 $4.25 .. 7 SS.7Q 000003 0.1,5 SO.OO 5 SI..07 0 SO.oo 7 SO.OO 0 SO.OO 0 SO.OO 0 SO.OO 0 sa.OO 0 SO.OO 0 0 5L S9.57 000010 0.26 S9.93 2 s9.35 2 S9.25 2 sa.OO 0 sa.OO 0 55 n.63 000017 0.52 S7.86 56 s13.'" 000002 0.00 s.o.OO 2 0 Sso7..o7o6 2 S7.U 0 SO.OO 3 $6.56 0 sa.OO 2 SO.OO 0 sa.OO 0 0 ".Slo f8 S39.% ()()(l;)()1 0.00 SO.OO 99 s26.97 00c003 SO.OO 0 sa.OO 0 SlJ.OO 0 SO.OO 0 SO.OO 0 sa.OO 0 SO.OO 0 SlJ.C'O 0 SlJ.OO 0 0 \~tero'l 2" r()Jll 0/" 1'.AAc.1 TfRII COO TfRII O.r.l I I "PE ..vrllI.GE 1011,1. SlD OEV PIlIC OCCllIl PRIC OCCllIl PP!CE OCClJIl PRIC OCClJIl PRICE OCC'" Ol. $41.8'- 000026 0.77 $43.95 OS $43."3 000028 5.98 $46.88 2 Sl.1.85 21 Sl.0.35 2 Sl.L.6L 21 $43.()l. .3 SO.OO SO.OO 0 sa.OO 0 SlJ.OO 0 0 08 S50.23 000009 0.89 SL9.30 2 SO.OO 0 SlJ.OO 0 so.00 0 SlJ.oo 0 12 t.L2.98 000008 O.M Sl.3.~ 2 SL3."'" 2 $42. U. 3 SO.OO 0 SO.OO 0 27 $1".13 000001 0.00 sa.oo 28 S6. QO 000008 0.25 S7.26 0 so.00 2 $6.96 0 SO.OO 2 $6.66 ~ SlJ.OO SlJ.oo 0 SO.OO 0 SO.oo 0 0 29 $4.3S 000001 0.00 SO.OO 31 n.6' 000058 0.76 ~.07 31 $7.6' 000058 0.10 S7.66 37 $10.30 000051 2.16 $12.35 37 $10.30 000051 2.16 $10.55 0 SO.OO '6 S7.97 2 S6.87 2 Sl1.85 2 $10.35 0 SO.OO 5 2 S$76.9.n6 2 Sll.1.5 3 SlO.<'5 i SO.OO S7.81 $6.67 $11.35 S9.95 0 sa.OO 5 S7.77 2 SO.OO 3 Sl1.05 2 so.00 0 5 0 2 0 39 S5.13 000056 0.28 S5."7 3 S5.23 2 S5.17 23 S5.07 10 SL.97 8 39 S5.13 000056 0.28 Sl..n 3 SL.67 2 SO.OO 0 SO.OO 0 SO.oo 0 "7 $9.63 000011 O.loT s9.96 5L S9.9S oooolL 0.70 SO.oo 2 S9.76 0 SO.oo 2 SlJ.OO 0 SO.OO 8 SO.OO SO.OO 0 SlJ.OO 0 $(,.(10 0 0 55 sa. so 0000l.1 0.L9 S8.86 13 S8.76 n55 sa.50 00<>0=\T ~ [J\'Q2C'~ 3'~' OC G~O:;GI~ I/l( 3-3'" \1),.'("'!R ~EDf,<'T!O'i HU(lU~TIO~ co:< TI;"<'2 "IO'l"S 1110(1 II..QT 0;,.<.3 RH"fS o.JI(l {\lIl!l 06L4 lQOGQ 245 0;,.<.8 JfR'lT S !(fO AXD ..... IT[ 63 0;,.<.<;> J r I651 GU'll T" 5 SlJPfRl'lA'l<. I 0652 "'lOGER 2'14 0654 _I.[ ~POTI"QT II;( 0655 (R"'-ICOQDVIl.lf SuP[RETTE 0657 rooo llO'i _ 167 0658 rcoo 1I001 .581 0660 r 000 1I 001 162 06;,.<. R~V(O 1518 ot67 QEV(O ."25 067S G<1'ltH"S .8657 1502 rOOOllO'l II;( .TI2 1 5 34 8'lTIIO:Al P>lOP 158'1 BI-I.O 15'13 rooo ltO'l .346 1700 SI.NDT"S lGA 1707 SAHPT"S lGA 1713 ~ET"S .8612 1716 BtOCUR"S RfD l ""'IT[ 18QQ rooo llO'l .407 2018 SAHPT"S lGA 2033 rooo llO'l .462 Zoq8 (,(HI O;wG (~""T Z146 81-1.0 .'86 Z147 r .l.JE .... I'IS l SO'l G':S 813 n5 "po. n '17 267 353 2'17 '17 18 243 267 10 72 18'1 62'1 611 0 ~ 5'10 668 5'0 1 705 67'1 218 522 6113 46L 1318 333 242 0 461 1'17 370 315 1 337 38 l.30 lYol 23'1 33 76 1'10 7:L; . ~~ 23 '13 321 411 2~ 101 31 393 3'0 L 7'1 123 733 6'17 ~ 8 521 7QQ 57 0 865 1QQ 285 5% 156 5'02 1530 406 260 0 5'00 I'll 421 368 0 42'1 32 607 1573 355 112 55 .. .'i\ ~, c~ ,= n'I3e 350 "i7:J 5'1 23- 3% 20 'I 55 167 t~2 536 2 '1 412 662 41 0 717 586 212 522 6'1'1 435 1172 ~1 3 25'1 0 1.27 165 3'5 321 0 365 16 1.51 1176 21'1 87 L~ ;.'"':<. ")tJ STATE WIC PLAN -~QQ 92 STATE WIC OFFICE VOUCHERS BY DAY CASHED Attachment E ~.;,rx ?~ 'lPC;' i:."'\'"Q~~ S'~'f C' GeR"l~ J!( S'S'i" \-oJ('"!~S 5' 01.' (I.S"O feR l ..f lQ';1" Of 'clWS I \"l:tG:\ Ol,T( D~. 10'''J. n'll 11 0 2S 0 21. S 25 2S 26 16 27 II. 2~ 2? s2o9 0 0 ~l 9 I.l'IOJ',, '%.19 \O.~ \O.O~ saL.I.S SY-T.61 '205.21 $198.16 S1s9o9.o.to9 $0.(\(1 tl1~.58 STATE WIC PLAN -~QQ- 93 STATE WIC OFFICE VENDOR VOUCHER DEVIATION REPORT Attachment F iA:"'~ 1 ~PORT EWVRlOOC: COOSA VAI.IZY HEAI.T8 STAn Of" CZ'ORGIA 1(JC SY~t1 VEROOR VOOCEER DZV'L'JION REPORT TOR TEE ~ OF .JUNE DIe P1l.G"E: 1 Rml DAn 8~~,~};~ "'elm TYPE VYNOOR 530 2. SUPr: R FOODS (284"813 ISSUE DT OS/271>3 O{O/eL WIC 10 VKDR AVC 06/09193 01-]-110 110003691 (i 1 $'- 72 $3,157.fi3 $16.12 VAR OVER $12.95 $9.40 VZNOOR 956 ""0 FOOD '115(1077 3507"'1'2 05/0'1>3 06/0.{93 01-}-023 023002757 5 1 $23.00 $1'-15 $13.(5 V"V'iOOR 1454 27 ~R tJ21 ]().()8408 '8773008 06/22/.3 06/081>3 06/29/.3 06115/93 01-1-0S'7 01-1-057 057010935 008004269 $10,'93.09 $15.(7 $,(0.10 $2<'15 $55.06 $10.62 $15.26 STATE WIC PLAN - ilQQij 94 STATE WIC OFFICE Attachment G VENDOR FPC COMPARE AND YC COMPARE REPORT ..~ p,""",'"' ~ ..,....,,>s C oan..,.. .... .....,. P< .~..a ..", rPCAnUQ onn>OO ~..", ... .'".. '" I ~1 ."' . 00 .00 '.". .. .... ,''"" .0' ,.00 . < ,,.00 .0' ... '" I ~. . 0< .00 .00 0 ... W .0< 0 '" .. .. ,'"'"."., ,.. .00 .00 .00 .0' .c< .00 .00 .00 .00 0 .. 1": ".1' .').'4. .00 00 ,s< ".U '12.'1 ',US"O, 4,.tO 41.1C '1.11 .. J .... .U ... .00 ,,,,OJ '1.11 .00 ''U" ,0 .'0 00 .00 ,0 .0' .'0 ;11 .00 .00 m .00 .00 ll< .0< .0< ....... C"r.I.D or czo.cu nc ~ no<: CDOoUlZ &ml 'W"C COCPol..ltZ J'OIl ~ ICWtlI c:w .......n. n ...,.,. ..,...,. I"OiOD PAClE"WZ cocpa.a: P JI.104 0 0 .... ........ f"f'C Ava:N::Z. .vn= ... 11.17 .00 n.12 0 .'."..., ... '1.14 U.H 21.S4 .0' 11." U.:3" '0' 1~,"'2 H.S) ... '''.lo Sl.I' , .'0 .00 .0< cl.,C< , c.a..n Cl1/1)/U .....,. .YE"'" P-069 O~l 03-1-602 03-2-611 03-3-3T1 03-3-1lL ST"Tf Of C;fORGI" "I( srSTf" VOVCNERS CIUtO:' v""D()ll O<.o.t\ 1.. IS I'\l)O;t .. l"IS flDl/l .. 11(/1$ ("we \ C"S".D 03-L< SIG Sl"~ -5716 Z5L l3.201.57 2.571 \33.765.33 0371 (O'll{ 1 OCWGS 7 Sm.52 ~ l3~5t5.66 OS99 PIGGlY "IGGlY _Z8 5L 133!l.'6 '61 "'.816.0< OL08 WIIN 011(1 _1998 1.()I.6 StO.596.38 11.5<7 StZO.5L7.01 OLOQ "Ifl'l OIXlE STOllE _1899 SlZ 15.'170.54 5.1150 159.505.Z5 OL20 GI'IOllOlS rooos ltle 1,95 15.787.55 7.096 n7.'1'5.''1 lSS0 (OlllET OllUGS .3 2 11'1.56 Il6 13.176.01 15<;L GOOCSBY rooos.z 581 17.970.66 7.t.Ql. 198.00Z.'9 '. lnL SOSEBEE rOODS 231 13.505.OL 2.'172 13'1.205.07 215L 2156 HOEIl'S GIl0CEIlY .t.IlOGfIl -339 0 SO.OO 1,52 '6.62'." m S.S15 IS.'5L.2' 176.211..57 2256 SuPEIl vl.LU 1,60 15.ClL2."- '.i.(3Z nO.892.83 ZL35 ~ROGER -388 ''10 IZ.'.i\l8.n 1.'101 IZL.743.37 Z75L ZSLL 2922 rUllER'S suPERETTE IlEVeO _Z6L9 IlEVCO ORUGS ,256 13.ll8Z.33 1132.25 0 SO.OJ 3.'77 '8 7 150.237.36 ll.72(.87 1223.31 (~tT lOll.!. - VENDOllS 0021 1,.856 '61.669.03 60.'63 l7LZ. 517 .2L e~IT 0300 0306 0551 0557 u5 UPSO'l COOcS SElr SERVICE rOl/HRS '''Illn""y. IIIC. flC( "RI1'S SuPERETTE (OlLIOlS ABC rooo (EHT~ 61 175Z.88 1,1 "'63.80 152 St.932.26 776 StO.l8L.ZB 7/7 518 1.871 8.813 18.65L.70 l7.Z97.SI. l2L.OOL.26 lI17.'11.3.68 IIIDICI.IES NO VOtlCHRS ("SilEO r()ll TillS V1lD0ll DlIQ(t(C, 1"( (\l'lREt(l fl:)l/l" STATE WIC PLAN -lQQ 97 STATE WIC OFFICE Attachment J GEORGIA WIC PROGRAM ORGANIZATIONAL CHART GEORGIA WIC PROGRAM STATE OFFICE ORGANIZATIONAL CHART 1995 --------------------------------------------- I I "EDCAl. EPlQEMB)LOGlSTo RAY GANGAAJSA 100' f47;&e:11l IEPlI I OATA PFOCESS1NG SPECIALIST- LAAAY"'UER 00 f47;e~ ""S PROGRAM DIRECTOR L '\'NOA PITTlAAN-COTTON (001 4799323) ----------------------- HUMAN SERViCES PROGRAM SPECW.IST II GENHUNl'ER "" 17040000 SR. SEC1lETAR"t' (VACANT) 1221 n000711 OOOROlNAlOR SPECt.Al PROJECTS lWERAK)wal 00 U7P9112 ADMINISTRATIVE SUPPORT UNIT ,.. PRINCIPAl SECRETARY I CINDY I\OODS [24J (7066194) OFFICE MANAGER SECfETAAY/ TYPIST MIMISENlON '10' (7ooon,) SENOR ''a.EilK lV",CANT) . fli,i .,i....l()OQ720 UNIT 10TAL - 3 I FINANCIAL MANAGEMENT UNIT FISCAl ANALYST PRINCIPAl CARa.YN Ha.LOWAY [35J (7066193) MANAGER OPEAATONS ANH.YST JIMCAMPBal 133) (7000e<521 FISCAL ANAl. YST WJMN STA'LEY 20 (70007001 ACM1NISTAAnVE a.EAK ANOREW IolLLER 1241 (7O1 l700el06) ACMINISTRATlVE Q.ERK SARITA MANGUM 1241 (70490"1 SENOR SECPETARY Q.AUOETTE WUINGHAM I22J (7000712) UNITrorAl. - g QUALITY I"lPROVEMeiT UNIT OPERATIONS ANAlYST PRINCIPAL NINA MURRAY [37J (7000715) MANAGER OPERATCNS ANALYST SONIA JACKSON 1331 (70400'5) co Mf'l.IANCE INVeSTIGAlOR SR. TERRY PARKER 100 "7~1 OPEAATONS ANAlYST VERNJN LAWTON 1331 (7Oril 17. 1995 The Youth Activitiy Center Buildin9 1056 Ft. Benning. Georgi. J 1905 1:30 p.m. - 4:30 p.m Linda tllne 'MEETING OPEN TO MILITARY ONLY Apn7 lB. 1995 David Green Community Center 30 Northside Ddve Americus. Georgia 3 f 709 1000 a.m 2:00 pm Michelle Sealy April 19. 1995 EU.viJle Primary Medicine Center EUavHle, Georpia 31B06 2:00 p.m. - 5:00 p.m. Hekn Schaefer AprH 20, 1995 Wilson Rental OffICe 3101 9th Avenue Columbus, Georgia 31904 9:00 a.m. - 1:00 p.m. Shirley Hood Apri/20. 1995 Peabody Nutrition Center 1100 27th Street Columbus, Georgia 31904 2:30 p.m. - 5:00 p.m. Z. Tate Valdosta B-1 April 17, 1995 Hvdson DockeN Community Center B07 S. Fry Street Valdosta. Georgia 31601 9:00 a.m. - 11:00 a.m. Janet McClure April 17, 1995 FitzgeraldlBen Hill County LitJrary 123 N. Main Street Fitzgerald, Georgia 31750 9:00 a.m. - 11:00 a.m. Janet McClure Albany B-2 Apr. 13, 1995 H.r,mbee Head Start Center 622 Tift Avenue Albany Georpia 31701 9:00 a.m. 11:00 8.m. Head Start P~rents Only 2:00 p.m. 5:00 p.m. N_(halie De/annoy Apn7 17,1995 Marine Corps Logistics Base Yv1C Clinic 1701 Geotgia Avenue Albany. Georgia 31705 3:00 p.m. - 6:00 p.m VirginiiJ JordanILinda Moore April lB. 1995 Southwest Georg;'a RC9ional Public Lib(~ry 30 f South Monroe Stre~t Beinbridge,Goorgie 31717 2:30 p.m. 6:00 p.m. Shelia \o'Vhite April lB. 1995 Moultrie. Colquflt County Library 204 5th Street, N.E. Moult(~. Georgia 31768 2:00 p.m. - 6:00 p.m. Joy Zacharia Savannah 9-1 Apn7 19. 1995 Housing Authority of S. "'dnn. h Cayton - Fr.ne, Homes 624 W. Gwinneff SfTeel Sav.nnah, GeO ~nc Semple Studies. Change" have been ~de to the random cozent sample fo~ and/or inctructiOCA for eacb quarter of the ctate fiscal year in response to the DeJ./FSlJDHR arrc-ement and a" needed to capture tice study data for reviced or nev program. Changes contained in each eeendmenC are summarized belov. ADend.-ent 91-11 Salary cupplements paid to councy Depart:menc of Feeily and Children Services yorkers (preViously direcc charged to county fund .ouTees) vere allo~teelJ)OS 1868,2"7 ",101274 1311,050 '.72,"35 I57IlO3 1&2,302 "38.075 I"O.(J)Sl SUI.l. 41,16$)042 152,125 13It,07. 1127.'" "~'0"'7 1'50...... "..~ $68"42 .,,.e.,,. n.. 177 U~2,'21 11$0,.$32 ".2'08.,.ua "03,420 '652.123 1134,~3 ',.130tlO2 Ul,2n &al.... S21,"" S6al,322 1702,4.503 Im.m 114,1l75 S364,1. . . ,013 I..... l32n ",$45 12.... "PU t2,5S' $2,128 "P24 IJ}'" ..",7 1..cP2' 1217 121t IlllU 17".704 11 ... 130.137 0.... ~P37 1I~4,T74 IS..... 1107.7U a:l~t3 a:no~ 134112 12,335,302 12t]1I '1,157.134 124.,U4 1',4.72,s&4 C2",a7.. I2MO~7 '11,43'" PO.,I'" ...,,, " ' 0 ' ' ' ' 11t,42t I W ",150 11.lIt,soe ".131 12t2,G3t "1$ "13,0$1 121'" 1121.0 $31231 WPIt 122.... 121'" '.37.108 .'3,12t n.un '21,4.31 150'112 ,,5,1.w '''''' .~t'"',3. IIUtZ "',115 "'27t """ 112'17 111;213 17~7 I38Pto "0,1"" 1"~22 12~3 t3pn 1'.,oGO 1,101 "",.400C 1..".',5.7 1221'3 I"~" '"$.' "."as 117'" 135'" 1232" 13"'1 to 10 1171,t24 47t,tOO 1457.m 112 . . $2 11"' 13UP23 1-C1o.m 1187,230S 1'271,142 0424,28_ ,'M,lD, 113,113 12SI.... Uca.oe7 N7~24 1132,3Of "",171 tm.n. 1187.Xle 1101.~3 It)O.1:n 1l22t..... . . . ~O, l32~tZ 1:21.117 lun . .13270P52 "."0.0.''.','.' 12,0,152 17,11',703 " "...toe 18.1GI)21 ... penn4 le~8ptJS SJn.c,.l:n "~7~ 13"".200 13 7.... I .... "P03~ 1$75,300 1715.52'1 "t5,2t4 1320.~ 1750,G3I S7tO,lto 17N,m 1472,000 S1~,141 -1564,20:) 1tJI.>ol 1522,102 1>t3.... 1121,787 1108.801 1m".. ....,3", i.ns.27S IU1.053 ':308,211 $.323.11a Ji2.t,710 1113,724 1300,1l711 12)1,133 I-3oCl,m S2u.ue &"','73 UJD7!l I44JI1 lOT,AL 11".',121 I\.NNNO TSl1,8e,.,?! S27.17t,104 "".'1'10430 "'''.'21 III~tSP" ..7... 1433."5130'''''' .......1 "'5.'" ....131 1SOO,o10 ""22 t3"'0~ 12,.21" ,"P"~ I12pn,." <1 ....".,,, ,co."",.. lco.nm "'."'51 ... "'.1II233 11225224 ....41~ ...,7t.124 113,071.134 113.10l1~ I"~",m '''P''~ ,o2l~ "0lI.12O~ "GO.n ... STATE WIC PLAN -~QQ 116 STATE WIC OFFICE Attachment P (cont'd) 02/0(/9( FEDERAL FISCAL YEAR lW4 FOOD ALLOCATION BASED ON TIiE PRfORllY SYSTEM ALTERNATlVE TO PAl ORllY SYSTEM BASED ON ClJ1RENT SYSTEM PROJECTlONS DISTRICT ROME (41) FFY94 FOOD ALLOCATlON PROPOSED OPT 1 $5,223,775 (42) CURRENT FFYQ3 FOOD GRANT (43) DIFFERENCE 94 NEEDED VS93 GRANT $(,864,122 5359,653 (44) REOD BASED ON STRAIGHT UNE PROJECTlON SYSTEM REPORT 55,399,719 (45) (46) COLUMN 44 GAIN OR LOSS PRORATED FROM THIS REPORT TO GIVE FUNDS NEEDED OUT ALL BUT $5:)0,000 (45) - (41) OPT 2 $5,341,771 $123,996 DALTON 53,167.730 52,887,8U 5299,918 53,184,133 53,153,500 (514,230) GAINESV1LLE 5(,3'0,529 5(,028,949 5281,580 54.235,958 5(.195,204 (5115.325) MARIETTA 53,419,(68 $3,027,724 5391.744 $3.687.186 53,851,713 $232,245 ATLANTA $9,728.078 $9,098,502 $829,576 $9,523,817 $9,431,994 ($294,084) FOREST PARK $2.710,494 $2,322,034 $386,480 $2,748,253 $2,721,813 $11,319 LAWRENCEVlllE $3,505.349 $3.308.868 $196,461 $3,577,937 $3,543,515 $38,186 DECATUR 56,931.895 $6.162.480 5769,415 58,658,082 $8.792,103 ($139.792) LAGRANGE $5,684,7 U 55,156,08( 5520.630 $5,727,942 55.872,836 (511,676) DUBLIN MACON AUGUSTA COLUMBUS 52,52I,(0( 57,(28,922 $1.117,29'" 56,726,058 52.312.410 56.929.75( S8,(91.230 S6.60 1,551 $206,93( $(99,168 5626.06( 512(,501 $2,548,183 $1,341,396 $7,126.102 $7.0:11.1118 $2.524,262 51,210,768 51,060,120 SII,1I63,552 $2.658 (5156.154) (551,174) $237,494 VALDOSTA $4.256,998 54.018,260 $236,729 ~Ml $4,296,659 $41,661 AJ.,BANY $6,666.681 $6,430,073 $438,606 $6,706,462 $6,641,942 ($228,730) SAVANNAH $3,913,267 $3,631,520 5"1,747 $4,193,427 $4.153,084 $179.617 WAYCROSS 56,989.226 56,825,725 $183,501 $7,156,944 $7,088,090 $98,664 BRUNSWICK $3,596,026 $3,472,597 $123,429 $3,802,251 $3,785,871 $189,845 ATHENS $3,117,361 $3,311,001 $406.360 $3,449,596 $3,418,409 ($300,958) SOUTHSIDE GRADY SI,052,624 $987,707 S2,048,745 $1,978,403 $64,917 , $70,342 $1,039,452 $1,928.038 $1,029,452 $1,909,489 ($23,172) (SI39,258) PAGE 4 (4n COLUMN ~l PRORATED TO GIVE OUT All BUT $SOO,OOO OPT 3 55,178,553 53, UO,307 5 "273.213 53,389.888 $9.841,880 $2,667,030 $3.475,004 58,871,886 55,635,501 $2.(09,516 51,36(.610 57,055,660 $6.667,631 $4,220,146 $6,609,219 $3,936,811 $6,928,721 $3,584,895 $3,885,188 $1,043,512 $2,031.009 TOTAL S100.976.6(6 594,02(,683 PROJECTED AVAILABLE - - > 100,110,000 OVERSPEND - - > (5866,6(6) 56,951,763 $101,609.(68 5100.631,946 ($344.698) 5100,102,(98 STATE WIC PLAN -lQQ 117 STATE WIC OFFICE Attachment P (cont'd) FEDERAL FISCAL YEAR , _ FOOOAU0CA70<' BASED ON THE PAIQRI1Y SYSTE'" EXf'V,NATo:JN 0" COUJMNS COlUMN 1 = TOT-'l AVERAGE PARTClPANTS FORQOSEONO NOVEM&R!13 PlLS POTENTIAl POST PARTUM. Sw 0" CQlLJ'NS 2 THRU 15 + CQlWN 17 (poTENT"!. POSTPARTUM) .J>JBl.. co..UMN <6 = COLUMN <5 COMPARED TO COlUMN <1 (51-2571 (912) 356- 2868 (912) 651- 2670 (912) 285-6031 (912) 287- 6521 (912) 285-6110 (912) 264- 3907 (912) 262-2315 (912) 264- 3961 (706) 542-9547 (706) 548- 5181 (706) 542- 9531 (404) 688-1350 (404) 688-2962 ext 244 (404) 616- 4932 (404) 616-5759 Systems (404) 657-2926 (404) 657-2910 Support (404) 657-2925 Viking Inc. 800-882-8411 (913) 888- 3824 800-899-7913 (317) 889- 9485 ADDRESS East Central Health District - WIC 1916 North Leg Road Augusta, GA 30909 West Central Health District - WIC P.O. Box 2299 2100 Comer Ave. Columbus, GA 31902 South Health District - WIC 312 North Patterson Steet Valdosta. GA 31603 Southwest Health District - WIC 1109 North Jakson Street A,Ibanv. GA 31708 East Health District - WIC 1602 Drayton Street Savannah, GA 31401 Southeast Health District - WIC 1115-B Church Street Waycross, GA 31501 Coastal Health District - WIC 1609 Newcastle Street Brunswick, GA 31521 Northeast Health District - WIC 468 North Milledge Avenue #101-B Athens, GA 30601 Southside Healthcare, Inc. - WIC 1039 Ridge Avenue Southwest Atlanta, GA 30315 Grady Memorial Hospital M & I Project/WIC Program P.O. Box 26011 80 Butler Street S.E. Room 1513E Atlanta, Ga 30335 Georgia WIC Program 2 Peachtree Street Suite 300 Atlanta, GA 30303 Viking Computing Inc. 13540 West 95th Street Lenexa. KS 66215 STATE WIC PLAN -IQQ 120 STATE WIC OFFICE ESTIMATED WIC POPULATION OF GEORGIA 30S,0.56 STATE WIC PLAN -lQQ 121 STATE WIC OFFICE GEORGIA WIC PROGRAM ESTIMATED PAPULATION OF PERSONS IN GEORGIA INCOME ELIGIBLE FOR WIC BY WIC DISTRICT BASED ON USDA ESTIMATES NON-BREAST BREAST TOTAL DIU PRENATAL FEEDING FEEDING WOMEN INFANTS CHILDREN ROME (1-1) 1,910 543 986 3,439 2,700 11,663 DALTON (1-2) 969 239 525 1,733 1,353 5,964 GAINESVILLE (2-0) 1,456 400 760 2,616 2,052 8,908 COBB (3-1) 1,164 356 583 2,104 1,657 7,076 FULTON (3-2)* 3,798 1,965 1,358 7,121 5,780 22,060 CLAYTON (3-3) 573 203 268 1,044 828 3,444 GWINNETT (3-4) 888 272 446 1,606 1,265 5,400 DEKALB (3-5) 1,758 813 695 3,266 2,631 10,337 LAGRANGE (4-0) 2,182 833 981 3,996 3,183 13,051 DUBLIN (5-1) 803 339 339 1,481 1,187 4,766 MACON (5-2) 2,443 1,141 957 4,541 3,660 14,346 AUGUSTA (6-0) 2,451 1,127 973 4,551 3,665 14,416 COLUMBUS (7-0) 2,356 1,127 904 4,387 3,542 . 13,799 VALDOSTA (8-1) 1,519 631 649 2,799 2,240 9,023 ALBANY (8-2) 2,659 1,252 1,035 4,946 3,990 15,605 SAVANNAH (9-1) 1,374 641 538 2,553 2,059 8,068 WAYCROSS (9-2) 2,245 821 1,034 4,100 3,258 13,476 BRUNSWICK (9-3) 903 373 387 1,663 1,331 5,364 ATHENS (10-0) 1,826 635 863 3,324 2,636 11,003 TOTAL 33,280 13,711 14,280 61,270 49,016 197,770 C\123R34\FILEOO21.WK3 TOTAL 17,801 9,051 13,577 10,837 34,962 5,316 8,270 16,234 20,230 7,434 22,546 22,632 21,728 14,062 24,541 12,681 20,834 8,357 16,963 308,056 STATE \VIC PLAN - i 122 STATE WIC OFFICE DISTRICT OBJECTIVES FFY'96 STATE \VIC PLAN- 123 STATE WIC OFFICE FEDERAL FISCAL YEAR 1996 DISTRICT I UNIT I LOCAL AGENCY WIC PROGRAM PLAN DISTRICT I, UNIT 1 FFY '96 PROGRAM PLAN Programmatic Administration Objective I - Prenatal Entrance By September 1996 increase the number of prenatal patients certified for WIC in the first trimester from 57.8% (third quarter '95) to 60%. Activities: Every prenatal patient with a positive pregnancy test pcrfomled by the health department in any of our clinics either receives WIC certification that day or is provided with an appointment for certification within the time frame for prenatals. Prenatal patients are enrolled in the PCM program simultaneously. PCM and WIC establish pattern of follow-up visits in accordance with voucher pickup schedule. Evaluation: Percent of prenatals certified in first trimester exceeds prior year.. Objective 2 - Immuni.iation By September 1996 increase the number of children on WIC in ages 23 to 24 months who are adequately immunized from 77% to 90%. Activities: WIC Coordinator is serving on lAP committee for the district. Immunization records are screened on each visit to the health department regardless of program accessed. Immunizations are available to customers during any programmatic access 5 days per week. Universal patient information systems identifY immunization needs for children. Distribution of immunization posters to supermarkets and other places where people congregate such as churches, civic clubs, DFACS, hospitals, and senior citizens centers. Evaluation: Percent of children ages 23 to 24 months who are adequately immunized. Objective - Nonparticipation By September 1996 the district nonparticipation will be at or below 10%. Activities: Continue current efforts in place for nonparticipating customers such as postcards and phone calls. Continue and increase access to vouchers through extended clinic hours, school health programs and the Floyd County mobile unit. Target Pre-K programs with information about WIC. 2 Food Instrument Accountability Objective Follow procedures manual. There is no room for any creativity or innovation within standard mandates. Vendor Management Objective Follow procedures manual. No room for creativity or innovation under current funds available to districts. System Information Management Objective Follow ARMIS datawhenever available. Maintain 2.5% or lower critical error rate. Reduce nonparticipation rate to below 10%. Activities: Target prenatals and infants for voucher pick-up/ollow-up by phone calls and sending postcards. Pursue changes in prorating voucher procedures from seven to fourteen days to encourage worth of late voucher pickup due to reasons beyond customers' personal control. Financial Management Objective Follow procedures manual. There is no room for creativity or innovations of any kind. Quality Improvement Objective Follow procedures manual. All spelled out. 3 Program Intervention Spelled out in administrative interventions. Objective As above. Additional Activities: Three monthly satellite clinics in Bartow, Gordon, Haralson Counties, plus Floyd County Mobile Unit covering 12 sites per month. Provision to People Who Work or Live in Rural Areas We serve them through satellite clinics, extended hour clinics, and the Mobile Unit in Floyd County in all areas who need the service. A time study is scheduled for June 1995. A local audit will b~ performed in each locality by September 30,1995. This whole thing is a redundant requirement. Most WIC programs in this state are components of or are integrated into the general public health programs within this state's public health system. Work performance of staff applies to all public health programs. WIC is no longer the island in Georgia that it may be in some other states. FEDERAL FISCAL YEAR 1996 DISTRICT 1 UNIT 2 LOCAL AGENCY WIC PROGRAM PLAN NO PLAN SUBMITTED FEDERAL FISCAL YEAR 1996 DISTRICT 2 UNIT 0 LOCAL AGENCY WIC PROGRAM PLAN District 2 FFY '96 Program Plan OBJECTIVE: To abide and comply with the Georgia DHR Administrative Policy and Procedures and DHR Grants-to-Counties Policies for administration offunds and to further abide and comply with USDA program regulations and State policies and procedures as outlined in the State Plan of Operation. The District WIC Coordinator, with the assistance of the District Clinical Coordinator, Deputy Director, Health Director, and other supervisors as needed, will adhere to the policies as outlined in the Georgia WIC Procedures Manual regarding the (ollowing areas: PROGRAMMATIC ADMINISTR A,TION: Two issues will be addressed in this area: I. Immunizations According to the review of inununization status conducted by the State Immunization Prograrn,on 8/1 1/94 the WIC OKAY status improved from 88.2 I% to 90.52% in one year. OBJECTIVE: By Sept. 1996 increase WIC OKAY to 95%. ACTION: Each WIC clerk will check inununization status of all children under two years old at the time of scheduling next WIC appointment. If the child is due to be immunized, the clerk will write in red on the appointment card a reminder for the caretaker to bring the child to be brought in at the WIC appointment for that purpose. At the time of the appointment, the child will first be routed to a nurse to get the immunization, then given WIC. When WIC LPN's are assessing clients and at secondary nutrition education appointment, immunizations are given if the child is due an immunization, instead of routing the child to the immunization clinic. EV ALUA TlON: Immunization status review. 2. First Trimester Enrollment: By Sept. 1996 increase percent of 1st. trimester enrollment from 60.59 to 65%. Action: The District WIC Coordinator will appoint a committee of six, which includes WIC nutritionist and WIC LPN's, to develop strategies for the district to follow in accomplishing the objective.. Evaluation: Georgia WIC Trimester Analysis Report. FOO D TNSIRUMEl'ITACCDUNT.AB1LIIY: By Sept. 1996 100% of WIC clinics will be in compliance with the Georgia WIC Procedures Manual regarding voucher security. Action: The District WIC Coordinator, or designated authority, will monitor one-two clinics a month to assure security measures. . Evaluation: Results of monitoring visit. .'lLlillDOR MANAGEMENT: By Sept. 1996, 100% ofWIC Vendors in the district will have a monitoring visit. Action: The WIC Vendor Coordinator and/or District WlC Coordinator will visit one-two stores a month to monitor compliance, according to specifications written by the State WIC Office. SYSTEM INEORMATION MANAGEMEl'IT: By Sept. 1996 100% of local WIC clinics will be have automatic TAD transmission. Action: District ADP Coordinator will work with each clinic site to accomplish this task. Evaluation: Number of clinics automated. 2 FfNANCIAI MANAGEMENT.: The District financial department will continue to comply with all regulations as outline in the Georgia WIC Procedures Manual. Action: The District WIC Coordinator will review budget reports with the District administrater quarterly within the year to assess any questionable issues. Evaluation: Number of report reviews. Results of State monitoring visits. QUAI lTV IMPROYEMENT- The District will comply with WIC Program regulations throughout the year. Action: The District WIC Coordinator, or a designated authority, will monitor one-two WIC clinics a month to assure compliance. Evaluation: Results of monitoring visits. PROGR AM fNTERVENTION' The District will make program interventions as necessary to correct non-compliance. Action: The District WIC Coordinator will follow procedures as outlined by the State WIC Office and will consult with other department heads or District Health Director when needed in order to assume compliance. Evaluation: Resolution of non-compliance. 3 FEDERAL FISCAL YEAR 1996 DISTRICT3 'UNIT 1 LOCAL AGENCY WIC PROGRAM PLAN District 3, Unit 1 FF'96 PROORAM PLAN Introduct ion District 3. Unit 1 Women,Infants and-Children's Program objective is to provide iow income maternal and child health clients with an easily accessible means to determine their current health status and to provide them with food and nutrition counselling to improve such status using a self-help approach. The WIC Program will be offered at whatever point of entry these clients access the health care system and will be referred to other appropriate health and social services as warranted. In FF'95 the Cobb/Douglas WIC Program continued to do vigorous outreach to areas with a high percentage of low income residents such as the Fort Hill/Roosevelt Circle area in Marietta. Permission was grantwed to set up a comprehensive WIC clinic in the largest hospital in our Distirct - Kennestone Hospital. We were given private office space on the maternal floor of the hospital and the room wired for telephone and computer hookup. We are now on line with our District computer system and are certifying clients and giving food vouchers from that office. We continue to offer evevning clinics at two sites in our District affording much needed access to our working -moms and those clients who for one reason or another have limited daytime access to our clinics. The following is a narrative summary of program objectives and accomplishments for FFY' 95 and objectives and interventions to improve and/or expand WIC operation and administration for FFY'96. Object ive 1 PRCGRAMMATIC AalINISTRATlON 1. Local Agency Reviews By '~September 30, 1995 seven (7) Program Reviews will be performed. As of this writing, two reviews have been completed. The remaining 5 revie~s'will be completed by September 30, 1995. 2. Coordination of WIC Services with the immunization Program In FFY'94, 91% of WIC enrolled children completed the Prim~ry series of shots by the age of two (2). The immunization status of WIC children are actively assessed at certification/recertification and voucher pickups. Acworth clinic had the lowest immunization rate of 71%. 3. Expansion of Hospital Based WIC Services Sites During FFY'94 a WIC clinic was fully implemented on the maternal floor at the Kennestone Hospital. Computerized issuance of vouchers has been a distinct advantage for staff and clients. Ob jec t i ve 2 SYSTEMS INFORMATION MANAGEMENT 1. Automated Turnaround and Voucher System Operation During FFY'94, the Mitchell McCormick Company upgraded the WIC computing operation to enable us to transmit turnaround documents and vouchers to the Viking computing company via modem. This has expedited our transmission of client data to the masterfi1e and decreased our error rate considerably. FFY'96 Program Objectives Objective 1 (Programmatic Administration) By September '96, District WIC staff will give training and technical assistance to all staff who perform WIC duties at Cobb/Douglas WIC clinic sites. Evaluation Design: Training and technical assistance on WIC procedures to all 7 WIC clinic sites will be conducted by September 30, 1996. Action Steps Activities/Methods Resources Milestones 1. Set dates and prepare for clinic reviews. SWO.OJN WIC Coord. Health Dir. 10/95 2. Complete clinic reviews SWO.OJN 1/96 3. Analyze reviews for corrective actions/recommendations WIC Coord. Nursing supvs. Nutritionists 2/96 4. Provide and evaluate District WIC staff 4/96 training/technical assistance to clinic staff Objective 2 (Food Instrument Accountability) By September 30, 1996, compile and utilize a training manual for all staff who issue WIC vouchers. Evaluation Ilesign: Completion and utilisation of a training manual for all staff who issue WIC vouchers .. Action Steps Activities/Methods Resources Mi les tones 1.0btain and review '96 WIC Procedures Manual (Food Ilelivery Section) SWO WIC Coord. WIC Clerk Nursing Supv. 11/95 2. Write District specific manual WIC Coord. 12/95 3. Pilot draft of manual at Nursing Supv. two clinic sites WIC Coord. 1/96 4. Revise and print manual WIC Coord. 2/96 5. Distribute to all WIC clinic sites District WIC secty. 3/96 6. Train all WIC clerical staff and evaluate training Nutritionists WIC clerks 4/96 Objective 3 rovide opoorlllnities for NutritionlWIC staff to participate in at least two workshoos and/or othei continuing education opportunities. MEASURE: Each emplqyee wjn be scheduled to participate in at least two WQr!csbt,. wit" {)ffiN> .<:t:>f( November, 1995 -- -- - -- OBJECI1VE: Provide ongoing special outreach efforts jn rural areas of Fulton County. MEASURE: By July. '996 establish a list of agencies. community organizatiOfls and agencies that wrll assist with WIC outreach efforts in the Palmetto. Fairburn and Alpharetta communities. IlElE - - - - - - - - - - - - - - - - - - - - - - - - - -~ - - -~ - -r - - -~ - - -~ - - -~ - - - l. Identify agencies, community based organizations, churcbes, grocery Nutrition Sernces Manager stores, doctors offices, clinics in rural Fulton Coonty communities Fairburn, North Fulton Health Center Stlff October, 1995 2. Prepare list of organizations with contact person(s). Nurse SupeJVisors WIC Stlff Outreach Stlff December, 1995 .... ..... 3. Prepare mailing lists for outreach efforts in P3lmetlo, Fairburn and Physical Health AssistmIs March. 1996 _ _ _ '0 _ _ _ _ _ _- - - - - - - _ . ---- f--.------- - 4. Conduct one Community meeting each year in these communities. Program Manager FaiIburn and North Fulton Stlff June, 1996 OBJECI'IVE: Peveto!) a pamphlet which details food assistant. social and beaJtbprouams for wbicb WIe [Wticipanls in district 3n may be eligible. MEASURE: By Much J996 !fle fina! drnft of t1Je pamOOlet wjll be ayaj)ab!e for review by !fJe Stile WIe Office and district mff..... ------------------------------------------- ~~ili~t=1~~~JiirB[J1II~ 1. Update draftofRderral Pamphlet. .. Nutrition ScMces Manager Physical Hea.Ith Assistant ill Navembc:r, 1995 2. Send to Prognms for review and com:ctiOllS. HeaJth Departma!t December, 1995 3. F'maJize PampbIct ". Send pamphJel to printing. Nutrloon ~ Man2gec PhysiCal Hea.Ith Assistants January, 1996 FebnI3Iy. 1996 ~le pampIileHo lieaIih cenm. -- PilYiicifHeah1i ASSistui~r-- March, 1996- FEDERAL FISCAL YEAR 1996 DISTRICT 3 UNIT 3 LOCAL AGENCY WIC PROGRAM PLAN HEALTH DEPARTMENT-SERVICES Clayton County Health District I I JONESBORO Forest Park Healtb Department 685 Forest P:trkway Forest P"lrk. GA 30050 366.6230 . . 1lllnClibllro lIe"lIb 1)ellartment I -lar.I 1I'''ltb Department 13~ Sl'nn~ Street 6-139'I"m BII'd.. Suite 17 J\1ll~~htlnl. CjA ~~{):!..~h I. \1 It'nl"'(lc! Shopping C("/It(I} ~71-X635.. JuneshnOl. GA 30236 . 473-60~-1 . PRIMARY SERVICES FOR CIllLDREN AND ADULTS Eye. Ear. Dental Exam for School Entrnnce Head Lice and Scabies Treatment Scoliosis Scr~g Health Check-ups Immunizations W1C Supplemental Food Program Nutrition Education and Counseling Employment Physical Exams Premarital Blood Testing (Jonesboro Hw1Jh Department Om)') Family PlanninglBirth Control Infertility Assessment Pre-conceptual Health Appraisal PregnancY Testing. Presumptive . Eligibility. and Prenatal Services (TaraITara Annex) Breast and Cervical Cancer Screening (Mammogram) Hormone Replacement Therapy Hypertension Screening Flu and Pneumonia Vaccine Infectious Diseases Treatment and Surveillance Sexually Transmitted Disease Treatment. HIV Counseling and Testing, Tuberculosis Screening and Treatment, Hepatitis B Vaccine ENVIRONMENTAL HEALTH 4886 Riverdale Road College Park, GA 30337 996-1794 Restaurant Inspections Sewage Disposal Personal Care Homes InsectJRodent Control SERVICES School Inspections Ambulance Services Inspections Public Swimming Pools HoteVMotel Inspections Well Water Analysis Handicapped Accessibility Administrative Office HOURS: M-W-F 8:30 to 5; Th-Th 7:30 to 6. No person shall, on the hasis o( race. color or national origin. be excluded (rom participation in. he denied the henefits of. 675 Forest Parkway or othetWise he subjected to discrimination under any program or activity conducted Forest Park. GA30050 or supported by the Clayton County Health Department. Fees (or most serviccs arc determined by a sliding fee scale hased on family income. No onc is denied serviCl'S (1) J~J-6780 LOCAL WIC AGENCY District3. Unit 3 CLAYTON C. W. Sargent, M.D. Paula Sherrer Kathy ThomasJoyce Howard- District Health Officer District Program Manager District WIC Coordinator District WIC VENDOR Coordinator CLAYTON COUNTY HEEALTH DISTRICT 675 Forest Parkway Forest Park, GA 30050 (404) 363-6780 - Phone Number (404) 366-2271 - Fax Number Local Sites Local Site Number Forest Park Health Department 685 Forest Parkway Forest Park, GA 30050 (404) 366-6231 - Phone Number (404) 366-8735 - Fax Number (311) Jonesboro Health Department 134 Spring Street Jonesboro, GA 30236 (404) 471-8636 - Phone Number (404) 478-3232 - Fax Number (312) Tara Health Department 6439 Tara Boulevard Suite 17 Jonesboro, GA 30236 (404) 473-6034 - Phone Number (404) 603-1503 - Fax Number (314) CLAYTON COUNTY HEALTH DISTRICT LOCAL WIC PLAN- FFY 1996 (2) INTRODUCTION AND GOAL Clayton County Health District (District 3, Unit 3) provides comprehensive health care to all Clayton County citizens requesting services provided at each health department site. Services are provided in an integrated manner (One Shop/Stop Health Care) so that the health care needs of the patient are addressed upon request at any clinic visit or referred to an available resource for resolution. Clayton County Health District's goal is to prevent illness and to encourage wellness through healthy life styles to as many ~f the Clayton County residents as pbssible, The health services .are provided in an environment which fosters personal dignity and promotes optimal attainment of individual ability. Clayton County health District's WIC Program will be innovative and expand the implementation of initiatives to increase WIC certification of prenatal participants during the first trimester of pregnancy; collaborate with the immunization program for the purpose of increasing the number and percentage of WIC participants under age 2 who are fully immunized; decrease the number/percentage of subsequent WIC teenage pregnancies and provide nutrition education to all WIC participants by no less than two contacts during each WIC certification period. CLAYTON COUNTY HEALTH DISTRICT LOCAL WIC PLAN-FFY 1996 (3) PERTINENT FACTS: Clayton County Health District's WIC Program is serving over 95% of the potentially eligible WIC population in ClaytonCounLy as identified by the State WIC Office. Clayton County WIC Program is serving over 7,500 WIC participants at 3 sites as of April 1995. Cumulatively, from October 1994 through April 1995, more than 144,000 vouchers earning over 1.8 million dollars were redeemed by the 30 approved WIC Vendors in Clayton County. Approximately $260,000.00 in cashed vouchers are received by Clayton County's WIC Vendors (local grocery stores and pharmacies) each month. Clayton County's WIC Program, final unreconciled voucher report indicates cumulatively that Clayton County's unreconciliation rate is 0.06% and the State's unreconciliation rate is 0.17%. Clayton County Health District initiated the first outreach project to provide nutrition education by a WIC Nutritionist to Food Stamp recipients at the Food Stamp Office in Clayton County. Clayton County Health District's WIC Program has been selected to participate in the WIC Nutrition Education Demonstration Study, funded by Food and Consumer Service of the united States Department of Agriculture. Clayton County Health District has been selected to receive a grant from the National Cancer Institute to research and a~sist African Americans in adopting eating patterns consistent with the National Cancer Institute's Dietary Guidelines. CLAYTON COUNTY HEALTH DISTRICT LOCAL WIC PLAN-FFY 1996 (4) , :DSASSESSMENT: In 1993, Georgia ranked 58th in infant mortality, tying with Mississippi for 49th place among the 50 states. Prenatal care significantly reduces the likelihood of infant mortality and morbidity and the costs associated with poor pregnancy outcomes. *Overall life and custodial care of one handicapped child runs $300,000.00 - $1,000,000.00 _ *ICU Limited care of 1 premature infant costs $20,000-$100,000.00 OBJECTIVE: By December 1995 increase the percentage of prenatal WIC participants certified in the first trimester from 43% to 54%. EVALUATION DESIGN: By September 30, 1996 the percentage of prenatal WIC participants certified on the WIC program by the first trimester of pregnancy will be increased by 21%. ACTION STEP ~;ACTIVITIES/METHODS RESOURCES 1 Each woman with a .positive pregnancy test will be enrolled in the WIC program and the Right From The Start Medicaid Program. 2. If the woman cannot stay for WIC certification, she will be given an appointment to return before the end of her first trimester. 3. Follow up will be provided on an ongoing hasis to those individuals not enrolled at the pregnancy test visit. 4. Referrals from private physicians will . be hand led with exped i ency with ina minimum period of time (24 hours from contact) Clinic Staff Clinic Staff Clinic Staff Clinic Staff MILESTONE OF ACTIVITIES Present-Sept. 1996 Present-Sept. 1996 Present-Sept. 1996 Present-Sept. 1996 CLAYTON COUN1Y HEALTH DISTRICT (5) LOCAL WIC PLAN-FFY 1996 NEEDS ASSESSMENT: During 1994 only 89.4% of children less than 2 years of age had been adequately immunized in Clayton County Health District. OBJECTIVE: By January 1996, no less than 95% of those WIC participants who -are less than 2 years old will be adequately immunized. EVALUATION DESIGN: Clayton County WIC Program's rate of children less than 24 months of age enrolled on WIC, will be no less than 95% for immunization adequacy. I IACTION STEPS/ACTIVITIES/METHODS i 1. Each time WIC servi-Ces are requested at each clinic visit, staff will maintain immunization adequacy on all I children less than 2 years of age. Proper documentation will also be found in the medical records. 2. Those children needing immunizations will be given the shot at the time of the clinic visit and medical record will be updated to indicate most current immunization given. RESOURCES Clinic Staff Clinic Staff MILESTONE_ OF ACTIVITIES January 1996 Janaury 1996 CLAYTON COUNTY HEALTH DISTRICT LOCALWIC PLAN-FFY 1996 ~. -os ASSESSMENT: Contract formula provides revenues to allow an increase in the number of participants on the WIC Program. Only 83% of of Clayton County's WIC Program infants were on the contract formula. OBJECTIVE: By October 1995, there will be an increase from 83% to 94% in Contract Formula Compliance at all clinic sites. EVALUATION DESIGN: As of September 1996, Clayton County's WIC Program will have a monthly average of 93-95% compliance rate for Contract Formula. ACTION STEPS/ACTIVITIES/METHODS RESOURCES MILESTONE OF ACTIVITIES 1. Unless a prescription has been received from the'private doctor, all babies receiving formula will be assigned Food packages consisting only of the contract formula Certified Professional Authority 2. Documentation of prescription will Certified be in patient's health record Professional indicating name of formula and reason Authority for formula from private doctor. 3. End of Month Reports will reflect monthly rate of compliance. WIC Coordinator Ongoing Ongoing Ongoing CLAYTON COUNTY HEALTH DISTRICT LOCAL WIC PLAN-FFY 1996 (7) NEEDS ASSESSMENT: Only 82% of Clayton County's WIC Program total caseload are partipants in Priority I through III. This represents those participants with the highest medical need. The State average is 86%. OBJECTIVE: By September 1996, at least 90% of Clayton County's Program Participants will be in Priorities I, II, and III resulting in targeting of WIC benefits to those who are of highest risk. EVALUATION DESIGN: End of month reports from State WIC office and ARMIS System will reflect increase rather than decrease of Priorities I through II 1. ACTION STEPS/ACTIVITIES/METHODS 1. Assess those clinics who "are below 90%. 2. Monitor and provide technical assistance to maintain compliance. 3. Develop strategies to maintain participation for high risk clients. 4. Provide private physicians and Hospital in Clayton County referral form for potentially eligible participants. RESOURCES MILESTONE OF ACTNITIES CHnic Staff Ongoing Clinic Staff Ongoing WIC Coordinator and District Staf Ongoing Clinic Staff WIC Coordinator Ongoing CLAYTON COUNTY HEALTH DISTRICT LOCAL WIC PLAN - FFY 1996 (8) ~ JS ASSESSMENT: During FFY-95, requests for special formula increased over the past years needs. Non-contract special formula requests from private physicians have increased for our WIC participants. OBJECTIVE: To solicit more Pharmacies in Clayton County to accept WIC vouchers for Redemption. Competition of more pharmacies being approved as WIC Vendors will be greater. EVALUATION DESIGN: More vendors will be available for greater access to WIC clients. Along with availability this will support cost containment of WIC Program funding. ACTION STEPS/ACTIVITIES/METHODS Visit local pharmgcies and explain WIC program benefits as applicable to being a WIC Vendor 2. Accept applications for WIC Vendor participation 3. Submit application to State WIC offi ce 4. Train new vendors to insure understanding of program regulations and policies RESOURCES MILESTONE OF ACTIVITIES WIC Vendor Coordinator Present-October 1995 WIC Vendor Coordinator Ongoing Ongoing WIC Vendor Coordintaor District WIC Coordinator CLAYTON COUN1Y HEALTH DISTRICT LOCAL WIC PLAN-FFY 1996 (Q, NEEDS ASSESSMENT: There are only 3 sites available in Clayton County providing WIC Services. To reach all who are potentially eligible and to support cost containment of medical care, more sites will be necessary. OBJECTIVE: By September 1996, an additional site or sites will be opened to-serve more potentially eligible WIC participants in Clayton County. EVALUATION DESIGN: By September 30,1996 at least one site will be opened to serve more potentially eligible WIC participants in Clayton County, if not, negotiations will have taken place and a plan established to begin addressing this issue. ACTION STEPS/ACTIVITIES/METHODS -RESOURCES MILESTONE OF ACTIVITIES 1. Request the State wic office to appropriate funds"to pilot a project of a WIC assessment site being located on or near the property of WIC approved Vendors in Clayton County. WIC Coordinator District Staff *Additional Admin funds 2. Compile information on minimal staff, WIC Coordinator equipment and space needed to District Staff service the site. 3. Discuss possibility of on site areas being established at the hospital (Southern Regional) and the Health Maintenance Organizations (HMO) located in Clayton County. WIC Coordinator District Staff *Additional Admin funds January 1996 November 1995 February 1996 CLAYTON COUNTY HEALTH DISTRICT LOCAL WIC PLAN-FFY 1996 (10) FEDERAL FISCAL YEAR 1996 DISTRICT 3 UNIT 4 LOCAL AGENCY WIC PROGRAM PLAN DISTRICT 3, UNIT 4 FFY '96 WIC PROGRAM PLAN PROGRAMMATIC ADMINISTRATION OBJECTIVE: By September 30, 1996 increase the number of WIC prenatals in the first trimester from 49% to 52%. EVALUATION DESIGN: Percent of increase in first trimester emollment exceeds prior year as compared in the Trimester Analysis Report. ACTIVITIES: 1) Continue to certify (for WIC) women with a positive pregnancy test on same day of Health department clinic visit and/or provide WIC appointment within the mandated processing standards. - 2) Continue to ~isseminate WIe referrals to local HMO's and private OB/GYN doctors. OBJECTIVE: By September 30, 1996 conduct local self reviews of five (5) WIC clinic sites to ensure compliance based on state policies, procedures, rules and regulations. EVALUATION DESIGN: Self review monitoring tool will demonstrate compliance based on fmdings. ACTIVITIES: 1) Prepare clinic schedules for self reviews. 2) Conduct reviews. 3) Smnmarize and review fmdings with staff. 4) Provide technical assistance based on fmdings. OBJECTIVE: Non-Participation Rate By September 1996, decrease district's non-participation rate at or below 10%. EVALUATION DESIGN: ARMIS will be used to monitor rate of decrease in non-participation rate. ACTIVITIES: 1) Continue to inform new and recerts of the importance of picking up WIC vouchers. 2) Continue to notify non-participants for missed pickups. 3) Continue extended clinic hours. 4) Continue 2 month voucher issuance. OBJECTIVE: Immunizations Continue the coordination of WIC and immunization services. EVALUATION DESIGN: Review district activities report to compare immunization rate of WIC participants. ACTIVITIES: 1) Assess WIC participants immunization status on each WIC certification and recertification visit. 2) Continue to offer immunizations daily on a walk-in basis. 3) Display information regarding the importance of immunizations in the WIC clinic areas and other conspicuous locations in each health center. 4) CPA will reiilforce importance of immunization to parent/guardian/caretaker of each applicant. OBJECTIVE: Food Instrument Accountability Assure WIC Food Instrument Accountability by following procedures as outlined in the Georgia WIC Procedures Manual. EVALUATION DESIGN: Local self reviews will be used to monitor compliance. ACTIVITIES: 1) Conduct self reviews. 2) Provide technical assistance as needed. VENDOR MANAGEMENT OBJECTIVE: By September 1996, complete 100% of the required vendor monitoring. EVALUATION DESIGN: State WIC Vendor monitoring report determines vendors in need of monitoring. ACTIVITIES: 1) Use state vendor monitoring report to identify vendors who need to be monitored. 2) Establish vendor monitoring schedule. 3) Attend annual statewide vendor training for WIC Vendor Coordinators. 4) Conduct required annual vendor training for current and new vendors. SYSTEMS INFORMATION MANAGEMENT OBJECTIVE: To continue operations with local contractor for certification and voucher production meeting all required specifications of the WIC Program. The last release addressed the need to print priorities on back of Termination! IneligibilitylWaiting List Form. This was effective May 31, 1995. QUALITY IMPROVEMENT OBJECTIVE: Con~inue quality improvement process as outlined in the Georgia WIC Procedures Manual. FEDERAL FISCAL YEAR 1996 DISTRICT 3 UNIT 5 LOCAL AGENCY WIC PROGRAM PLAN District 3 Unit 5 FFY 1996 Program Plan ApMINISTRATION I. Early Enrollment of Prenatal women. Objective: The percentage of women enrolled in the DeKa1b County WIC Program 4uring the first trimester will be at least 60t. Activities: Maintain the three alternative hour certifioation sites the are now established. Increase the number of alternative hour certification sites to a total of 5 by the end of FFY 1996. ,Maintain present distribution of Outreach/Referral pamphlets to all identified Gervice providers for Maternal services to include all HMO's, 0' 'obstetricians and hospitals in the county. Maintain a multi-service walk in clinic in 8 of the county's health centers. Services include pregnancy test, presumptive certification for Medicaid, and enrollment in PCM and WIC. II. Immunization Status. Objective: By September 1996, increase the number of children 23-24 months old that are adequately immunized from 62 to 7S percent. Activities: Beginning August 1, all infants and children through age 24 months will have their immunization status checked each voucher pick up (bimonthly). At the present time, status is routinely checked only at certification and nutritional assessment visits. III. Non Participation Objective: Non participation will be at cr below 10 percent. Activities: continue mail notifioation of missed appointment, inclUding voucher pick up appo1ntment~. Expand alternative hourG for voucher pickup from tour to seVen health centers. Request that the formula for calculation of non participation loa reviewed by the Sat. WIC Offioe. The present formula, vouChers printed and issued divided by the total numb= of vouohers issued ....., causes programs that prorate correctly to be penalized. IOOD lliB'fRJOO?N'J: ACCOJlliTl\lIILITY ObjactivQ: continue complianoe as outline in the Georgia State Procedure Manual Activities .\lllltandardll all outlinQQ in the ProcoCluro Manual will be followed. Objeotive. continue oomplianoe ae outlineCl in the Georgia State Procedure Manual. Activiti'lIl: All standards as outlinad in the Procedure Manual will be followed. XBTEM INlORXArION MANAGEMENT Objective: .' By the end of FEY 1996, thQ DeBR will have a new patient management system to inolude a WIC TAD modUle, WIC certification 5hQQt and an on-site computerized vouchQr production ayatem that will be part of a comprehensive patient manaq.ement system. Activities: Training began in Hay 1995. The WIC certification and VOUCher module will be installed in the fall of 1995. ObjQctive: continue oomplianoe as outlined in the Georgia state Procedure Manual. All #tafidards as outlined in the Prooedure Hanual will be followed. OUALITY IMPROVEMENT Objeotive. continue oompliance as outlined in the Georgia State Procedure Manual. A.ctivitiaCl: All atandarda aa outlined in the Prooedure Manual will he followed. PROGRAM INTERVENTION See Adminiatrat1on, pago 1. Provision or Service, to people yho wort or Live ip Bural ArOAI- Objootivo: Appointed service. and altarnate hour services vill bo availablo to facilitate services to working participants. Activities: see activitiee under early onrollment of prenatal Yomen. certification is also furnished to infante and children during alternate hour clinics. Certification appointments are routinely by appointment. Walk in services are furnished if possible. Voucher issuance servioos are turnished during lunCh hour for working participants. FEDERAL FISCAL YEAR 1996 DISTRICT 4 UNIT 0 LOCAL AGENCY WIC PROGRAM PLAN FFY'96 LOCAL AGENCY PROGRAM PLAN I. Introduction II. Programmatic Administration A. Clinic Monitoring B. Medical Record Review C. Clinic Flow Analysis III. Food Instrument Accountability A. Manu'll Voucher Copies B. Manual Voucher Inventory C. Voucher Security D. Voucher Register Documentation IV. Vendor Management A. Vendor Monitoring B. Vendor Training V. System Information Management A. ATVS - Mitchell & McCormick - Computer Processing B. System Maintenance Indicators VI. Financial Management A. Vacant Position B. District Policy VII. Quality Improvement A. CUR Reporting B. Vendor Abuse C. Participant Abuse VIII. Program Intervention IX. Program Integration A. Coordination of Services X. Provision of Services to Prenatal Participants A. First Trimester Enrollment XI. Working Mothers A. Appointment Scheduling and Accommodation XII. Participants Residing in Rural Areas A. Appointment Scheduling and Accommodation I. INTRODUCTION the It is the goal of District 4 Health Services to provide our clinics with support and training necessary to carry out the guidelines of the Georgia WIC Program. We value our clients and pledge to provide them with the best possible quality customer service. Our ultimate goal is to reach out to all eligible prenatals, breastfeeding women, postpartums, infants and children and to provide them with good nutrition information and the supplemental food necessary for a wellbalanced diet. Following are steps that District 4 will take to insure we provide an efficient, effective and quality program to those communities located in our area. II. . PROGRAMMATIC ADMINISTRATION FFY'95 OBJECTIVE 1 - Clinic Monitoring By September 30. 1995, complete monitoring reviews of 100% of the clinics in District 4. District 4 Health Services has a total of seventeen (17) clinics. FFY'95 OBJECTIVE 1 - Summary By June 1, 1995, 100% ofthe District 4 clinics were monitored. Each review was followed by a conference with the lead clerk and each WIC clerk, along with a follow-up review letter outlining all corrective actions. Each clinic was asked to respond within 30 days of the letter. FFY'96 OBJECTIVE 1 - Clinic Monitoring By September 30, 1996, complete monitoring reviews of 100% of District 4 clinics. Action Steps, Activities, Methods: 1. Set up dates for all clinics to be reviewed. Resources Milestones WIC Administrative Manager Administrative Clerk 10/95 Annually 2. Complete each review and write corrective action letters to Lead Clerk. Resources Milestones Administrative Clerk 6/96 3. Request response from clinics within 30 days, Clinics must explain actio~s"taken to correct findings. Resources Milestones Administrative Clerk within 30 days of each review letter 4. Provide training and technical assistance to those clinics in need. Resources Milestones WIC Administrative Manager Administrative Clerk 9/96 FFY'95 OBJECTIVE 2 - Medical Record Review By September 30, 1995, complete monitoring reviews of 100% of the clinics in District 4. 2 FFY'95 OBJECTIVE 2 - Summary As of June 1, 1995, 50% of all clinics have had a medicalre.cmd,review. enehundred (100) percent will be reviewed by September 30; 1995. Ea~1) review is followed by a conference with the lead nurse, along with a follow-up review letter outlining all corrective actions. Each clinic is asked to respond within 30 days of the letter. FFY'96 OBJECTIVE 2 - Medical Record Review By September 30, 1996, complete medical record reviews of 100% of District 4 clinics. Action Steps, Activities, Methods 1. Set up dates for all clinics to be reviewed. Resources Milestones WIC Coordinator PrincIpal Nutritionist 10/95 annually 2. Complete each review and send corrective action letters to the lead nurse. Resources Milestones Principal Nutritionist 9/96 3. Request response from clinics within 30 days of the letter. Clinics must explain actions taken to correct findings. Resources Milestones Principal Nutritionist within 30 days of review letter 4. Provide training and technical assistance to those clinics in need. Resources Milestones WIC Coordinator Principal Nutritionist 9/96 3 FFY'95 OBJECTIVE 3 - Clinic Flow Analysis By September 30, 1995, conduct clinic flow analysis in selecta-d Clinics- to help evaluate the WIC clinic flow. Based on findings, recommendations wiU .I;le made on how the clinic can better serve its clients. - FFY'95 OBJECTIVE 3 - Summary Due to changes in management, only one clinic flow analysis was performed during FFY'95. FFY'96 OBJECTIVE 3 - Clinic Flow Analysis By September 30, 1996, conduct clinic flow analysis of at least two (21 clinics to help evaluate WIC clinic flow. The District Administrator will train the new WIC Administrative. Manager on the process. Based on findings, recommendations will be made on how the clinic can better serve its clients. Action Steps, Activities, Methods 1. District Administrator will train the new WIC Administrative Manager on procedures for completing a clinic flow analysis. Resources Milestones District Administrator WIC Administrative Manager 1/96 2. Choose clinics and dates for analysis to be performed. Resources Milestones WIC Administrative Manager Lead Clerks Administrative Clerk 1/96 3. Perform clinic flow analysis in selected counties. Based on findings, recommendations will be made on ways the clinic can better serve its customers. 4 Resources WIC Administrative Manager District Administrator . Adminstrative Clerk Milestones 9/9(> III. FOOD INSTRUMENT ACCOUNTABIUTY FFY'95 OBJECTIVE 1 - Manual Voucher Copies 100% of all clinics' manual voucher copies completed accurately and on file. FFY'95 OBJECTIVE 1 - Summary Two (2) of the seventeen (17) clinics (approximately 12%) in District 4 were cited .for corrective actions in the area of manual voucher copies. The clerks have 'been sent a review letter explaining their mistakes. Each clinic has responded to I)ave 100% of their manual vouchers complete and on file in the future. FFY'96 OBJECTIVE 1 - Manual Voucher Copies 100% of all clinic manual voucher copies completed accurately and on file. Action Steps, Activities, Methods: 1. Clinics will be monitored to review manual voucher copies. Resources Milestones WIC Administrative Manager Administrative Clerk Principal Clerks 6/96 2. Corrective action letters will be sent to the lead clerks. Resources Milestones Administrative Clerk 7/96 5 3. Clinics will be required to respond within 30 days of the let~e.~ Resources Milestones Administrative Clerk within 30 days of each review letter 4. Training and technical assistance will be provided to clinics as necessary. Resources Milestones WIC Administrative Manager Administrative Clerk Principal Clerks 9/96 FFY'95 OBJECTIVE 2 - Manual Voucher Inventory Have 100% of all clinic inventories accurately completed with a physical inventory conducted at least monthly. FFY'95 OBJECTIVE 2 - Summary Five (5) ot the District's seventeen (17) clinics were cited for corrective actions in this area. Approximately 29% of the clinics are not accurately completing the manual voucher inventory log. FFY'96 OBJECTIVE 2 - Manual Voucher Inventory Have 100% of all clinic inventories accurately completed with a physical inventory conducted at least monthly. During one of the 1996 quarterly clerical staff meetings, a training will be provided for all clerical staff. Action Steps, Activities. Methods 1. Clinics will be monitored to review accuracy of inventory logs. Resources Milestones WIC Administrative Manager Administrative Clerk Principal Clerks 6/96 6 2. a. Corrective actions will be reported to the lead clerk via :corr~tive action letter. Resources Milestones Administrative Clerk 7/96 3. lead clerks will be required to respond to the corrective actions within 30 days of letter. Resources Milestones Administrative Clerk within 30 days of each review letter 4. Training will be provided to WIC clerks during WIC clerical staff meeting. Resources Milestones WIC "Administrative Manager Administrative Clerk Principal Clerks 9/96 FFY'95 OBJECTIVE 3 - Voucher Security Implement voucher security procedures in each clinic. FFY'95 OBJECTIVE 3 - Summary Security procedures were put into place regarding the storage of vouchers during and after hours and on the issuance of vouchers. Clinics were given options of five (5) ways of properly storing the vouchers and proper procedures to follow when issuing vouchers to insure they are safe-guarded. FFY'96 OBJECTIVE 3 - Voucher Security Monitor all clinics to insure proper security procedures over manual \louchers and computer vouchers are in place. 7 Action Steps, Activities, Methods 1. Clinics will be monitored on voucher security procedures to insure vouchers are properly secured. Resources Milestones WIC Administrative Manager Administrative Clerk Principal Clerks 6/96 2. Results of the review will be sent to the lead clerks in the form of a letter. Resources Milestones Administrative Clerk 7/96 3. Clinics will be required to respond within 30 days of the review letter. Resources Milestones Administrative Clerk within 30 days of each review letter 4. Training and technical assistance will be provided to all clinics showing non-compliance in this area. Resources Milestones WIC Administrative Manager Administrative Clerk Principal Clerks 9/96 8 FFY'95 OBJECTIVE 4 - Voucher Register Documentation 100% accuracy in completion of all voucher register docunie-ntatiiin:. __ FFY'95 OBJECTIVE 4 - Summary Eleven (11) of the seventeen (17) clinics (approximately 65%) were cited for corrective actions in this area. Violations include primarily inaccurate documentation of the disposition of the vouchers. FFY'96 OBJECTIVE 4 - Voucher Register Documentation 100% accuracy in completion of all voucher register documentation. Training will be provided for all WIC clerical staff during one of the quarterly clerical staff meetings in FFY'96. Further training will be provided as necessary. Action Steps; Activities, Methods 1. Clinics will be monitored to review voucher register documentation. Resources Milestones WIC Administrative Manager Administrative Clerk Principal Clerks 6/96 2. Corrective action letters will be sent to the lead clerks. Resources Milestones Administrative Clerk 7/96 3. Clinics will be required to respond within 30 days of the review letter. Resources Milestones Administrative Clerk within 30 days of each review letter 9 4. Training will be provided during WIC clerical staff meatu,j:l'. Resources Milestones WIC Administrative Manager Administrative Clerk Principal Clerks 9/96 IV. VENDOR MANAGEMENT FFY'95 OBJECTIVE 1 - Vendor Monitoring By September 30, 1995, monitor 50% of all vendors in District 4. FFY'95 OBJECTIVE 1 - Summary By June 1, 1995,65% of the vendors in District 4 were monitored. Of those vendors monitored, 35 thirty-day follow-up visits were required and performed. All vendor complaints have been handled promptly and investigations have been requested when necessary. FFY'96 OBJECTIVE 1 - Vendor Monitoring By September 30, 1996, monitor 75% of vendors in the District 4 area. Provide for all necessary 30-day follow-up visits. Handle vendor complaints promptly and provide documentation to the State. Action Steps, Activities, Methods 1. Set up dates for vendors to be monitored. Resources Milestones WIC Administrative Manager Vendor Coordinator 10/95 annually 10 2. Complete each vendor review and meet with vendor manager to explain the results. Resources Milestones Vendor Coordinator Principal Clerks 9/96 3. Set dates for follow-up visits when vendor does not comply with proper procedures. Resources Milestones Vendor Coordinator within 30 days of annual review 4. Schedulll with vendor managers all wanted and necessary staff trainings. Resources Milestones Vendor Coordinator within 30 days of request or review FFY'95 OBJECTIVE 2 - Vendor Training By September 30, 1995, train all WIC vendor managers in District 4 area. FFY'95 OBJECTIVE 2 - Summary As of June 1, 1995, when this Local Agency Program Plan was due, the annual vendor training had not yet been conducted. However, plans have been made for the FFY'95 training to be held approximately the third week of September 1995. FFY'96 OBJECTIVE 2 - Vendor Training By September 30, 1996, train all WIC vendor managers in the District 4 area. 11 Action Steps, Activities, Methods 1. Meeting to set up dates of trainings. dates for vendo'r letters and locations for training. Resources Milestones WIC Administrative Manager Vendor Coordinator 6/96 2. Prepare all vendor agreements and all vendor packets for training. Resources Milestones WIC Administrative Manager Vendor Coordinator Administrative Clerk Principal Clerks 8/96 3. Send letters to all vendors to explain the trainings. locations and times. Resources Milestones Vendor Coordinator Principal Clerks 8/96 4. Conduct training sessions in at least four (4) different locations. Resources Milestones WIC Administrative Manager Vendor Coordinator Principal Clerks 9/96 12 V. SYSTEM INFORMATION MANAGEMENT FFY'95 OBJECTIVE 1 - ATVS: Computer Processing By September 30, 1995, have 100% of clinics running on ATVS Processing, including modems and communication software. FFY'95 OBJECTIVE 1 - Summary By December 1, 1994, 100% of clinics received and loaded the ATVS version 2.26 which contained the communications software required for transferring batch information to Viking. By January 1995, 100% of the clinics had modems installed and had version 2.30 downloaded via modem. All clinics transmit TAD and voucher information via modem. FFY'96 OBJECTIVE 1 - Mitchell & McCormick Conversion By September 30, 1996, District 4 Health Services will have converted to Mitchell and McCormick. WIC is expected to go on-line at the end of FFY'96 or the beginning of FFY'97. Future plans will be adjusted accordingly. Action Steps, Activities, Methods 1, Work with District Computer Systems Analyst on specific plans for WIC conversion. Resources Milestones District Health Director Computer Systems Analyst WIC Coordinator WIC Administrative Manager 2/96 13 2. Have a schedule of dates for each WIC clinic to go on-line with Mitchell and McCormick. Resources Milestones Computer Systems Analyst WIC Administrative Manager Lead Clerks State WIC Systems Analyst 7/96 3. Have all clinics converted to Mitchell and McCormick. Resources Milestones Computer Systems Analyst WIC Administrative Manager WIC Coordinator State WIC Systems Analyst 1/97 FFY'95 OBJECTIVE 2 - System Maintenance Indicators Continue to use the monthly SMI reports to evaluate the District's performance as well as each individual clinic's performance. FFY'95 OBJECTIVE 2 - Summary The WIC Administrative Manager has developed a notebook in which the District, State, and individual clinic percentages are plotted. This system allows for quick reference and evaluation of each indicator. An evaluation of the FFY'95 indicators through 3/30/95 shows a need to improve in the area of Concentrated Rebate Compliance. District percentage. = 85.93%. Two (2) of the clinics had individual percentages below 70%. FFY'96 OBJECTIVE 2 - System Maintenance Indicators Have a District Concentrated Rebate Compliance percentage at or above 93%. Have all individual clinic percentages at or above 93%. 14 Action Steps, Activities, Methods 1. Work with nutritionists, nurses, WIC clerks and local phy!!.i~ians to increase compliance and to decrease prescriptions for 'non-contract formulas unless absolutely necessary. Send letters and .conduct meetings as necessary until compliance has been increased. Resources Milestones WIC Coordinator District Health Director WIC Administrative Manager Principal Nutritionist 1/96 2. Provide training, if necessary, to nutritionists, nurses and other WIC staff. Resources Milestones WIC Coordinator WIC Administrative Manager Principal Nutritionist 3/96 3. Continue to stress on a daily basis the importance of maintaining a high percentage of compliance. Resources Milestones WIC Coordinator WIC Administrative Manager Principal Nutritionist on-going VI. FINANCIAL MANAGEMENT FFY'95 OBJECTIVE 1 - Hire for Vacant Position Hire a new WIC Administrative Manager to fill vacancy. The new manager's job would be to handle all WIC budgets and allocate expenditures a,s well as manage all administrative services of WIC. 15 FFY'95 OBJECTIVE 1 - Summary March 1, 1995, Barbara Stephens was hired as the District's. IilEWII WlG Administrative Manager to fill vacancy left by Wanda Scarborough. By".July 1; 1995, Barbara will have been trained on all budgeting responsibilities'. 'Wanda provides assistance as necessary. FFY'96 OBJECTIVE 1 - District Policy To develop a written District Policy regarding the financial management of WIC funds. This document will provide all Federal, State and District requirements on the documentation and distribution of WIC funds. Action Steps, Activities, Methods 1. Meet with District Administrator to gather information on all current management requirements by the Federaland State WIC Program. Resources Milestones WIC Administrative Manager District Administrative State WIC Office 10/96 2. Have a draft of the policy to be reviewed and approved by District Administrator. Resources Milestones WIC Administrative Manager District Administrator 6/96 3. Provide final draft of policy to be approved by District Administrator and District Health Director. Resources Milestones WIC Administrative Manager District Health Director District Administrator 8/96 16 VII. QUALITY IMPROVEMENT FFY'95 OBJECTIVE 1 - CUR Reporting To maintain a percentage of unreconciled Cumulative Unmatched Redemptions (CUR) below 1% and to send reconciled reports to Viking in a timely manner. FFY'95 - OBJECTIVE 1 - Summary During FFY'95, District 4 maintained a percentage of unreconciled CUR (original and final) well below the state average. The district average was below 1%. In March 1995, a training was held on CUR reports during a WIC clerical staff meeting. FFY'96 - OBJECTIVE1 - CUR Reporting To maintain a.percentage of unreconciled Cumulative Unmatched Redemptions below 1% and to send reconciled reports to Viking in a timely manner. Action Steps, Activities, Methods 1. Monitor the System Maintenance Indicator report on a monthly basis to insure clinics are keeping their percentages low. Resources Milestones WIC Administrative Manager Principal Clerk throughout FFY'96 2. Provide necessary training to clerks showing a trend of high percentages in this area. Resources Milestones WIC Administrative Manager Principal Clerk Administrative Clerk 9/96 17 FFY'95 OBJECTIVE 2 - Vendor Abuse Document and follow-up on 100% of vendor abuse 'Corop1alrftst provide calls, visits, monitoring, and training as necessary. Coordinate with State W}~,Office any requests for investigation. FFY'95 OBJECTIVE 2 - Summary Beginning June 1995, the WIC Administrative Manager and Vendor Coordinator agreed that all vendor complaints will be documented in a separate file and followed up with the appropriate action. FFY'96 OBJECTIVE 2 - Vendor Abuse Document and follow up on 100% of vendor abuse complaints. Provide calls, visits, monitoring and training as necessary. Coordinate with State WIC office any requests for investigation. Action Steps, 'Activities. Methods 1. Vendor coordinator receives complaint on vendor. WIC Administrative Manager is notified. Resources 'Milestones Vendor Coordinator WIC Administrative Manager on-going 2. Vendor is called, visited or monitored. Resources Milestones Vendor Coordinator Principal Clerks on-going 3. If sanction points are required, the State WIC Office is notified. Resources Milestones Vendor Coordinator on-going 18 4. If training is necessary, the vendor coordinator provid.e~"'-';.t. Resources Milestones Vendor Coordinator Principal Clerks on-going 5. Documentation is recorded in the vendor file and a separate vendor complaint file at the District Office. State WIG Office is notified if an investigation is required. Resources Milestones Vendor Coordinator WIC Administrative Manager State WIG Office on-going FFY'95 OBjEGTIVE 3 - Participant Abuse Document and follow up on 100% of participant abuse complaints. Provide calls and letters as necessary. Coordinate with State WIG Office and local clinic when suspension is required. FFY'95 OBJECTIVE 3 - Summary During FFY'95, District 4 received only a few participant complaints. All were documented and followed up with calls or letters. No one as of June 1, 1995, was placed on suspension due to abusive behavior. FFY'96 OBJECTIVE 3 - Participant Abuse Document and follow up on 100% of participant abuse complaints. Provide calls and letters as necessary. Coordinate with State WIG office and local clinic when suspension is required. 19 Action Steps, Activities, Methods 1. WIC clerk receives complaint on participant. WIC Admi!li"trative Manager is notified. Resources Milestones WIC Clerk WIC Administrative Manager on-going 2. Client is called or sent a letter of warning. Resources Milestones WIC Administrative Manager on-going 3. Documentation is maintained in WIC Administrative Manager's office. Copi~s' sent to client's file and State WIC Office. Resources Milestones WIC Administrative Manager on-going 4. If abuse continues, coordinate with local clinic and State WIC Office to sanction. Resources Milestones WIC Administrative Manager State WIC Office WIC Clerks on-going VIII. PROGRAM INTERVENTION See Program Integration (per Lynn Flen - 5/18/95) 20 IX. PROGRAM INTEGRATION FFY'95 OBJECTIVE 1 - Coordination of Services By September 30, 1995, coordinate WIC services with immunizations and health checks. Encourage clinics to use the" Athens Model" to enhance this coordination. FFY'95 OBJECTIVE 1 - Summary All seventeen (17) clinics adopted the"Athens Model." The tickler cards have been revised to include a schedule of appointments and a completion date for each screening. WIC clerical staff is responsible for scheduling both health check and immunization appointments to coincide with WIC appointments. Clinics continue to operate under the Coordination of Health Services and Voucher Issuance Policy implemented in October 1992. This policy allows clinics to pli\ce vouchers in order to improve WIC Participant Immunization Compliance. FFY'96 OBJECTIVE 1 - Coordination of Services Continue to coordinate immunizations and health checks with WIC voucher pick-up appointments. Action Steps. Activities. Methods 1. Monitor all clinics to insure that procedures are being followed. Will include this with annual monitoring visits. Resources Milestones WIC Administrative Manager Administrative Clerk Principal Clerks 6/96 21 2. Provide training and technical assistance to clinics which fail to a'Q:mply. Resources Milestones WIC Administrative Manager Administrative Clerk Principal Clerks 9/96 x. PROVISION OF SERVICES TO PRENATAL PARTICIPANTS FFY'95 OBJECTIVE 1 - First Trimester Enrollment By September 30,1995, to have a District percentage of prenatals enrolled in the first trimester at or above 50%. OBJECTIVE 1 - Summary As of the end of 2nd quarter 1995, District 4's percentage of prenatals enrolled in the first trimester was 53.2%. Five (5) of the 17 total clinics were below 50%. FFY'96 OBJECTIVE 1- First Trimester Enrollment By September 30,1996, have all seventeen (17) District 4 clinics at or above 50% in their percentage of first trimester prenatals. Action Steps, Activities, Methods 1. Encourage clinics to enroll all clients with positive pregnancy tests on WIC the same day as test. Resources Milestones WIC Administrative Manager WIC Coordinator Lead Nurses Lead Clerks on-going 22 2. Encourage counties having prenatal clinics to enroll the clientoo ;WIG ~he same day as the exam. Resources Milestones WIC Administrative Manager WIC Coordinator Lead Nurses Lead Clerks on-going 3. After receipt of the quarterly Trimester Analysis Report, write those counties having a percentage below 50%. Request them to contact the local OB/GYN for referrals. Resources Milestones WIC Administrative Manager Lead Nurses quarterly 4. Reinfo.rce and encourage staff to meet the 1O-day processing standards. Resources Milestones WIC Administrative Manager WIC Clerks Lead Nurses on-going XI. WORKING MOTHERS FFY'95 OBJECTIVE 1 - Appointment Scheduling and Accommodation Accommodate working mothers as necessary and respond as need arises. OBJECTIVE 1 - Summary In FFY'95, two (2) of the 17 clinics provided WIC during lunch hours to accommodate working mothers. Clinic monitoring questionnaires showed results that the majority of working mothers have a proxy to handle their WIC. Upson County is testing extended hours. This county provides WIC from 10:00 a.m. - 6:30 p.m. every Tuesday. Results of this trial have not yet been formulated. Effective June 1. 1995, Carroll County will begin offe-ring WIC from 10:00 a.m. - 7:00 p.m. every Monday. 23 FFY'96 - OBJECTIVE 1 - Appointment Scheduling and Accommodation Survey each county to determine need for special accommodations fo'r working moth.ers. Evaluate the results to determine which counties shouk' trial a new system to accommodate these clients. Action Steps, Activities, Methods 1. Survey clients to determine their need for special services to accommodate. Request comments. Resources Milestones WIC Administrative Manager lead Clerks WIC Clerks 1/96 2. Needs. assessment would be based on percentage of working mothers in each'c1inic and the extent of hardship placed on client~:. Resources Milestones WIC Administrative Manager WIC Coordinator 3/96 3. Based on need, the clinics will be ranked 1-17. The top five clinics showing the greatest need will be given priority. The:"a clinics will be asked to submit a report on the feasibility of alterkc. the system to accommodate. Resources Milestones WIC Administrative Manager WIC Coordinator Lead Clerks WIC Clerks 6/96 24 XII. PARTICIPANTS RESIDING IN RURAL AREAS FFY'95 OBJECTIVE 1 - Appointment Scheduling and AccOllli't:1bi.h~tioni Make provisions in health departments to coordinate WIC appointme"!ts with other program services to eliminate the need for several visits to the clinic. Clients to be given an opportunity to make appointments when transportation is easily ac.cessible. OBJECTIVE 1 - Summary During FFY'95, all clinics worked with clients to coordinate WIC appointments with other program services. District 4 clerks "work in" clients whenever possible . . FFY'96 OBJECTIVE 1 - Appointment Scheduling and Accommodation Identify client~ residing in rural areas who have limited transportation. Set up guidelines to help accommodate these participants. Action Steps, Activities, Methods 1. Set up a system on the tickler cards to identify these clients. Train the WIC clerks on the importance of trying to accommodate the clients and being sympathetic to missed appointments by "working them in:' Resources WIC Administrative Manager WIC Clerks Milestones 8/95 2. Survey lead clerks to determine service transportation available in each county. Resources Milestones WIC Administrative Manager WIC Clerks lead Clerks 1/96 25 3. Review survey data to determine counties with th"e greatest transportation hardship. Resources Milestones WIC Administrative Manager WIC Coordinator 3/96 4. Request the identified counties to evaluate their current appointment scheduling system and devise a plan of action to accommodate those participants having transportation difficulty. Resources Milestones WIC Administrative Manager WIC Cle"rks Lead Clerks 6/96 26 FEDERAL FISCAL YEAR 1996 DISTRICT 5 UNIT 1 LOCAL AGENCY WIC PROGRAM PLAN DISTRICT 5, UNIT 1 FFY '96 WIC PROGRAM PLAN INTRODUCTION The goal of the Women, Infants and Children's Nutrition Program in District 5, Unit 1 (Dublin) is to provide comprehensive health and nutrition services that encourage wellness, healthy lifestyles, and preventive health care to low-income women, infants, and children. OBJECTIVES A. Summary of FFY '95 Objectives Objective I - Programmatic Administration - Early Trimester Enrollment By fourth (4th) Quarter 1995, increase the percentage of prenatal WIC participants certified jn the first trimester from 55.3% (4th quarter FFY '94) to 60% by 4th quarter FFY '95. Objective 1'- Summary During FFY '95 each clinic in the district was requested to refer women with a positive pregnancy to the WIC Program the same day. Prenatals who call the health department are appointed within 10 days. All health department services are integrated to provide more timely and efficient delivery of services. As of third (3rd) quarter FFY '95 first trimester enrollment of WIC prenatals has increased to 60.5%. Objective II - Programmatic Administration - Contract Formula Compliance By fourth (4th) quarter 1995, issue contract formula to at least 95% of the formula-fed infants who are certified for WIC. Objective 11- Summary An Infant Formula Protocol was developed by District 5-1 in December 1993. A letter from the District Health Director along with a copy of the protocol was mailed to each pediatrician and/or primary care physician within our district. The public health nurses and nutritionists were instructed to follow the Infant Formula Protocol. As a result of the implementation of the protocol and active communication, the contract formula compliance rate in District 5-1 is 96.03%. Objective III - Systems Information Management - EDP AutomationBy third (3rd) quarter 1995, each WIC clinic site in District 5-1 would be fully automated with electronic data processing equipment to allow computer issuance of vouchers to all newly certified WIC clients and to allow downloading of client and voucher issuance information directly into Viking Computing Company. Objective III - Summary All WIC clinic sites in the district are fully automated completed in March 1995 with modem capabilities to allow transmission of client and voucher issuance information directly into Viking Computing Company and to allow Viking Updates to be downloaded back into the ATVS program at the clinic site. Objective IV - Programmatic Administration - Decrease Clinic Critical Error Rate By fourth (4th) quarter 1995 the clinic critical error rate for TAOS submitted to Viking would decrease from 1.55% (4th quarter FFY '94) to 1.20% by 4th quarter FFY '95. Objective IV - Summary Data/Clerical Staff in the district have been trained on the preparation of TAOS in the ATVS program for Certifications, Sub-eertifications, Transfer Into, Transfer Out-of, Terminations, Updates, etc. Staff meetings are held with ATVS users to discuss common critical errors. The critical error rate continues to decrease and thus far in FFY '95, District 5-1 has maintained the lowest critical error rate in the state. Objective V - Vendor Management - Compliance Monitoring By fourth (4th) quarter FFY '95 all WIC vendors (grocers) in the district will have been monitored for WIC program compliance twice within the fiscal year. Visits to WIC participating vendors by the vendor coordinator will eliminate potential WIC program abuse and/or provide insight to targeting potential abuse by vendors. Objective V - Summary In August 1994 a full-time Vendor Coordinator was hired to handle all vendor related activities and problems. The vendor coordinator has monitored each store (48 grocers and 13 pharmacies) once this fiscal year and will complete the second monitoring visit to each vendor by September 1, 1995. Follow-up visits are being made to vendors who are out of compliance or need additional training. 2 B. FFY '96 Program Objectives Objective I - Programmatic Administration - Non-participation By fourth (4th) quarter FFY '96 the non-participation rate in each clinic in District 5-1 will decrease to 10% or below. Activities: Continue current efforts of notifying non-participants by sending postcards or calling after first failed appointment. Continue and increase access to voucher pick-up through extended clinic hours and service integration. Terminations for failure to pick up vouchers for two (2) consecutive months will be completed in a timely manner to avoid higher non-participation rates. Evaluation: By September 1996 the non-participation rate will be at or below 10% in each clinic in District 5-1, a decrease from the current 11.63% district average. Objective II - Programmatic Administration - Non-Redemption. .. By fourth (4th) quarter FFY '96 the non-redemption rate in each clinic in District 5-1 will decrease to 5 % or less. Activities: Nutrition staff will prOvide nutrition education on the use of WIC food items to include recipes, proper food storage, snack ideas, etc. Data/clerical staff issuing WIC vouchers will provide education and instructions on redeeming WIC food vouchers. Evaluation: By September 1996 the non-redemption rate for WIC vouchers will decrease in each clinic from the current district average of 6.80% to 5% or less. Objective III - Program Integration and Intervention - Immunizations By fourth (4th) quarter FFY '96 the rate for children who are adequately immunized by their second birthday will be at 90% or greater in each clinic in District 5-1. Activities: The immunization status of all WIC infants/children from birth to 2 years of age will be adequately assessed at certification, midcertification assessment and sub-certification at each WIC clinic site. Services will be integrated so that immunizations can be provided at the time of certification, mid-certification, and subcertification. Appointments for immunizations will also be given to coincide with the next WIC voucher pick-up. The integration of HOST and WIC will provide more readily accessible information to 3 .est'lblish the infant/child's immunization status. The District WIC \loiicy to issue a partial package of WIC vouchers to infants/children who are not adequately immunized for age will be enforced. Evaluation: By September 1996 the percent of children ages birth to 24 months who are adequately immunized will be increased in each county health department in District 5-1 to 90% or greater. With the advent of HOST/WIC capabilities the immunization status of WIC enrolled children (birth to 24 months) will be assessed for future objectives. Objective IV - Quality Improvement/Food Instrument Accountability Voucher Issuance Security By fourth (4th) quarter FFY '96 voucher issuance security will be strengthened in each county health department in District 5-1 by ensuring that 2 persons perform a physical inventory of blank manual vouchers and VOC cards on a monthly basis. Blank computer printed v9ucher~ will be logged into the ATVS .batch'log immediately upon receipt by the clinic. All vouchers will be secured in a locked cabinet/file, in a locked office, in a locked building. Computers, printers, and vouchers will be situated so that they are out of reach of clients. Activities: Efforts will be continued to ensure that a physical inventory of VOC cards and blank manual vouchers is conducted monthly in each clinic by the data/clerical staff person and a supervisor or other professional authority. Upon receipt of manual vouchers from Viking and logging into the computer and/or inventory log, the voucher cycle packing list will be reviewed and signed by county data/clerical staff and a copy forwarded to the District Office. Efforts will be continued to secure WIC vouchers and issuance materials by locking in a secure location. New health department buildings are being constructed in District 5-1 or renovations made to existing health departments to ensure security and delivery of efficient quality service. Evaluation: By September 1996 monitoring review visits by district and/or state staff will reveal compliance with voucher issuance security guidelines in each county health department. Half-walls and windows will separate staff from clients to ensure security and that computers, printers, vouchers, and issuance materials are out of reach of clients. New or renovated health departments will provide for maximum security of WIC voucher issuance" and food instrument accountability. 4 Objective V - Program Integration - Working Mothers and Rural Residents ey fourth (4th) quarter FFY '96 WIC services will be available to aCC0mmodate working mothers and participants residing in rural areas In each county in District 5-1. Activities: Extended clinic hours are presently available in eight (8) of our ten (10) county health departments. Efforts will be made to extend clinic hours in the remaining two (2) county health departments through communication with county health department staff, county commissioners, and our District Health Director. Surveys will be completed to determine the most suitable clinic hours to accommodate working mothers and rural residents. WIC services will continue to be provided each day in each county health department throughout the work day without closing for lunch. Services will continue to be integrated and coordinated to eliminate multiple trips to the health department for the working mother or rural resident. Evaluation: By September 1996 monitoring review visits by district staff will reveal that extended clinic hours are available in each county health department to accommodate working mothers and rural residents. The clinic appointment system will show that multiple services have been delivered throughout the day and that duplicate visits to the health department have been avoided". Coordination of services and communicatioC1 among health department staff will ensure timely, efficient services have been delivered to working mothers and rural residents. 5 FEDERAL FISCAL YEAR 1996 DISTRICT 5 UNIT 2 LOCAL AGENCY WIC PROGRAM PLAN FFY 1996 PROGRAM PLAN DISTRICT 5, UNIT 2 DISTRICT NUTRITION COORDINATOR: Jacquelynn Nelson INTRODUCTION: District 5, Unit 2's Women, Infants, and Children Program's objective is to continue providing quality services to current and potential participants. OBJECTIVE I: Quality Improvement: By October 31, 1996, complete self-reviews with proper documentation of all 16 clinic sites in District 5, Unit 2. EVALUATION DESIGN: ACTION STEPS/ACTIVITIES/METHODS RESOURCES 1. Schedule dates for all clinics to Nutritionists be reviewed. Clerical Staff 2. .Design a report to be used to WIC Coordinator communicate strengths and Nutritionists weaknesses. Clerical Staff 3. Complete each review as Nutritionists planned and write an official Clerical Staff report for each clinic. 4. Compile a summary of WIC Coordinator corrective actions and determine method to be used to strengthen weaknesses. 5. Implement agreed upon method WIC Coordinator to correct weaknesses, such as Nutritionists memoranda or training. Clerical Staff MILESTONE OF ACTIVITIES October 1, 1995 October 31, 1995 October 1, 1995 - April 1, 1996 April 1, 1996 - October 31,1996 October 1,1995 - April 1, 1996 April 1, 1996 - October 31,1996 October 1, 1995 - April 1, 1996 April 1, 1996 - October 31, 1996 Page...L of...;L FFY 1996 PROGRAM PLAN DISTRICT 5, UNIT 2 DISTRICT NUTRITION COORDINATOR: Jacguelynn Nelson OBJECTIVE II: EVALUATION DESIGN: System Information Management: By October 31,1996, provide instructional materials to clinic sites to reduce the number of system critical errors committed at the local level. ACTION STEPS/ACTIVITIES/METHODS RESOURCES MILESTONE OF ACTIVITIES 1. Research number and frequency WIC Coordinator October 31,1995 of critical errors 2. Determine method of training to WIC Coordinator November 30,1995 reduce number of critical errors. Clerical Staff 3. Train employees on how to WIC Coordinator December 31, 1995 reduce the number of critical Clerical Staff errors. 4. Monitor critical error reports for WIC Coordinator January 1, 1996 - September 30,1996 progress. Clerical Staff Page 2 of 2 FFY 1996 PROGRAM PLAN DISTRICT 5, UNIT 2 DISTRICT NUTRITION COORDINATOR: Jacquelvnn Nelson OBJECTIVE III: EVALUATION DESIGN: Program Integration: By October 31,1996, investigate the possibility of integrating the WIC Program with other agencies in the community where pregnant women, infants, and children seek other services. ACTION STEPS/ACTIVITIES/METHODS RESOURCES MILESTONE OF ACTIVITIES 1. Seek ou1 other community WIC Coordinator groups who provide services to pregnant women, infants, and children. November 30,1995 2. Meet with other community WIC Coordinator groups who express an interest in providing on-site WIC services. January 31,1996 3. Develop staffing and equipment WIC Coordinator needs for other clinic sites. Nu1ritionists Clerical Staff February 29,1996 4. Make arrangements for clinic WIC Coordinator sites. April 30, 1996 5. Make clients aware of clinic site Nu1ritionists changes. Clerical Staff 6. Follow up on frequency of usage WIC Coordinator of new clinic sites. Nu1ritionists Clerical Staff May 31,1996 September 30, 1996 Page -'L of -'L FEDERAL FISCAL YEAR 1996 DISTRICT 6 UNIT 0 LOCAL AGENCY WIC PROGRAM PLAN ,----. iOOD INSTRUMENT ACCOUNTABILITY I. MONTHLY CLOSE-OUT A. WIC Clerk Rotation--to explore the feasibility of rotating WIC Clerks to perform close-out activities for a peer Clerk on an unannounced basis in Richmond County clinic sites B. Incomplete record report--to assess the number of incomplete records in ATVS during clinic self-review District Administrative Clerk Richmond County Administrative Clerk District Administrative Clerk VENDOR MANAGEMENT I. VENDOR TRAINING A. Annual Vendor Training--to implement pre-registration to establish owner/manager to insure contracts are signed by the vendor's legal agent District Administrative Clerk By 9/30/96, pilot will have been done By 9/30/96, clinic selfreviews shall include this assessment By 9/30/96, procedure shall be implemented SYSTEM INFORMATION MANAGEMENT I. DISTRICT OFFICE AUTOMATION A. CDC INPHO--install and train District staff B. FOLIO--to explore the feasibility of installing software to minimize dual storage of information District Nutrition Consultant District Secretary-Typist, Sr. By 9/30/96, feasibility study will have been done and staff will have been trained FFY '9G DISTRICT PLAN-(OG) AUGUSTA WIC PROGRAM OBJECTIVE: To abide and comply with all GA WIC Program requirements--GA DHR AdministratiY ~olicy and Procedures, GA DHR Grant-to-Counties Policies for administration of funds, USDA p~ogrum x~~ations, GA WIC Procedures Manual EVALUATION: ;Assessment of Annual Self-Reviews performed by District Nutrition SerVlces staff ACTION STEPS ACTIVITIES/METHODS PROGRAMMATIC ADMINISTRATION I. STAFF RECRUITMENT/RETENTION A. AP-4 Program--to conduct AP-4 Program for approved Nutritionists B. Clerical Training--to design/implement formal curriculum and implement with any new Clerks hired in District C. WIC Certifier Training--to explore the feasibility of converting existing 3-day training to self-instructional modules RESOURCES District Registered Dietitians Local Health Care Systems affiliated with AP-4 (Medical College of Georgia, St. Joseph Hospital, Community Dialysis Center, Reliance Nursing Home DHR Office of Nutrition AP-4 Coordinator GA WIC Procedure Manual District Administrative Clerk District ADP Coordinator Professional Educational Consultant District WIC Certifier Curriculum Professional Educational Consultant MILESTONES OF ACTIVITIES By 1/1/96, 1 Nutritionist will have completed the AP-4 Program By 9/30/96, arty new Clerk will have completed the training By 9/30/96, feasibility study will have been done II. HEALTH CARE REFORM A. WIC Block Grants/GA Better Health Care/Medicaid HMO's--to stay abreast of current events and assess impact on provision of WIC Program Services NAWD Monday Morning Report CNI Nutrition Week MCH Updater media By 9/30/96, information shall be assessed and shared as appropriate II. ENHANCED ATVS TRAINING A. Custom Report Training--to develop/implement training and incorporate into Clerical Training FINANCIAL MANAGEMENT I. TIME STUDY A. To conduct Time Study to document distribution of WIC Assessment funds ATVS User Manual District Administrative Clerk District ADP Coordinator District Administrative Clerk District Clerk, Sr. District Sec-Typist, Sr. By 9/30/96, a pilot training wiU have been held By 9/30/96, Time Study will have been done QUALITY IMPROVEMENT I. FRAUD AND ABUSE A. To provide guidance and assistance in programmatic compliance and in the investigation of suspected fraud and abuse in WIC Program-participants, clinic staff, vendors, etc. II. CUSTOMER SERVICE A. Auto-dialers--to explore the feasibility of utilization in clinics that exceed 1000 participants III. SELF-REVIEWS A. To explore the feasibility of doing ATVS portion of SelfReviews by modem - PROGRAM INTERVENTION District Nutrition Consultant District Administrative Clerk By 9/30/96, all suspected and reported fraud and abuse shall be investigated District ADP Coordinator District Administrative Clerk Richmond Co. Administrative Clerk Richmond Co. Nutritionist principal By 9/30/96, feasibility study will have been done District Administrative Clerk State WIC ADP Unit By 9/30/96, feasib:llity study will have been done I. OUTREACH A. 1st Trimester Enrollment--to market WIC Program to all OB/GYN physicians in District B. 1st Trimester Enrollment--to market WIC Program to all Family Connection nurses in District via their attendance at WIC Certifier Training C. 1st Trimester Enrollment--to assess the feasibility of performing own bloodwork and anthropometric measurements at Ft. Gordon rather than rely on referral data from OB/GYN Clinic D. Health Fairs--to purchase/design a WIC Program table-top exhibit for use at Health Fairs E. DHR Marketing Campaign--to market WIC Program through speaking engagements obtained via District Marketing Committee II. IMMUNIZATION A. District Immunization Rate--to increase District Immunization level Richmond Co. Nutritionist Principal District High Risk Nutritionists Physician Marketing Folder FAX Referral Forms WIC Certifier Training curriculum Family. Connection nurse preceptors Richmond Co. Nutritionist Principal District Nutrition Consultant DHR Marketing Campaign Slide Show District Nutrition consultant District Nutrition Consultant District Immunization coordinator By 9/30/96, physicians will have been visited By 9/30/96, all new Family Connection nurses will have attended WIC Certifier Training By 9/30/96, feasibili ty study will have been done By 9/30/96, exhibit will have been completed By 9/30/96, 3 speaking engagements will have been done By 9/30/96, the rate shall have increased from 97.13% to 98% FEDERAL FISCAL YEAR 1996 DISTRICT. 7 UNIT 0 LOCAL AGENCY WIC PROGRAM PLAN District _7_ Unit_O_ FFY '96 Local Agency WIe Program Plans INTRODUCTION The West Central Health District will continue to strive to provide comprehensive health and nutrition services to its women, infants and children population. Our staff will encourage wellness, healthy life styles, and the use of preventative health care by implementing innovative initiatives which will increase WIC prenatal enrollment and participation during the prenatal's first trimester of pregnancy; collaborate with immunization programs for the purpose of increasing the number/percentage of two year olds who are fully immunized; and decrease the number/percentage of subsequent teenage pregnancies. Objective I: By September 30, 1996 improve migrants access to public health clinics and the WIC Program services in Macon, Schley, and Sumter Counties. (1) Needs Assessment: Migrants must be notified of their eligibility within ten calendar days of their visit to the health center or written request for WIC services. The Georgia WIC Program procedures require automatic placement of migrants onto the WIC Program when a VOC card is presented to a local agency representative. The VOC card must have at a minimum a valid certification date and participant's name. WlC vouchers, Identification card and VOC card must be given to the migrant the same day the he/she is certified or determined eligible with valid VOC data. WIC staff shall make every effort to provide access to health services for migrants and their families in a timely manner. The loCal agency is tasked with the responsibility ofcontacting other agencies and community organizations which serve non-English speaking persons to ensure eligible members of the migrant population participate in the program. The local agencies are encouraged to identify individuals in the service areas who can provide bilingnal services to translate or interpret; or contract with an agency to provide a translator or interpreter. (2) Evaluation Design: Monitor migrant activity in the Public Health Clinic(s) and the WIC Program to determine if the migrant's access to the WIC and Public Health Clinics were improved over the prior fiscal year. ACTION STEPS ActivitieslMetbods (I) Create an Exempt Position. (2) Recruit, interview and hire a bilingual staff person to serve as an interpreter or translator for migrants in Macon, Schley and Sumter counties. (3) Develop a mey tool to identifY the following: A. Name of Camp B. Name of Crew Leaderllnterpreter C. Migrant Arrival Dates D. Number of Prenatals, Breast-feedingINon-Breast-feeding Women, Infants and Children up to 5 years of age E. Nutrition Education materials most often needed F. Types of services needed most often (Program Plans continued) (4) Obtain written authorization from camp owner to visit the camp to service WIC eligible migrant prenatals, postpartum women infants and children. (5) Develop Spanish outreach and nutrition education materials, purchase appropriate video tapes, poSters and order Spanish nutrition education material that are available through the State WIC Office and the Office.of Nutrition. (6) Implement migrant client swyey to determine the clients clinic and WIC program preference(s). (7) Incorporate clients preference(s) in our migrant services plan. (8) Coordinate referrals to other agencies. (9) Review migrant activity to determine the migrants' increased access to Public Health and WIC Program Services. Resources (l) Local Agency Personnel Representative WIC Coordinator FFY '95 Georgia WIC Procedures Manual (2) Local Agency Personnel Representative, WIC Coordinator & County Health Opt. Staff (3) Local Agency InterpreterlWIC Staff (4) State WIC Office Staff District Staff Camp Owner Georgia Procedures Manual (5) Local Agency Interpreter (6) Local Agency Interpreier (7) Survey Tool Local Agency Staff Local Agency Interpreter State Staffs Milestones 6-1-95 within 30 days of approval to hire 6-30-95 6-30-95 6-30-95 and on going 7-30-95 8-30-95 Objective II: By September 30, 1996 maintain a WIC non-participation rate of 10% or less. (1) Needs Assessment: The State WIC Office requires each local agency to maintain a non-participant rate of 10% or less. An agency with a non-participant rate of 11 % or greater will receive a corrective action at the time of local agency review. (2) Evaluation Design: Review the System Maintenance Indicators Report to determine if non-participation rate for FFY '96 was equal or less than 10% for FFY '96. ACTION STEPS ActivitieslMethods (1) Notify staff in each local county health department ofthe programmatic requirement: To maintain a WIC non- participant rate of not more than 90%. Review reports monthly. (2) Coutact with county clinics personnel with a non-participant rate of greater than 90%, and discuss strategies to increase participation to at least 90% or greater. (3) Meet with local staff to obtain feedback and implement changes as needed. (4) Prepare and mail missed appoiniinent notices on a weekly basis. (Program Plans continued) Resources (I) State System Maintenance Indicators Report versus County Clinic Reports. (2) S.W.O.lSyst~mMaintenance Indicators Report Local County Health Department personnel District WIC Office (3) Loca1 Connty Health Department personnel (4) Local County Health Department personnel. Milestones Initiate 10-95 and monthly then9~-30-96 Begin 10-1-95 and on monthly basis until 9-30-96 on going 7-95 Objective III: By September 30, 1996 increase the 1st trimester prenatal enrolhnent by 5% from 39% to 44%. (1) Needs Assessment: The 10cal agency's percent (40"10) of 1st trimester prenatal enrolhnents are significantly lower than the State percentages (50"10). State objective for FFY '95 is to increase 1st trimester prenatal enrolhnents to 55%. '. (2) Evaluation Design: Revi<;w the quarterly Trimester ofEnrollment Report (10-1-95 quarterly and as needed) to monitor the number of prenata1s that were enrolled in the 1st trimester and determine ifWIC prenatal enrolhnents increased by 5% from 39% to 44% during the period October I, 1995 through September 30,1996. ACTION STEPS Activities!Method. (I) Meet with local agency staff and County Health Department personnel to discuss alternatives for increasing prenata1s in 1st trimester enrollment. (2) Distn1>ute local agency WIC referral forms for prenatal physicians and community agency use.' (3) Schedule follow-up visit to provide and obtain feedback on agreed alternatives for inereasing WIC prenatal enrolhnents during I st trimester ofpregnancy. (4) Request technical assistance from S:W.O. for the County Health Department who have difficulty in enrolling preuatal WIC participants. (5) Ou 9-30-96 evaluate the quarterly Trimester of Eurollment Reports to determine if the number of prenatal 1st trimester enrolhnents increased by 5%. Objective IV: By September 30, 1996 conduct an internal self-review for each clinic in the District. (1) Needs As.e';'ent: The local agency is required to conduct an internal self-review of programmatic operations on:a ;annual basis. The internal self evaluation is designed to assist the WIC Coordinator or designee in assessing compliance of program operations with WIC policies and procedures. Deficiencies must be written to resolve non-<:ompliance areai. The assessment must include all components of the program's operations. The State WIC Office Local Agency Monitoring Tool may be used to evaluate clinic program's operations. (Program Plans continued) (2) Evaluation Design: Review reports of internal self-reviews and determine if each clinic was reviewed before September 30, 1996. ACfrON STEPS ActivitieslMetbods (I) Contact clinics within District to scbedule 10081 agency self-reviews for FFY '96. (2) Begin local agency self-review and provide technical assistance based on findings. (3) Prepare and submit written report of 10081 agency self-review to supervisory personnel in each Local County Health Department. . (4) Clinic(s) will prepare a written response to corrective actions listed in report. (5) Review clinic response(s) and assess. (6) Ana1yze summary of internal local agency selfreviews. Prepare written reports for State Review term for FFY '97 WIC program review. (I) District WIC Office Staff LocaI County Health D<;partment Staff State-Local Agency Monitoring Tool (2) District WIC Office Staff Local County Health Department Staff State-LocaI Agency Monitoring Tool (3) District WIC Office Staff Designee(s), WIC Coordinator (4) clinic Supervisory Staff (5) District WIC Office Staff 7-95 10-95 30 days from self review completion date 45 days from receipt of written report 9-30-% District _7_ Unit_O_ Local Agency Response To FFY '96 State WIC Program Plans FOOD FUNDS MANAGEMENT Objective I: By January I, 1995 complete the first year of a three year cost containment initiative in the form ofrebates on purchases of infant formula thereby reducing the overall food package cost and increasing caseload participation. Objective I Summary: The West Central Health District and its sixteen local county health departments participated in the conversion process ofthe new contract formula: EnfamillProsobeelLactofree. Each local vendor coordinator of the sixteen county health departments as well as the district office staffcontacted the W1C approved vendors in their assigned service areas to remind them of the change in the contract formula and the implementation date. The brochures: "W1C Is Changing Infant Formulas" and "Formula Preparation" were mailed to each health department and were given to each guardian with child participants that were on standard formula. The concentraied rebate compliance report based on redemption for the month ofFebruary was 90.88% while March reports indicated 89.95%. .. Objective II: By September 30, 1995, districts will issue contract formula to at least 93% of the infants certified for WIC. At this writing (May 1995) the concentrated rebate compliance report based on redemption months "fFebruary was 90.88% and the March report indicated 89.95% counties have been notified of the decreased percentage ofcontract formula redeemed in our district Counties were informed ofthe 93% contract formula redemption requirement, and were encouraged to use the brochures "WIC Is Changing Infant Formula" and "Formula Preparation" to discuss the normal reaction to formula changes, formula preparation, feeding, and storage recommendations with moms during infant W1C enrollment and subsequent W1C screening. The District Nutrition Staff will monitor the contract redemption percentages in assigned counties. RATE OF ACCURACY OF MONTHLY FOOD OBLIGATIONS TO EXPENDITURES Objective III: Summary: As of this writing (May 1995) according to our W1C food cost projection report for February '95 the projected grant e,,:penditure for FFY is 100.12% approximately $8,722 over the original budget. However, the state has a 98.33% monthly food obligation to expenditures. CASELOAD MANAGEMENT-OBJECfIVES IV and V: Targeting Benefits-Objective IV: Our local agency is unable to determine the percentage of priorities I-III that are among our caseload. However, according to the FFY '95 participation summary for issue month: February 95, 83.64% (11,488) of the District's participation (13,734) were comprised of priorities 1-1II. (Local Agency Response continued) Early Trimester Enrollment-Objective V: According to the trimester analysis July-September 1994 priority 1-4 percentages prenatal women our agency certified only 38.52% of the prenatal women during their first trimester. Our ageucy will coutinually seek ways to eoioll prenatals early in their first trimester. QUALITY IMPROVEMENT Quality Improvement-Objective VI, VII, and VIII: Vendor Investigation-Objective VI: Each local vendor coordinator monitors WIC approved stores in assigued couuty. Written reports are submitted to the state WIC office for their review and evaluatiou ofcompliance. Quality Improvement Guidelines-Objective VII: The local agency implemented the procedur~listed in the FFY '95 Georgia WIC ProCedures Manual ou January 2, 1995. Technical assistance is provided to local county health departments staff on an as needed basis. Participation VerificationlProxy Identification-Objective VIII: The local agency will continue to follow procedures as are outlined in the food delivery and vendor sections of the FFY '95 Georgia WIC Procedures Manual. PROGRAMMATIC ADMINISTRATION , Program Administration-Objective IX, X, XI, XII: Revised Income Guidelines-Objective lX: The local agency received the WIC Income Poverty Guidelines ou March 13, 1995. Local county health departmeuts were instructed to implement the WIC income guidelines effective March 23, 1995. Local Agencies reviewed X: The West Central Health District WIC local agency review was conducted during December 1995. A written response to the corrective actions were submitted to the State WIC Office and the Office of Nutrition on March 27, 1995. The local agency is awaiting written notification of Program Review Closure. State Plan and Procedure Manual Revisions XI: The West Central Health District participated: (I) In a WIC Public Meeting during the weed of April 17-21, 1995. The verbally recorded information was prepared in typed form and submitted to the State WIC Office to review and consider for incorporation to the FFY '96 Procedures Manual. (2) Participated in a food package subcommittee meetlng and prepared revisions for the food package section. (Local Agency Response continued) Ensure Program Benefits Are Provided to Unserved Infants and Children Under the Care of Foster Parents, Protective Services, or Child Welfare Authorities, Including Infants Exposed to Drugs Perinatally-Objective XII: The West Central Health District has worked closely with program service agencies such as the Department of Family and Children Services (DFCS) to ensure program benefits were provided to the unserved infant and children population. FEDERAL FISCAL YEAR 1996 DISTRICT 8 UNIT I LOCAL AGENCY WIC PROGRAM PLAN HEALTH DISTRICT NO.8, UNIT 1 312 North Patterson Street P.O. Box 5147 Valdosta, Georgia 31603 (912) 333-5290 Fax: (912) 333-7822 WIC OBJECTIVES FOR FY '95 COtiNTIES, Ben Hill Berrien Brooks Cook Echols Irwin Lanier lowndes Tift Turner Objective I: By October I, 1995 increase the percentage of prenatal WIC participants certified in the first trimester from 46% to 50%. Outreach and staff availability will be increased to accomplish this goal. Evaluation Design: On a quarterly basis review the Trimester Enrollment Report and assess progress. Objective II: Several vendors in the district have been identified as High Risk Vendors and are creating a negative image for the WIC program. By December 1994 identify those v'endors that could be detrimental and begin monitoring on a quarterly basis for WIC program compliance and/or violation. Evaluation Design: Vendors out of compliance will be assesed sanction points. If a total of twenty-five points are accumulated the vendor will be terminated. Monitoring reports and activity will document completed investigations. Objective III: Continue to increase the monthly average of breastfed infants from 79 to 95 by October, 1995. Breastfeeding promotion will expand and assistance will be provided to prenatals that deliver at Hahira Hospital. Evaluation Design: On a monthly basis review participation reports and assess progress. Objective IV: There is a need for additional and appropriate nutrition education materials for prenatals (particularly those over age nineteen). By October 1995. review and purchase appropriate pamphlets and videos for use in health departments. Evaluation Design: Nutrition education materials will be available for both English and NonEnglish speaking prenatals. FEDERAL FISCAL YEAR 1996 DISTRICT 8 UNIT 2 LOCAL AGENCY WIC PROGRAM PLAN ,. WIC PROGRAM DISTRICT 8, UNIT 2 FFY' 96 PROGRAM PLAN 231 TIFT AVENUE ALBANY, GA 31701 DISTRICT WIC PROGRAM District ChiefcifNutritionlWIC Program Coordinator - Charlotte W. Bedell, MS,RD, LD, CPM Administrative Clerk - Karen C. Parks, AA Principal ClerklVendor Coordinator - Andrena Williams Data Transcriber - Virginia Jordan NUTRITIONISTS Principal NutritionistINutrition Education Coordinator - L. Susan Miller, BS, RD, LD Senior NutririonistlDistrict Breastfeeding Coordinator - Janice M. Newberry, BS, LD Senior NutritionistlPNSS Data Coordinator/ Worth, Lee, MCLB - Linda Moore, PhD, RD, LD NutritionistlBaker, Miller, Seminole - Michelle Akins, BS (vacant as ofJuly IS, 1995) Nutritionist! Dougherty - Valerie Bius, BS . NutritionistIDougherty, Early - Nathalie DeLannoy, BS (Dietetic Intern) NutritionistlThomas 0- Nancy Jeffery, BS, RD NutritionistlMitchell, MCLB - Dawn Vanis, BS NutritionistIDecatur, Grady - Sheila White, BS, (Dietetic Intern) Nutritionist!Colquitt -Vacant as ofJune 15, 1995 / OTHER WIC STAFF Breastfeeding Counselor/Dougherty & District - Bernice Dixon, BS Licensed Practical Nurse, Senior/Dougherty - Diane Mays Data Transcriber/Dougherty - Cornelia Stroble Data TranscriberlDougherty - Ruthie Simmons DISTRICT OFFICE PERSONNEL District Health Director - J. Paul Newll, MD District Program Manger - Barbara S. Evans, Rt"l, MSN District Nursing Director - Brenda McCook, RN, MP A District Senior Systems Analyst - Tony Clark, AA PROGRAMMATIC ADMINISTRATION OBJECTIVE I: By April 1, 1996, implement revised WIC eligibility guidelines as directed by the State WIC Office. EVALUAnON DESIGN: The District WIC Program will notify County Health Clinics of income guideline changes and implement revised guidelines as policy by April I, 1996. Action Steps ActivitiesIMeth{lds Resources Milestones I. Receive official USDNSWO notification of new income poverty guidelines. Program Management and Review Unit District WIC Program Coord. 3/25/96 2. Send memorandum to District Senior Systems Analyst (EDP Coordinator) fordistribution to County Clinics. WIC Administrative Clerk 3/27/96 3. Instructions to change WIC income eligibility in the county computer systems will be sent with implementation date of April 1, 1996. District St. Systems Analyst 3/28/96 4. Review county computer update tables WIC Administrative Clerk to assure that income guidelines were District Sr. Systems Analyst correctly updated. 4[fl/96 PROGRAMMATIC ADMINISTRAnON OBJECTIVE II: By September 30, 1996, 7 county clinics and the MCLB clinic will have been reviewed to ensure their programmatic compliance with federal Regulations, State Policies and Procedure, and District Policies and Procedures. By September 30, 1997, the remaining 7 county clinics and any additional new clinics will be reviewed to ensure their compliance with Federal Regulations, State Policies and Procedures and District Policies and Procedures. EVALUATION DESIGN: Eight (8) clinic programmatic reviews will be conducted by September 30, 1996. Action Steps ActivitieslMethods Resources Milestones 1. Finalize clinic review schedule for FFY '96 and .F:FY '97. Principal Nutritionist Data Transcriber 8/01/95 2. Complete eight reviews. Principal Nutritionist Nutritionists District Chief of Nutrition Principal Clerk Data Transcriber 7/01/96 3. Prepare clinic review reports and submit to Supervising nurse of the county clinics, District Clinical Coordinator. Same as #2 On-going within 45 days oftKe review. 4. Conduct follow-up reviews of any clinics with deficiencies less than standard. Same as # 2 On-going within 6 months of review. PROGRAMMATIC ADMINISTRATION OBJECTIVE III: By September 30, 1996, the irrununization rates that are "OK for WIC" will be at 90%in District 8, unit 2 and no clinic will have less than 88% "OK for WIC". EVALUATION DESIGN: The immunization audit will be reviewed by the District Immunization Program Director by September 30, 1996. Action Steps ActivitieslMethods Resources Milestones l. A District Immunization Protocol and District Immunization! WIC Collaboration Plan will be developed. District Chief of Nutrition District Immunization Coordinator Principal Nutritionist County Health Dept. Directors .. 8/01/95 2. Provide training.to County Health Dept. Same as:l 1 Directors and pertinent staff. 9/30/95 3. Conduct immunization audits. State Epidemiologist County Immunization staff Annually Monthly 4. Compile results and distribute to County Health Dept. Directors, District Clinical Coordinator and District Program Manager. Same as # 3 On-going / 5. Hold Post-audit Review meeting with county staff to discuss needed changes. State Epidemiologist Annually District Immunization Coordinator District Chief of Nutrition 6. Evaluate changes made to assess effectiveness. Same as # 1 Ongoing PROGRAMMATIC ADMlJ.'HSTRATION OBJECTIVE IV: By September 30, 1996, District 8, Unit 2 will continue to encourage impleme~t~tion of a comprehensive smoking cessation intervention program for WIC prenatal participants.- EVALUATION DESIGN: WIC prenatal participants will receive information at the initial certification concerning the hazards of smoking. Action Steps ActivitieslMethods Resources Milestones 1. Continue previously developed smoking cessation initiative for prenatal participants District 8, unit 2 program staff, Women's Health and Perinatal Case Management Program staff On-going 2. Monitor smokil)g cessation initiatives implemented by the county clinics. Same as # I On-going PROGRAMMATIC ADMINISTRATION OBJECTIVE V: By September 30, 1996, District 8, Unit 2 will investigate the establishment of WIC-Clinic(s) at sites other than county health departments. EVALUATION DESIGN: Sites for the establishment and expansion ofWIC clinic services will have been investigated through other agencies. Action Steps ActivitieslMethods Resources Milestones 1. Investigate establishment of a WIC clinic site at East Albany Primary Health Care.. District Chiefof Nutrition District Program Manager District Health Director East Albany Primary Health Care Administrators 12/30/95 2. Investigate the need for WIC clinic sites at other facilities who provide health care for women., infants and children. District Chief of Nutrition District Program Manager District Health Director District WIC Program Staff 06/30/96 SYSTEMS INFORMATION MANAGEMENT OBJECTIVE I: By September 30, 1996, District 8, Unit 2 aU WIC Program certifications, manilal v~~chers and other computer programs wiU be generated through the MitcheU McCormick (M&M) Public Information System. EVALUATION DESIGN: All WIC Program Operations in the county health departments wiU be computerized with the M&M Public Information System. Action Steps ActivitieslMethods Resources l\Iilestones 1. InstaU M&M computer hardware. Seminole County Health Dept. District Sr. Systems Analyst 06/30/95 2. Training will be p~ovided to the Seminole CountY CHD Staff to generate computer WIC certification forms. WIC Administrative Clerk District St. Systems Analyst 07/30/85 3. Training will be provided to the Seminole CHD staff to print WIC manual vouchers, and transmit TAnS and manual vouchers to Viking. WIC Administrative Clerk Principal Clerk 09/30/95 4. Provide training and technical WIC Administrative Clerk assistance to county health departments District Sr. Systems Analyst concerning the computerization of aU WIC Principal Clerk WIC procedures. WIC Data Transcribers Ongoing VENDOR lY1ANAGEMENT OBJECTIVE I: By September 30, 1996, District 8, unit 2 will monitor 50% of the vendors in the distnCt and will assure that all vendors had a monitoring visit within the past two years. EVALUATION DESIGN: Fifty (50) percent ofthe vendors in District 8, unit 2 will have a monitoring visit and all vendors will have a monitoring visit within the past two years. Action Steps ActivitieslMethods Resources Milestones 1. A list of all vendors, that were not monitored in FFY '95, will be generated from the vendor computer file. District Vendor Coordinator 12130/95 2. Vendors on the list 'in # 1 will receive District Vendor Coordinator a monitoring visit. 09/30/96 3. Copies ofthe vendor monitoring forms will be mailed to the SWO. District Vendor Coordinator 9/30/96 4. New vendors will receive a monitor- District Vendor Coordinator ing visit within 60 days of enrollment. On-going PROGRAM INTERVENTION OBJECTIVE I: By September 30, 1996, District 8, unit 2 will investigate improved access to the W!C Program for participants and prospective applicants who are employed or reside in rural areas. . EVALUATION DESIGN: Each Health Department Clinic in District 8, unit 2 will investigate and identify improved access to the WIC Program and prospective applicants who are employed or reside in rural areas. Action Steps ActivitieslMethods Resources Milestones 1. The Directors of the County Health Departments will be asked to investigate improved assess to the WIC Program for participants and prospective applicants who are employed or who reside in' rural areas. District Chief ofNutrition Principal Nutritionist and other Nutritionists District Program Manager District Clinical Coordinator 10130/95 2. The Directors of the County Health Departments will be requested to report their findings and plans to implement changes that will meet the objective. Same as # 1 1/30/96 3. The District WIC Program will share the ideas and plans with all the counties of the district. Same as# I 3/30/96 QUALITY IMPROVEMENT OBJECTIVE I: By September 30, 1996, seven (7) county clinics and the MCLB clinic will have been reviewed to assure that all policies and procedures related to quality improvement are implemented. - EVALUAnON DESIGN: By September 30, 1996, seven (7) county clinics and the MCLB clinic were reviewed to ensure compliance with quality improvement policies and procedures. Action Steps ActivitieslMethods Resources Milestones 1. Finalize clinic review schedule for FFY '96. Principal Nutritionist Data Transcriber 8/01195 2. Complete dght reviews. Principal Nutritionist Principal Clerk Data Transcriber 7/01/96 3. Prepare clinic review reports and submit to Supervising Nurse of the county clinics Same as #2 On-going within 45 days of the review 4. Conduct follow-up reviews of any clinics with deficiencies less than standard. Same as #2 On-goingwithin 6 months of review. FOOD INSTRUMENT ACCOUNTABILITY OBJECTIVE I: By September 30, 1996, seven (7) county clinics and the MCLB clinic will have been reviewed to assure that all policies and procedures related to food instrument accountability are implemented. EVALUATION DESIGN: By September 30, 1996, seven (7) county clinics and the MCLB clinic were reviewed to ensure compliance with food instrument accountability policies and procedures. Action Steps ActivitieslMethods Resources Milestones 1. Finalize clinic review schedule forFFY'96. Principal Nutritionist Data Transcriber 8/01/95 2. Complete eight reviews. Principal Nutritionist Principal Clerk Data Transcriber 7/01/96 3. Prepare clinic review reports and submit to Supervising Nurse of the county clinics Same as #2 On-going within 45 days of the review 4. Conduct follow-up reviews of any clinics with deficiencies less than standard. Same as #2 On-goingwithin 6 months of review. EARLY ENROLLMENT OF PREGNANT WOMEN FEDERAL FISCAL YEAR 1996 GEORGIA DEPARTMENT OF HUMAN RESOURCES DISTRICT 8, UNIT 2 1109 NORTH JACKSON STREET ALBANY, GA 31708 Charlotte W. Bedell, M.S., R.D., C.P.M. District Chief ofNutrition WIC Program Coordinator Sheila White, B.S. Nutritionist WICPROGRAM District 8, unit 2 1st Trimester Enrollment Plan INTRODUcrrON Enrollment in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) during the 1st Trimester will assure that prenatals have early access to nutritious foods, health care, and nutrition education. According to an extensive Multi-year medical evaluation supported by the U.S. Department of Agriculture (USDA) in 1986, WlC participation resulted in a significant increase in the number of women seeking prenatal care early in pregnancy and an overall decrease in the proportion of women with too few prenatal visits to a health facility. The promotion of good nutrition and health care early in pregnancy can help to prevent the incidence of low birth weight babies and reduce infant mortality. Therefore, it is essential to develop a plan to increase the number ofprenatals enrolled in the WIC Program during the 1st trimester. NEEDS ASSESSMENT In the State of Georgia WlC System Trimester Analysis Report for the 3rd quarter of fiscal year 1995, District 8, unit 2 had a first trimester prenatal enrollment rate of 52.6% of all prenatals enrolled. Further review of the report indicates that 8 out of the IS clinic sites within the district had a first trimester prenatal enrollment rate of at least 50% or above. The highest rate was 61.5% and the lowest rate was 28.6%. The lowest rate has occurred at the Marine Corps Logistics Base (MCLB) clinic which has a high number oftransfers from other clinics and other states. It is believed that the original enrollment date is much earlier that the reports indicate. This will be investigated. OBJECIlVE I: By September 30, 1996 the following objectives will be met: 1) The first trimester prenatal enrollment rate for District 8, unit 2 will increase from 52.6 % to 55 %. 2) All clinic sites within District 8, unit 2 will have a first trimester prenatal enrollment rate of no less than 50%. Action Steps Activi ti cs/Mcthods 1. WIC Information and Outreach materials to encourage early enrollment of pregnant women will be developed and delivered to the following locations: Hospitals, doctors' offices, libraries, school prenatal programs, grocery stores and DFCS. Resources District WIC Program Staff Nutritionists Couniy Health Dept. Staff 2. The nutritionist will conduct a focus group in their assigned county(ties) to address the first trimester prenatal enrollment. The focus group will include, but is not limited to, the following: perinatal case managers, nurses, WIC clerks and other pertinent people. Each group will address problems and possible solutions to increase the 1st trimester enrollment percentage. A report from the focus groups will be submitted the District WIC Coordinator. Nutritionists 3. The District WIC Coordinator or her designee will compile the results of the focus groups into a list of solutions to increase the first trimester prenatal enrollment rate. This list will be sent to all County Supervising Nurses for them to review and pick at least two solutions to implement in his/her county. Supervising Nurses, County Health Depts County Health Dept. Stafr Nutritionists WIC Program Coordinator 4. Each nutritionist will schedule an appointment with the General Manager of the three largest employment corporations in their county(ties). The nutritionist and other pertinent staff will discuss the benefits of early WIC enrollment and participation with the manager. Tile manager will be requested to cooperate in arranging time off for the pregnant woman to enroll in WIC and attend Nutrition Education classes. Nutritionists County Health Dept. Staff Milestones 11/30195 12/30/95 01/30/96 02128196 5. Each nutritionist, WIC Clerks or other Health Department staff will schedule an appointment with local area junior high or high school principals to discuss the WIC Program benefits on teenage pregnancy outcome, Each principal will be asked to offer a WIC referral to every pregnant student. 6. A referral form will be developed and provided to local physicians 10 make WIC Program prenatal referrals, The anthropometric and lab data will be utilized by the local CPA for efficient certification, Nutritionists County Health Dept. Staff Private physicians Nu'rse Midwives Nutritionists County Health Dept Staff 10/30/95 12/30/95 FEDERAL FISCAL YEAR1996 DISTRICT 9 UNIT 1 LOCAL AGENCY WIC PROGRAM PLAN EAST HEM:m DISIlUcr WIC l'RCXiRl\M PIAN FEY'95 DISIlUcr 9 1 rnAnW1/EFFINGHAM INrRaXJCITON The goal of the East Health District WIC Program is to provide comprehensive health and nutrition services that en=urage ~lness, healthy life styles by directing efforts toward prevention, identification and treabnent of nutritional problem to as many low-incane ~, infants and children as p:Jssible. An average of 8,070 p3.rticipants or 47.70% were enrolled on WIC in FFY'93. Based on ranking of Districts by need, WIC p:>tential p:Jpulation is 16,918. The p:>pulation at risk include pregnant, breastfeeding and p:Jstp3.rturn v.anen, infants and children less than five years of age. studies have shown that an inadequate diet or poor nutritional status is linked to low bi.rthweight infants, iron deficiency anemia and short statue in children, malnutrition and other related problems. WIC contributes to the over all effort in decreasing nutrition related .problems .by providing nutritious foods along with nutrition education and referrals to other servi"Ce5. Factors that contribute to reduced services single parent households, transp:Jrtations problems, clinic schedules that do not meet the needs of \>1:)rking parents, and the lack of o::rnplete coordinated health services. East Health District WIC services are provided at all five Health deparbnent sites, Westside Urban Health (2 locations), Memorial Medical center OUtpatient Clinic, Tuttle Military Clinic and st. Pius X Family Resource center. '!be District plan outlines strategies for arlministering the WIC Program in Olatham/Effingham =unties. Program functions include: Programnatic Administration, Food instrument accountability, Vendor management, System Infonnation management, Quality Improvement, Provision of services to prenatal, WIOrking IlOthers, and Participants residing in rural areas. EAST HEALTH DISTRICT WIC PROGRAM PLAN FFY 95 DISTRICT_ _9'-1f'-"1 _ FFY 95 DISTRICT NUTRITION COORDINATOR: _:.;Pa::.;t:...:J:;:a:;:ck.s=o:,:n=-- _ OBJECTIVE: 1. 2. By June 30, 1995 with current staff; maintain caseload of 8,000 eligible WIC participants. By september 30, 1995 increase average non participation rate from 15% to 10% or below. EVALUATION DESIGN: Review systems indicators,annis reports Ironthly ~CTION STEPS/ACTIVITIES/METHODS RESOURCES 1 Extend outreach materials to local churches, beauty salons and other non health delivery services. 2. Continue to provide WIC referrals to local physicians Continue media marketing 4. Continue implementation of District's Non-Participation Policy WIC STAFF NPC NPC WIC STAFF MILESTONE OF ACTIVITIES On-going On-going an-going <:n-going EAST HEALTH DISTRICT WIC PROGRAM PLAN FFY '95 PROGRAMMATIC ADMINISTRATION DISTRIC"l'_ _"",9,:.;_1::.- _ FFY 95 lISTRICT NU;'RITION COORDINATOR: --P-at=J.ac:k:so:n. =....~~:..-_--------- lBJEC'IIVE: By September 30, 1995, complete review of all 10 clinics based on policies/ procedures to ensure programmatic compliance. :VALUATJ:ON DESIGN: Reviews will be completed by September 30, 1995 ~J:ON STEPS/ACTIVITIES/METHODS RESOURCES Finalize review schedule ~. Complete reviews 1. Summarize and review findings with clinic staff Secretary/Typist NPC NPC NPC MILESTONE OF ACTIVITIES June 30, 1995 September 30~- 1995 September 30, 1995 EAST HEALTH DISTRICT WIC PROGRAM PLAN FFY' 95 DISTRICT k9.~1~ PROGRAMMATIC ADMINISTRATION __ FFY 9S !STRICT NU~RITION COORDINATOR: __~P~a~t~J~a~c~k~s~on~ __ llT "VE: Continue "Atliens Mode" to enhance the coordinator of WIC/ItmIlunization Services. lALUATION DESIGN: Review DistrictP!I:'otocol :ION STEPS/ACTIVITIES/METHODS RESOURCES Continue District's Integration of WIC/Immunization Services Policy Local Agency Staff MILESTONE OF ACTIVITIES On-going EAST HEALTH DISTRICT W1C PROGRAM PLAN FFY 95 FOOD FllNDS HANAGEMENT DISTRICT_ _9"".:..!1__. _ .... FFY 95 ISTRICT NUTRIT~ON C'?ORDINATOR: ---P:a;t.:Ja:c:k.s..o.n.::..::::::::.::.::..._------------ aJECTIVE: Based on System's Indicators, District 9.1 average Formula rebate % February/ 4rch 1995 was 77.53%. According to state calculations, we must at all times have a minimum 'f 93% of all infants on Contract Formula. This formula is either Enfamil with Iron, 'rosobee, or Lactofree. By September 30, 1995, issue Contract Formula to at least 93% of he infants certified for WIC. lALUATION DESIGN: Review System's Indicators Report as needed. rION STEPS/ACTIVITIES/METHODS RESOURCES l. Distribute handout to all new prenatals. 2. Contact local physicians. WIC Staff NPC Nutritionist 3. Monitor Concentrate Rebate Compliance NPC Report MILESTONE OF ACTIVITIES On-going June 1, 1995 As needed EAST HEALTH DISTRICT W1C PROGRAM PLAN FFY' 95 Dl:snuC'l' 9i:.:.~1 VENDOR MANAGEMENT _ FIT 95 . . . . _ - - - - - - - - - - - ISTRl:c:r NUTRITION COORDINATOR: -.,P,a;t=.J.a;c:k.s:o:n=~ )BJ IVE: By September 30, 1995, complete 100% Vendor Monitoring. VALUATION DESIGN: Review District's Vendor monitoring procedures. ~ION STEPS/Ac:rXVITIES/HETHODS RESOURCES MILESTONE OF Ac:rIVITIES Establish review schedule based on needs. Vendor Coordinator March 1, 1995 \ P-'iew Vendors/Submit report to :rict/State WIC Office Vendor Coordinator Quarterly - \ >. Conduct Annual Vendor Training Vendor Coordinator September 15, 1995 \ EASTHEALTH DISTRICT WIC PROGRAM PLAN FFY 95 SYSTEMS INFORMATION MANAGEMENT DISTRIe:t'_ _9......1.._ _-,- _ FFY 95 IISTRIe:t' NU'J;'RITION COORDINATOR: _.:.P::.a::.t..:J~a~c~k:::.s~on::.... ~." _ IBJECTIVE: By January 31, 19S5, complete implementation of ATVS modems communication to Viking. VALUATION DESIGN: Modem Installation at all clinic sites. ~ION STEPS/ACTIVITIES/METHODS Complete Modem Installation for each clinic .. Train staff. I, Implement Communication Schedule RESOURCES District MIS Unit MIS Unit NPC MILESTONE OF ACTIVITIES January 31, 1995 January 31, 1995 January 31, 1995 EAST HEALTH DISTRICT WlC PROGRAM PLAN FFY 95 QUALITY IMPROVEMENT DISTRICT_ _9::.,.:.:;1 _ FFY 95 :STRIc.r NUTRITION COORDINATOR: -P-at :Jac:kso~n =~~---------- wn .VB: To continue Quality Improvement guideline based on Policies/Procedures in addressing potential program abuse. 'ALUATION DESIGN: Clinic Reviews 7ION STEPS/ACTIVITIES/METHODS RESOURCES Continue Monthly Review of Clinic Close NPC outs procedures. (VC"'-her Register. Manual Voucher copies, Secretary/ M 11 Voucher inventory) etc. Typist MILESTONE OF ACTIVITIES On-going EAST HEALTH DISTRICT W1C PROGRAM PIAN FFY' 95 PROGRAM INTEGRATION DISTRICT- - =9.1" " - - - - - - - FFY 95 CSTRICT NUTRITION CqQRDINATOR:--P=at =Ja.ck.s.o:n;;;=,;;,;:..------------- iJECTIVE: By January 30, 1995, establish an interagency network for information and resources sharing to provide and improve program service for women, infants and children. lALUATION DESIGN: Collabrate and attend meetings with other agencies. (All Kids ,ount, Healthy Start, Youth Futures, Head Start, EFNEP, CMS) Food Stamp, medicaid and ,thers) rrON STEPS/ACTIVITIES/METHODS RESOURCES MILESTONE OF ACTIVITIES L. Contact Agency Representative NPC On-going to receive 95 meeting schedule. \ I 2. Attend meeting or send representative NPC On-going \ \ I EAST HEALTH DISTRICT W1C PROGRAM PLAN FFY' 95 PROVISION OF SERVICES TO PRENATALS DISTRICT_ _9~.:.=I _ -" FFY 95 ISTRICT NUTRITION COORDINATOR: --P-a:t:J.a=ck:s:on...::.==:::::._------------ BJ. VE:l.By,June 30, 1995 increase first trimester enrollment for eligible prenatals from 32.45% to 40%. 2. By September 30, 1995 continue implementation of the smoking cessation. v.ALUATION DESIGN: 1. Review Records, Quarterly Trimester Enrollment Report. 2. Focus groups, surveys. rION STEPS/AC'I'IVITIES/ME'I'HODS RESOURCES Implement WIC enrollment at first'clinic Nurses visit (positive test) Nutritionist L .uss Implementation plans with NPC Nursing Supervisors. Continue follow-up. NPC MILESTONE OF AC'I'IVITIES June 30, 1995 June 15, 1995 September 30, 1995 EAST HEALTH DISTRICT W1C PROGRAM PLAN FFY' 95 DJ:STRJ:CT_ _9::.:.~1 PROVISION OF SERVICES - WORKING/RURAL PARTICIPANTS _ FFY 95 .. :STRJ:CT NUTRITION COORDINATOR: Pat Jackson --'=...;;,;;;=~------------- UECIIVE: By June 1, 1995, improve access to WIC for participants who are employed. TALUATJ:ON DESIGN: 1) Implement Surveys 2) Modify clinic schedules as needed ~ION STEPS/ACTIVITIES/METHODS RESOURCES Assess evening clinic hours for West Side. Urban, York Street. WIC Staff Assess Saturday clinic hours at Family WIC Staff Resource Center. MILESTONE OF ACTIVITIES July 1, 1995 July 1, 1995 FEDERAL FISCAL YEAR 1996 DISTRICT. 9 . UNIT 2 LOCAL AGENCY WIC PROGRAM PLAN SUMMARY REPORT LOCAL AGENCY PROGRAM PLAN FFY'95 SOUTHEAST HEALTH DISTRICT 9,2 Several projects were undertaken throughout this fiscal year that were intended to improve the programmatic administration of the WIC Program in SEHU, District 9,2. 1. In October, 1994, training was required for all local county WIC clerical staff who are responsible for voucher issuance and TAD submission to Viking Computing. Training was targeted toward prevention and reconciliation of the CUR report. From October, 1994, through June, 1995, technical assistance has been provided by local agency WIC staff to assist counties in decreasing their CUR reports. . Prior to.this training, cumulative unmatched redemptions totaled $5800.00 for Part 2 (not matched to a record of certification) based on CUR Report for October, 1994, 11-10-94. As of April, 1995, CUR Report, 5-11-95, there has been a 40% decrease in CUR report Part 2, down to $3500.00. We are continuing to work toward decreasing Part 1 CUR. Completed installation and activation of modems in all clinics should make a significant impact on the CUR. 2. The last statewide clerical training was conducted by the SWO in 1986. Since that time there have been many staff changes in the health departments of District 9,2. Current staff have, for the most part, been trained by staff currently working in the clinics and by letter and verbal instruction from the District WIC staff. Assessments of system indicators reports for the district have indicated a need for clerical training to improve such areas as critical errors, voided voucher rates, manual voucher rates, sub-certs overdue, etc. Page Two Summary Report Southeast Health District 9,2 Two district-wide clerical in-services were planned so that all clerical staff could rotate out of the clinic to attend: May31, June 1 &2,1995 August 28-30, 1995. Participant evaluations completed following the first training have indicated increased understanding of the above named indicators. Upcoming monthly WIG reports and FFY'96 SWO Agency Review will show improvements in program administration at local health department clinics. 3. The SEHU District WIG Program's goal for FFY'95 has been to complete an on-site WIG review in each of 20 clinics that provide WIG services. As of October 31, 1995, all 20 WIG clinics will have been reviewed using the Local Agency Monitoring Tool provided in the Georgia WIG Procedures Manual, FFY'95. Reports of these reviews will be on file in the District WIG Office. District 9, Unit 2 FFY'96 PROGRAM PLAN OBJECTIVE I - SYSTEMS INFORMATION MANAGEMENT: By April 1, 1996, expand ATVS and Mitchell and McCormick Computer Systems in all 21 clinics of District 9, 2, to include operational modems. EVALUATION DESIGN: Modems installed in all 21 clinics will transmit voucher issuance and TAD information to Viking Computing or allow automatic collection as needed. ActiOn Steps Activities/Methods Resources Milestones 1. Assure that all clinics have either external or internal modems for computer systems and that they are operational. WIC Office Supervisor Local WIC Clinics 10/31/95 2. Install software into computers at local WIC clinics and activate modems. WIC Office Supervisor SEHU EDP Coordinator EDP Staff SWO 12/31/95 3. Establish frequency of transmissions and/or automatic data collection timeframes with local WIC clinics WIC Office Supervisor Viking Computing SWO 04/01/95 4. Provide training and technical assistance to local WIC clinics. WIC Office Supervisor SEHU EDP Coordinator EDP Staff SWO Ongoing through 9/30!96 OBJECTIVE II - PROGRAM INTERVENTION: By September 30, 1996, decrease the WIC non-participation rate for District 9, 2. EVALUATION DESIGN: WIC Program non-participation rate will decrease to less than 10% of WIC certified caseload. Action Steps Activities/Methods Resources Milestones 1. Identify clinics. with extended or-nontraditional hours. WIC Coordinator 10/31/95 2. Develop a plan for modifying clinic schedules to offer WIC services during evening clinic hours or other nontraditional hours for WIC participants with special needs. WIC Coordinator 04/01/96 SEHU Nursing Coord. Local Clinic Nurse Mgrs. 3. Work with all local WIC clinics to utilize appointment systems for increased availability of WIC services. Present suggestions at WIC/Nutrition Nursing Update, Fall, 1995. WIC Coordinator SEHU Nursing Coord. Local Clinic Nurse Mgrs. 12/31/95 OBJECTIVE III - FOOD FUNDS MANAGEMENT: By September 30, 1995, SEHU will issue contract formula to 93% of nonbreastfed infants certified for WIC. E:VALUATION DESIGN The Concentrate Rebate Compliance Report for close-out month of September, 1995, will show a concentrate formula compliance rate of at least 93% for District 9,2. Action Steps Activities/Methods Resources Milestones Identify local WIC clinics that are below the state average of compliance. WIC Coordinator Meet with Nurse Managers in targeted local clinics to develop plans for increasing contract formula compliance. WIC Coordinator Organize a district work group to review policies for accepting prescriptions for milkbased and special formulas. WIC Coordinator Child Health Coord. SEHU Nursing Coord. 10/31/95 12/31/95 04/01/95 FEDERAL FISCAL YEAR 1996 DISTRICT 9 UNIT 3 LOCAL AGENCY WIC PROGRAM PLAN NO PLAN SUBMITTED FEDERAL FISCAL YEAR 1996 DISTRICT 10 UNIT 0 LOCAL AGENCY WIC PROGRAM PLAN NO PLAN SUBMITTED FEDERAL FISCAL YEAR 1996 DISTRICT 11 UNIT 0 LOCAL AGENCY WIC PROGRAM PLAN SOUTHSIDE HEALTHCARE~ INC. ANNUAL PROGRAM PLAN, FFY '1995 Introduction District 11, Unit ~Women, Infants and ChildTens Program objective is to Gontinue to: Develop and maintain programs that will teach and increase Early Trimester enrollment; Capture all High risk participants and continue intense education; maintain a sound immunization program and improve all progi-amatic administration programs with inservices and follow-up supervision. Listed below is a summary ofDistrict II, unit ";8 program objectives for FFY' 95. Summary of EX' 95 objectives The summary of each objective provides details concerning each accomplishment of efforts made to meet the objective. Objective I - Food Fund Management Maintain 95% or aboyc'percentage ofInfants ~rtified for WIC on contracted formula. Objective 1- Summm During FFY' 95, 96% ofInfants certified for WIe received contracted formula. With proper meetings and physicians Inservices the coordinated efforts were measurable and compliance increased. :lhjective II - Caseload Management 50% of all prenatal women will be certified for WIC in their First Trimester. )bjective II Summary A continued effort with Obstetrical/Gynecological medicine and their same day referral of all lrenatals to our walk-in clinic helps to increase first Trimester enrollment. Jbjective III- Programmatic Administration To implement a coordinated Immunization program. Jbjective TTl - Summary . _. All Infants and Children, at certification were a:.k:ed to provide a Gold Certificate for proof of rnmunization. Vouchers are paced accordingly. FFY' 96 Program Objectives Objective I - Food Fund Management . During FFY' 96 93.65% or more ofInfants certified for WIC will receive contracted formula. Eyaluation Design: To tract all non-contracted formula prescription and conduct a self audit to assess patterns and yearly comparison. Action Steps Act I Methods 1. Conduct Department inservices 2. Conduct Insexvices to IPhysicians and m~dical staff. 3. Conduct self-audit to assess patterns 4. Review and develop corrective actions as needed Resources WIC Coordinator Nutritionist WIC Coordinator Nutritionist WIC Coordinator WIC Coordinator Milestones I Annually 10-30 Annually 10-30 Bi annually 2-30 & 8-30 Bi annually 2-30 & 8-30 Objective TJ - CaseJoad Man3gement 55% of prenatal women will be certified for WIC in their First Trimester. Evaluation ~: To review quarterly 1st Trimester report from the State Office, to conduct self assessments at time of certification to find out why? or why not? a participant didJor did not enroll in WIC earlier. Action Steps Act / Methods 1. Continue open !communication with OB for all prenatal referrals 2. Conduct self audit to Idetermine enrollent patterns 3. Educate client on the importance of early enrollment Resources WIC Coordinator WIC Coordiantor Nutritionist Nutritionist Milestones Ongoing 10-1 to 09-30 3-96 Ongoing 10-1 to 09-30 Objective III - Programmatic Administration All infants and children will be immunized. Evaluation Desjgn: At certification the paitiCipant Will be assess for a current Gold Certificate. An active list will be maintained and Follow-up validation will be noted in next months voucher register. Action Steps 1. Inservice Pediatric ))epartment staff on the importance oftheir cooperation for client request for current Gold Certificate 2. Develop Tracking for Follow-up needed to acquire cun-ent Goid Certificate from participant 3. Implement voucher pacing system Resources WIC Coordinator Staff Milestones Ongoing 10-1 to 09-30 WIC Coordinator .. Nutritionist 10-9(i WIC Coordinator Clerks 11-96 Objective IV - Programmatic Administration All eligible WIC Participants will be asked to register to vote via moter voter registration. Evaluation Design: Review Summary sheets for voter registration and compare declination vs. accetptance vs. number of adults schedules for certification. Action Steps 1. Conduct inservices for all WIC staff 2. Review all completed Ivoter registration forms 3. Observe clerk when idata is being collected Resource WIC Coordinator WIC Coordinator WIC Coordinator Senior Clerk Milestones bi annually 1-30 & 07-30 ongoing 10-1 to 09-30 on going 10-1 to 09-30 Objective Y - (Quality Improvement): Beginning October, 1995, Self Reviews will be conducted. Evaluation Design: The monitoring Tool will be uses to assess program procedures and determine if action is needed to correct deficiences. Action Steps 1. Set a date for clinic to be reviewed 2. Complete review and develop a report 3. Complete summary and any needed training for District 4. Train staff on .. corrective actions Resources WIC Coordinator Nutritionist WIC Coordinator WIC Coordinator WIC Coordinator Milestones 10-1 annually 5-96 7-96 9-96 FEDERAL FISCAL YEAR 1996 DISTRICT 12 UNIT 0 LOCAL AGENCY WIC PROGRAM PLAN FY 1996 Program Plan for District 12-{) Objectives Problem Statement In order for the WlC program to have the greatest positive impact on pregnancy outcome, it is imperative that she receive prenatal care and WlC as early in pregnancy as possible. Objective 1 Program Administration By September 30, 1995 the Grady WlC program will increase the percentage of prenatal clients enrolled during the first trimester from 56% to 65%. CWe are limited here by the fact that we cannot enroll patients on WlC until they enter the Grady system for prenatal care. The Grady OB clinic is also working on strategies to encourage early prenatal care. These strategies will in tum benefit our objectives.) Strategies: 1. Provide inservices to Grady OB clinic staff which encourge staff to refer patients to WlC during the first trimester. 2. Continue to proVide walk-in service to all prenatal WlC clients. Evaluation: This objective will be evaluated through the use of the State of Georgia WlC System Trimester Analysis Report. Problem Statement Because many WlC participants are employed, it is important to make arrangements for them to receive services without negatively impacting their employment. Objective 2 The Grady WlC program will make arrangements to provide services to working mothers. This is done on an ongoing basis and within the constraints of the Grady system. . Strategies: 1. The Grady WlC program will be open during all hours that the health clinics we operate in are open. This includes Saturday morning hours for the infant WlC clinic and evening hours for Lindbergh. (The exception to this is the Boatrock clinic where we are there two days a week based on caseload.) 2. When possible, WlC clinics will be staffed to offer service during the lunch hour. Problem Statement Unfortunately, the Grady WlC program has had difficulty with missing or stolen vouchers. Therefore, this area of operations is of the utmost importance. Objective 3 Food Instrument Accountability All food instruments will be properly accounted for at all times. Strategies: 1. Follow all procedures as outlined in the Georgia WlC Policy and Procedure Manual with regard to food instrument accountability. 2. Analyze clinics that have had problems with food instrument accountability to assess problem areas. 3. Institute a bank teller system in clinics with identified problems. Evaluation: This objective will be evaluated through the use of yearly audits of each clinic. Objective 4 System Information Management By september 30. 1996 the ATVS system and the equipment used to operate it will be run in the most efficient manner possible, given monetary and technological constraints. Strategies: 1. We will continuously assess equipment needs to update equipment as needed. 2. Purchase soflwqre to improve the speed of computer back-up and batching operations. Evaluation: This objective will be assessed through the yearly audits of each clinic. The state audit tool (which includes a system information section) will be used. Problem Statement In recent months, the Grady WlC program has seen our unclaimed rate increase to over 11%. Although this is partly due to staff shortages, we will also be implementing other strategies. Objective 5 By September 30, 1996 the unclaimed rate for District 12-0 will be less than 10% Strategies: 1. Contact all clients who have not picked up their vouchers by the third week of the month. 2. Continuously update phone numbers and addresses to aid in contacting clients. Objective 6 Financial Management District 12-0 will continue to manage WlC funds in a manner consistent with WlC program rules and regulations as outlined in the WlC Policy and Procedures manual. Strategies: 1. Conduct a yearly time study. 2. Accrue expenses and submit expense reports in accordance with WlC regulations. Problem Statement The Grady WIG program continuously strives to operate a=rding to WIG program regulations. Conducting self audits during the year is an aid to assessing program operations and to correcting problems in a timely manner. Objective 7 Quality Improvement District 12-0 will continue to conduct yearly audits on each of the six clinics. Strategies: 1. At the beginning of each fiscal year, a schedule will be developed which provides for at least one yearly audit of each clinic. 2. Each clinic will be audited based on the schedule. The state monitoring tool will be used for this purpose. 3. A summary of findings and recommendations will be kept on file in the district office. Evaluation: The summaries of each audit will be proof that the audits were conducted. Objective 8 Program .Iiltegration By September 30, 19.96 each Grady WIG clinic will be integrated into their respective health clinics. . . Strategies: 1. WIG program enrollment will continue to be included as a service to eligible patients receiving care in locations where we operate WIG. 2. A system will be put into place to ensure that all eligible patients are referred to the WIG program. This will involve continuous inservicing of non-WIG staff. 3. WIG appointments will be coordinated with physician appointments. Evaluation: This objective will be audited through the use of yearly clinic audits. OFFICE OF NUTRITION DIVISION OF PUBLIC HEALTH GEORGIA DEPARTMENT OF HUMAN RESOURCES Georgia State Plan for Nutrition Education in the Special Supplemental Food Program for Women, Infants, and Children (WIC) Fiscal Year (October 1, 1995 to September 30,~22~) Submitted in accordance with USDA Food and Nutrition Service Federal Regulations 246.4 - State Plan Federal Regulations 246.11 - Nutrition Education August, OFFICE OF NUTRITION Director Frances Hanks Cook, M.A., R.D., L.D. WIC Nutrition Program Consultants NPC - WIC (1) Carol MacGowan, M.P.H., L.D. NPC - WIC (2) Marilyn Hughes, M.S., R.D., L.D. NPC - WIC (3) Donna Henry, M.P.H., R.D., L.D. Child Health Section/Women's Health Section/ Office of Adolescent Health Nutrition Program Consultant NPC - CH Cathy McCarroll, M.P.H., R.D., L.D. State Breastfeeding Promotion Coordinator NPC - WIC (1) Carol MacGowan, M.P.H., L.D. Support Staff SS (1) Kathryn Thompson, Senior Secretary SS (2) Beverly James, Project Coordinator STATE WIC PLAN- OFFICE OF NUTRITION TABLE OF CONTENTS Introduction Quality Assurance Model . . . . . . . . . . . . . . . . . . . . . . . . . . . :.. 2 Summary of Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 3 Needs Assessment I 5 Objective I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 6 Needs Assessment II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8 Objective II _..' . . 9 Needs Assessment III 10 Objective III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11 Needs Assessment IV 18 Objective IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 19 Needs Assessment V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 21 Objective V 22 Needs Assessment VI 24 Objective VI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 25 Needs Assessment VII . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 27 Objective VII 28 Needs Assessment VIII 29 Objective VIII . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 30 Needs Assessment IX 32 Objective IX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 33 Budget 35 STATE WIC PLAN- OFFICE OF NUTRITION INTRODUCTION ltil' The Fiscal Year Georgia WIC Nutrition Education Plan was developed to address the health outcomes and programmatic aspects of the nutrition education component of the Georgia WIC Program. The Program needs assessment was based on: 1. Identification of health and nutrition problems of women, infants and children in a . Georgia, including those participating in the WIC Program; 2. Program review reports conducted during Fiscal Year ~~ (October I, to September 30, ~~); 3. Evaluation of the Fiscal Year Georgia WIC Nutrition Education Plan; 4. Assessment of participant views conducted at tl\e local agencies through consultation, site visits, and participants Focus Groups; 5. WIC Participant Totals Report for March, 1994; 6. WIC Program Breastfeeding Study conducted in 1991 and 1992. 7. Quality assurance model outlined on page two (2); 8. Requests received by the Office of Nutrition. The Georgia Department of Human Resources continues to make progress towards reaching its long range goal which is "A healthier generation of Georgians through primary prevention of physical and mental disabilities with early intervention and treatment." Concurrently, the goal of the Office of Nutrition is to improve the nutritional status of individuals by directing efforts toward prevention, identification, and treatment of nutrition problems. Nutrition education is the most integral strategy utilized in reaching this goal. As the Georgia WIC Program begins Fiscal Year the Georgia Department of Human Resources currently provides prenatal care services for one third of all pregnant women in this State. The infant mortality rate is 10.3 deaths per 1,000 live births in 1992. Although the Georgia infant mortality rate and percentage of low birth weight infants remain high, the nutrition services provided through the Program are making a significant impact on the solution to these multifactorial issues. Nutrition education is provided through individual participant counseling and group nutrition education classes. Both methods are developed by assessing the individual's or group's needs and developing a plan to address these needs. Implementation of nutrition education utilizes a variety of patient nutrition education materials including, but not limited to, pamphlets, slides, video tapes, food models, flipcharts, and posters. The Office of Nutrition is charged with the responsibility to supply the guidance and support needed by local agencies in the provision of effective nutrition education services. STATE WIC PLAN- OFFICE OF NUTRITION QUALITY ASSURANCE MODEL FOR NUTRITION SERVICES I. Division of Public Health and Office of Nutrition Goal: To improve the health status of participants by assuring the provision of high quality nutrition services. II. V. Establishment of structure, process, outcome criteria, and standards for nutrition services. A. Program standards 1) Community assessment/ planning 2) Nutrition assessment 3) Nutrition education 4) Referral 5) Documentation 6) Evaluation 7) Staff recruitment and training B. Guidelines for Practice C. Program and participant outcomes ill. Improvement of program standards. IV. Selection and interpretation of alternatives for program standards. A. Training/continuing education B. Resource assistance C. Management/operational changes D. Policy revisions Assessment of degree. of discrepancy between criteria and program participant outcomes and program standards. A. Nutrition surveillance B. Problem oriented record reviews C. Program reviews ADAPTED FROM THE LANG'S MODEL STATE WIC PLAN - - 2- OFFICE OF NUTRITION Summary of Objectives fil!I~~ NUTRITION EDUCATION PLAN Objective I: By September 30, ili~, ensure that 100% of local agencies have documented the provision of: a. basic nutrition education contacts to 100% of WIC participants; b. secondary nutrition education contacts to.. 100% of WIC participants; c. referral screening for 100% of WIC participants; d. prescriptions for 100% of WIC participants receiving special formulas; e. dietary intakes (I.e., 24-hour recall, food frequency, diet history, etc.) for 100% ofWIC participants; f. summary and evaluation of dietary intakes for 100% of WIC participants. Objective IT: BySeptember 30, i~.~, evaluate the system for collecting health data (CDC Surveillance). Objective ID: To continue to increase the percentage of WIC infants in Georgia who are initially breastfed from !mIl] and who are breastfed until six (6) months of age from 9 % to 12 % by September Objective IV: By September 30, t2g~, provide nutrition education services to local agencies, and the general public by: a. having appropriate education materials available and accessible to local agencies and the general public; b. providing program planning and technical assistance to local agencies; c. completing the Fiscal Year ~~~i Nutrition Education Plan. Objective v: By September 30, ~g~, meet the training needs of persons responsible for providing nutrition education and WIC Certification services by: a. providing inservice training and technical assistance to local agencies and State nutrition staff. b. promoting the implementation of the American Dietetic Association AP4 Program for Georgia Public Health Nutritionist. STATE WIC PLAN- -3- OFFICE OF NUTRITION Objective VI: Develop and monitor the use of the Georgia Nutrition Guidelines for Practice by September 30, I~. Objective VU: Bit By September 30, continue to target WIC services to the homeless in Fulton County. STATE WIC PLAN- -4- OFFICE OF NUTRITION NEEDS ASSESSMENT I In Fiscal Year 1987 a program review system was instituted in which 20% of the State clinics would be randomly selected for review. Additional clinics are selected in order to assure that at least 20% of the clinics (up to a maximum of 5) in each local agency are reviewed. In Fiscal Year '92 the State began reviewing each local agency every other year. The largest clinic in each local agency will be automatically included in each review, since it represents a majority of the participants in the local agency. The record selection for local agency reviews is weighted towards women; 50 of the health records selected are women's, and 50 % infants' and children's. Results of the reviews are used to determine where the State stands relative to selected areas of certification, and allows the Office of Nutrition to examine trends and identify problems. The results provide rationale felr making changes in policies, procedures and workplans, and planning for the provision of appropriate training and technical assistance. summary of program reviews conducted during Fiscal Years 1993 and 1994 revealed the following: 1. The documented provision of basic nutrition education contacts remained at 96 % in Fiscal Years 1993 and 1994. 2. The documented provision of secondary nutrition education contacts remained at 78%. 3. The documentation for dietary intake and evaluation was 96%, up from 91 % in Fiscal Years 1991192. 4. The documentation for nutritional risks was 89% up from 78% in Fiscal Year 1991192. 5. Plotting of anthropometic measurements was appropriate in 90% up from 89% in Fiscal Year 1991192. 6. Documentation for encouragement to breastfeed was 81 % up from 71 % in Fiscal Year 1991192. STATE WIC PLAN- -5- OFFICE OF NUTRITION OBJECTIVE I: By September 30, _ , ensure that 100% of local agencies reviewed have documented: a. provision of basic nutrition education contacts to 100% of WIC participants; b. provision of secondary nutrition education contacts to 100 % of WIC participants; c. prescriptions for 100% of WIC participants; d. dietary intakes (Le., 24-hour recall, food frequency, diet history, etc.) and evaluation for 100% of WIC participants; e. appropriate nutritional risk assessment for 100% of WIC participants; f. accurate plotting of anthropometric measurements for 100% of WIC participants; g. encouragement to breastfeed for 100% of prenatal participants. EVAIJIATION DESIGN: Comparison of the program review report from Fiscal ~~I$j'!Qi~~:@1~.::.!~~!~, with Fiscal~. ~l2~S~. Action Steps ActjvjtieslMpfhods Resources Milestones I. Produce a summary of program review findings conducted during Fiscal ~ jt[~~ and f!l~l NPC - WIC (3) 2. Conduct a comparison of program review reports from Fiscal Years ~ll~!i~j@1pn!~~$lf~~. NPC - WIC (3) 12/311~ 12i311~~ 3. Based on the above assessment and comparison, identify specific areas or local agencies that require technical assistance. 4. Investigate and develop appropriate methods for the alleviation of any deficiencies, (e.g. form revisions, training, alternative methods of delivering and documenting services). NPC - WIC (3) ALL NPC - WIC 6 6/30/~q STATE WIC PLAN- - 6- OFFICE OF NUTRITION Action Steps ActivitieslMetbods 6. Revise FFY l~J~R review tool as needed. 7. Continue to research and update Nutrition Risk Criteria. 8. Conduct 10 local agency WIC Program reviews per year. 9. Monitor the health management of all WIC infants discharged on hospital - based special formulas through local agency program reviews. Resources ALLNPC-WIC NPC - WIC (3) ALLNPC- WIC ALLNPC -WIC Milestones 9/3~6 9/30/~p 9/30lQp STATE WIC PLAN - -7- OFFICE OF NUTRITION NEEDS ASSESSMENT IT Georgia's Pediatric Nutrition Surveillance System (pedNSS) tracks the nutritional status of the Georgia WIC pediatric population through anthropometric and hematological measurements. A close relationship exists between optimal nutritional status and positive health outcomes. Thus improvements made in WIC participants' diets, through nutrition education and food supplementation, should contribute towards improved nutritional status and health outcomes. The WIC population is at increased risk for health problems by nature of the Program's requirements for eligibility: low economic status and high nutritional risk. Measurements tracked by the PedNSS are strong indicators-for WIC Program success in Georgia as a significant number of WIC infants and children in ~~,!11 were nutritionally eligible based on anthropometric and/or hematological risks. Data from the i~~ Georgia PedNSS show the percentage of children enrolled in Georgia's WIC Program falling below the 5th or above the 95th percentile as follows: Ideally, no more than 5% of children should fall below 5% or above 95% in height for age and weight for height, respectively. STATE WIC PLAN- -8- OFFICE OF NUTRITION OBJECTIVE U: By September 30, lf~, evaluate the system for collecting health data (CDC Surveillance). EVALIIATIDN DESIGN: Completion of the evaluation of the system. Action Steps AetivitieslMethods ReS0I1rces Mjlestones I. Work with assigned districts on utilization methods of the Pediatric Nutrition Surveillance System within the local agency Nutrition Education Plan. 2. Provide annual reports of PedNSS data to all health districts. 3. Facilitate the use of monthly surveillance data in local health clinics for targeting WIC services to children at highest risk. 4. Work with all districts to incorporate Pregnancy Nutrition Surveillance system into the District WIC Programs. NPC - WIC (1,2,3) _ NPC - WlC (3) NPC - WIC (2) Qllitlllj ~lilg~ ~t(lllm STATE WIC PLAN- -9 - OFFICE OF NUTRITION NEEDS ASSESSMENT ill The Georgia Department of Human Resources, Division of Public Health Position Paper on Breastfeeding states that if the children of Georgia are to be healthy and strong, it is essential that they receive the best possible nutrition when they are infants. Research findings have documented the benefits of human milk and lactation, and support the concept that breastfeeding is one of the most important factors in ensuring optimal infant health and reducing high infant mortality. In addition to the nutritional benefits for the infant, breastfeeding offers unique physiological and psychological advantages to both the mother and the infant. The 1984 Surgeon General's Workshop on Breastjeeding and Human Lactation recommended expanding the knowledge of health providers through. continuing education programs and establishing breastfeeding support networks. A sound program of information and support is necessary to promote the successful establishment and maintenance of breastfeeding. Such a program should be integrated into the health care system and should encompass both the prenatal and postpartum period. A prospective infant feeding study was conducted in 1986-87, the purpose of which was to set a base-line and determine breastfeeding patterns of women attending WIC clinics in Georgia. The study results indicated 24% of these women initially breastfed; however, only 6% continued for 6 months or longer. In 1990-91, the breastfeeding study was again conducted in the Georgia WIC population. Data indicated that the rates of breastfeeding had increased to 35 % for initiation of breastfeeding and to 8 % for a duration of 6 months or more. These studies allowed the Office of Nutrition to start monitoring breastfeeding trends in the WIC population, set educational objectives, train public health staff, and design programs to promote breastfeeding as part of Georgia's commitment to raise a healthier generation of Georgians. In FFY 1994, the Office of Nutrition coordinated the development of the Infant Feeding Characteristics System. Using data derived from the Infant WIC Assessment/Certification Form, a report is produced on a monthly and cumulative (by FFY) basis by county, local agency and State Agency. The tltlj~R cumulative report indicated that ~Qi~% of infants initiated breastfeeding. Accurate completion of the form by clinic staff is an issue current!y being addressed by the Office of Nutrition, in cooperation with local agency staff. In 1990, the U.S. Public Health Service released the report Healthy People 2000. In this report the National objective for breastfeeding is to increase to at least 75 % the proportion of mothers who breastfeed their babies in the early postpartum period and to at least 50 % the proportion who continue breastfeeding until their babies are 5 to 6 months old. Georgia's programs to promote and support breastfeeding must strive to contribute to the achievement of this objective for the Nation. STATE WIC PLAN - - IO- OFFICE OF NUTRITION OBmCTIVEm~ To continue to increase the percentage of WIC infants in Georgia who are initially breastfed from %, and who are breastfed until six (6) months of age from 8% to a~j~ftby September 30, EVAI,IIATTON DESIGN: Breastfeeding data derived from the WICIAssessment Certification Form will be used to evaluate the breastfeeding initiation and average duration rates for FFY '95. Action Steps ActiYitieslMetbads ReSOJlrces I, Coordinate Statewide breastfeeding activities. NPC - WIC (1) 2. Coordinate breastfeeding promotion and support efforts with Child Health, Women's Health and. Immunization sections. NPC - WIC (I) 3. Facilitate breastfeeding promotion and support efforts, among local . agencies, through coordination and referrals. See pages 16-17 for suggested referral list. NPC - WIC (1) 4. Monitor the utilization rate of breastfeeding educational materials, NPC - WIC (2) 5. Evaluate breastfeeding materials,on an ongoing basis, for content and reading level. NPC - WIC (I) 6. Obtain materials, as needed, for the OON breastfeeding resource files. NPC - WIC (I) STATE WIC PLAN- - 11 - OFFICE OF NUTRITION Action Steps AdjvjtieslMetbods 7. Monitor breastfeeding rates throughout the State on a quarterly basis, using the Infant Breastfeeding Characteristics Report, and provide monthly reports on breastfeeding rates to each local WIC agency. 8. Implement inclusion of breastfeeding data in the CDC Pediatric Nutrition Surveillance System. 9. Work with the Office of Epidemiology and continue to investigate different methods for determining breastfeeding rates in the MCH population, through public health clinics, hospitals and private health care providers. 10. Provide on-going technical assistance to local agencies in developing, implementing and maintaining a strong breastfeeding component in the WIC Program. 11. Work with local agencies in the development of breastfeeding program plans which work towards ensuring that women have access to breastfeeding education and support during the prenatal and postpartum periods. Resources NPC - WIC (1) NPC - WIC (1) NPC - WIC (1) ALLNPC - WIC NPC - WIC (1) STATE WIC PLAN- - 12- OFFICE OF NUTRITION Action Steps A ctivitieslMetb ods 12. Evaluate local agency updates on breastfeeding promotion and support. 13. Evaluate local WIC agency breastfeeding related activities through monitoring of health records, staff interviews and annual breastfeeding plan updates. 14. Work with the local agencies to establish guidelines for a positive clinic environment which endorses breastfeeding as the preferred method of infant feeding. 15. Work with local agencies to establish systems for assuring that mothers who are separated from their infants are able to continue providing their infants with breastmilk. 16. Work with local agencies to assure that task appropriate breastfeeding information is included in staff orientation. 17. Work with local agencies to assure that regular educational opportunities are available to staff. 18. Continue to encourage the expansion of the role of breastfeeding coordinators in order to provide services and training across programs. STATE WIC PLAN- - 13 - ReSOIJrces NPC - WIC (1) All NPC - WIC Milestones NPC - WIC (1) NPC - WIC (1) NPC - WIC (1) NPC - WIC (1) NPC - WIC (1) OFFICE OF NUTRITION Action Steps ActjyjtieslMetbods 19. Work with local agencies in the expansion of breastfeeding services through such means as peer counselor programs, support groups, pump loan programs, and coordination with the Medicaid Program. 20. Work with the MCR-funded Georgia Breastfeeding Project (GBP) local sites. Encourage other sites to form community coalitions based on the GBP model. 21. Encourage local agencies to establish referral systems with hospital and community resources in order to assure continuity of education and support services for prenatal and breastfeeding women. 22. Encourage a cooperative initiative between local WIC agency breastfeeding projects and community or hospital task forces. 23. Collaborate with the Georgia Task Force for Breastfeeding to promote statewide membership consisting of local agency staff, community advocates, private citizens, etc. 24. Coordinate two (2) Statewide meetings of the Georgia WIC Program Breastfeeding Advisory Committee. Resmlrces NPC - WIC (1) NPC - WIC (1) NPC - WIC (1) NPC - WIC (1) NPC - WIC (1) NPC - WIC (1) STATE WIC PLAN- - 14 - OFFICE OF NUTRITION Action Steps AetivitjeslMetbods 25. Collaborate with the Georgia Task Force for Breastfeeding on organizing a round table discussion between public health staff, and breastfeeding advocaresinrerestedin volunteering in public health clinics. 26. Complere the revision of the clerical! paraprofessional training manual and pilot it in at least two (2) local agencies. 27. Implement the professional lactation specialist self-study modules Statewide. 28. Update local. agencies, on a quarterly basis, about new materials, workshops and information related to breastfeeding. 29. Produce a report documenting breastfeeding activities in the State of Georgia. Resources NPC - WIC (I) NPC - WIC (1) NPC - WIC (1) NPC - WIC (I) NPC - WIC (I) STATE WIC PLAN- - 15 - OFFICE OF NUTRITION BREASTFEEDING SUPPORT AND PROMOTION REFERRAL LIST Coordination among local agency breastfeeding projects is encouraged. Local agency breastfeeding coordinators, listed below, are the best source of information within the State. La Leche League of Georgia chapters exist in several communities within the State and may be contacted. I Deal Agency Breastfeeding Coordinator 1-1 (Rome) Ann Newland (706) 295-6752 GIST 231-6752 1-2 (Dalton) (706) 272-2342 GIST- 234-2342 2 (Gainesville) 3-1 (Cobb/Douglas) 3-2 (Fulton) 3-3 (Clayton) 3-4 (Gwinnett) Rena Pyrzak Noretta Bunyon (404) 535-5743 GIST 261-5743 (404) 739-3212 (404) 730-1441 3-5 (DeKalb) 4 (LaGrange) 5-1 (Dublin) 5-2 (Macon) 6 (Augusta) STATE WIe PLAN- Carol Boe Kathy Brown Margaret Turner Jackie Nelson Rebecca Black - 16- (706) 845-4035 GIST 290-4035 (912) 275-6559 GIST 259-6559 (912) 751-6118 GIST 321-6118 (404) 860-8935 OFFICE OF NUTRITION T.oc;)l Agency 7 (Columbus) 8-1 (Valdosta) 8-2 (Albany) 9-1 (Savannah) 9-2 (Waycross) 9-3 (Brunswick) 10 (Athens) 11 (Southside) 12 (Grady) BreastfeeJiing Coordinator (Vacant) Contact: Jacquelyn Miller, WIC/Nutrition Coordinator Linda Horton Janice Newberry Susan Horne Jo Bishop Manning Starla Sutton Ann Sears Patricia Harris Arlene Toole Ebone (706) 322-0851 GIST 259-7496 (912) 386-3394 GIST 342-3394 (912) 430-4310 GIST 341-4310 (912) 651-2640 (912) 427-2042 GIST 366-5752 (912) 264-3907 GIST 365-7326 (912) 767-4489 (404) 542-9004 GIST 241-9004 (404) 688-1350 ext. 244/256 STATE WIC PLAN- - 17 - OFFICE OF NUTRITION NEEDS ASSESSMENT IV The Office of Nutrition is responsible for the identification and development of resources and educational materials for use in the local agencies, including materials in languages other than English for local agencies where a substantial number of persons do not speak or read the English language. The WIC Participant Totals Report for March :W~S, revealed that Georgia's WIC Program served 1@.!~~1. Hispanic participants and ~i!ll: Asian/Pacific Islander participants. These figures indicated a non-English speaking population of up to participants. The Office of Nutrition has targeted 3 % of the WIC caseload as non-English speaking participants. The Office of Nutrition receives requests from local agency personnel and the general public for nutrition education materials. The Office of Nutrition is responsible for developing a State Nutrition Education Plan and providing technical assistance and training to local agencies regarding their nutrition education plans. STATE WIC PLAN- - 18 - OFFICE OF NUTRITION OBJECTIVE IV: By September 30, g9~;~, provide nutrition services to local agencies and the general public by: a. having appropriate nutrition education materials available and accessible to local agencies and the general public; b. providing program planning and technical assistance to local agencies; c. completing of the Fiscal Year ~~ Nutrition Education Plan. EVALUATION DESIGN: a. Summary of utilization of materials by local agency; b. Review and approval of local agency Nutrition Education Plans for Fiscal Year 1991; c. Completion of the Fiscal Year Nutrition Education Plan. Summary of accomplishments for Fiscal Year Action Steps Activities/Methods 1. Develop criteria for the evaluation of nutrition education audiovisual materials. ReSOJlrces NPC- WIC (2) Milestones 9/30/2~ 2. Monitor nutrition education materials in stock by summarizing utilization of materials. NPC - WIC (2) 12/30/95 and 6/30/!!~ 3. Maintain an adequate supply of nutrition education materials for districts, local agencies, and the general public. 4. Provide technical assistance to local agencies for the development and implementation of nutrition education plans. NPC - WIC (2) Sr. Sec. (1) 12/30/95 and 6/30/~ NPC - WIC (1,2,3) 9/30/2~ STATE WIC PLAN - - 19 - OFFICE OF NUTRITION Action Steps ActivitiesfMetbods 5. Conduct the annual nutrition education survey to detennine WIC participant's views. 6. Write the results of the current year Nutrition Education Plan and update the FY '95 Nutrition Education Plan. 7. Evaluate and approve local agencies plans and progress reports. 8. Evaluate the utilization of non-English speaking nutrition education materials in local agencies. 9. Develop and coordinate pictorial Nutrition Education materials for non-English speaking WIC participants. 10. Publish six (6) Nutrition llpdate articles. 11. Respond to requests from the general public and document each request in OON files. 12. Provide nutrition education materials and WIC outreach materials to agencies sponsoring activities. ResOllrces NPC - WIC (2) Milestones 6/1/. NPC - WIC (2) 7/2ffta NPC - WIC (1,2,3) - 3/1~9 NPC - WIC (2) 12/31/~'} NPC - WIC (I and 2) 9/30/9~ NPC - CH ALLNPC NPC - WIC (2) 9/30/2~ 9/30/~~ 9/30/9~ STATE WIC PLAN- - 20- OFFICE OF NUTRITION NEEDS ASSESSMENT V The Office of Nutrition is responsible for training staff who provide nutrition education. Methods to accomplish this include inservice trairiing and technical assistance for professional and paraprofessional staff at local agencies; conducting Competency Based Skills Workshops, statewide nutrition conferences and meetings; and writing continuing education articles. Training is designed to provide nutrition education training for each nutritionist, nurse, physician, and paraprofessional providing nutrition education to W1C participants. The Office of Nutrition has identified breastfeeding and substance abuse as focal points for staff development. STATE W1C PLAN- - 21 - OFFICE OF NUTRITION OBJECTIVE V; 1., By September 30, meet the training needs of persons responsible for providing nutrition education and WIC Certification services by: a. providing inservice training and technical assistance to local agencies and State nutrition staff. b. promoting the implementation of the American Dietetic Association AP4 Program for Georgia Public Health Nutritionists. EVALUATION DESIGN: a. Number of health providers receiving nutrition training b. Number of technical assistance visits c. Submission and approval for the AP4 Program for Georgia Public Health Nutritionists by the American Dietetic Association Action Steps ActivitieslMetbods ReSOIlrces Milestones 1. Continue DHR sponsored AP4 Program to prepare Public Health nutritionists for R.D ..eligibmty. 2. Monitor revised standards for WIC nutrition education contacts based on USDA regulations. OON Director NPC - WIC (2) 9/30/~ 3. Perform at least one (1) technical assistance visit to each local agency 4. Based on the results of these visits, provide further technical assistance as needed. 5. Based on the 1989 training survey of local agencies, provide nutrition training for approximately 1000 local health care providers. a. Competency Based Skills Workshop Level I-III b. Competency Based Skills for Paraprofessionals ALL- NPC ALL- NPC ALL- NPC SS 2 NPC - 2 9/30/9 9/30/~~ 9/30/~~ STATE WIC PLAN- - 22- OFFICE OF NUTRITION Action Steps Activities/Methods 6. Conduct nutrition updates during Coordinators' Meetings. 7. Provide technical assistance in the area of medical research for all districts through the use of the Medline Computer Software. 8. Offer to co-sponsor training activities with other agencies. 9. Prepare and monitor training contracts and prepare summary reports. a. Program Planning for Nutrition Services b. Paraprofessional Development Workshop c. Competency Based Skills Workshop d. Care of the Pregnant Family e. Nursing Basic Skills f. District training as requested ResOJlrces ALL-NPC ALL- NPC OON Director SS 2 Milestones 9/30/~ 9/30/~~ 9/30(~ STATE WlCPLAN- - 23 - OFFICE OF NUTRITION NEEDS ASSESSMENT VI Quality assurance is an important component of all phases of nutrition care. Health care providers need to be able to identify the essential elements of nutrition care and to assure that the services they provide are based on the most recent findings of nutrition science. All providers of nutrition care need to be able to assess nutritional status, identify nutrition related health problems, select effective intervention strategies, develop and implement nutrition care plans, and maintairr patient monitoring and follow-up. Fifty-eight (58) Nutrition Guidelines for practice and eight (8) supplements to existing Guidelines have been developed. TheSe Guidelines cover normal as well as high risk conditions and can be applied to the prenatal and postpartum woman, infant and child. Additional guidelines need to be developed to address other areas of nutrition management. STATE WIC PLAN- - 24- OFFICE OF NUTRITION OBJECTIVE VI: Develop and monitor the use of the Georgia Nutrition Guidelines for practice by September 30, m~. EVALUATION DESIGN: Identify the percentage of the districts that use the Nutrition Guidelines for practice in the management of their patients and the training of staff. Action Steps AcfivitiesfMetbods ReSOJlrces Milestones 1. Provide technical assistance in implementing new Nllhition Gl,jdeljnes for Practice during quarterly Coordinators' Meetings, district site visits and Competency Based Skills Workshops. ALLNPC 9/30/96 2. Perform subjective evaluation of Nutrition Guidelines for Practice as part of local agency program reviews. 3. Update teaching packets for Guidelines presentation when applicable. 4. Provide technical assistance and training to local agencies and programs on the Nutrition Guidelines for Practice. NPC - WIC (1,2,3) 9/301Q NPC - CH ALLNPC 9/30/~ 9/3019~ 5. Investigate funding sources for publication of newly developed Nutrition G1Jjdelines for Practice. OON Director 9/301Q 6. Investigate the possibility of integrating existing guidelines and transferring to computer diskette for easy accessibility. NPC - CH STATE WIC PLAN- - 25 - OFFICE OF NUTRITION Action Steps ActivitieslMetbods 7. Revise existing Nutrition Gujdelines for practjce to assure the current research references are included. Resources NPC-CH Milestones On Going STATE WIC PLAN- - 26- OFFICE OF NUTRITION NEEDS ASSESSMENT VII Nutrition personnel in the Georgia Department of Human Resources have expanded in the past eight (8) years from ten (10) nutritionists to one hundred and twenty-five (125) nutritionists. This has required hiring nutritionists with different levels of skills and experience. The present nutrition classification and compensation levels are no longer compatible with duties and responsibilities. Furthermore, it does not allow Georgia to be competitive in the nutrition personnel market. Public health nutritionist recruitment and retention is becoming more difficult, especially in the positions of nutritionist, senior nutritionist, principal nutritionist, and nutrition program consultant. Nutrition is a basic component of preventative health programs. The goal of nutrition in public health is to promote a healthier generation of Georgians and to promote independence for older Georgians by promoting health and preventing diseases. In Fiscal Year 1984, the average turnover rate for public health nutritionists was 15%. Exit interviews revealed that approximately 54% of the turnovers were related to salary. STATE WIC PLAN- - 27- OFFICE OF NUTRITION OBJECTIVE VII: Design, implement and evaluate the State Nutrition Classification Series to assure adequately trained nutrition staff and competitive compensation levels by September 30, !11~~. EVALUATION DESIGN The proposal is to be submitted to the Division of Public Health Personnel Office by ~*$mg. Action Steps ActiyitieslMetbods 1. Continue task force to review and evaluate State Nutrition Classification Series according to g~rg!~ gB~ 2. Investigate strategies used by other public health professionals who have been successfully upgraded. ReSOIlrces OON Director Local health districts Milestones 9/30/~ OON Director 9/30~ 3. Prepare the Nutrition Classification document and submit to the Division of Public Personnel Office. OON Director 9/30196 STATE WIC PLAN- - 28- OFFICE OF NUTRITION NEEDS ASSESSMENT VIU Currently there are 10,000 - 15,000 homeless persons in the State of Georgia; 5,000 - 8,000 of which are in the Atlanta metropolitan area. Of these, 45% are women, infants and children. Besides being homeless, these individuals have limited access to medical care and nutritional support. There have been several organizations that have addressed the needs of the homeless, one of which provides medical care to this vulnerable population. The Atlanta Community Health Program for the Homeless (ACHPH) began in 1984 as a completely volunteer program with its headquarters based in St. Joseph's Hospital in Atlanta. Health professionals began providing health care to homeless persons in shelters at night. ACHPH is one of several health care agencies in the United States that utilizes a "mobile health approach". They provide physical evaluation of health problems and treat infections, colds, etc. Hematological and anthropometric assessments are a part of the physical assessment. Persons with chronic illnesses, such as hypertension, are monitored and referred to Community Health Centers for follow-up. From April to July, 1988, services were provided to 210 children 0-4 years of age and 295 women 15-44 years old. Many of these women have several children and may be pregnant. The Fulton County Health Department WIC Program has been working with ACHPH staff who provide WIC services to eligible homeless participants. However, these clients must travel to designated homeless shelters to receive these services. Approximately 500 participants have received WIC services through this effort since February 1989. Eligible participants are certified according to customary WIC procedures and are given thirty (30) days advance notice prior to disqualification. Although WIC is providing benefits to homeless women, infants and children; services need to be continued to serve a greater number of WIC eligibles for WIC certification and voucher issuance as an integral part of the ACHPH mobile health care agency. STATE WIC PLAN- - 29- OFFICE OF NUTRITION OBJECTIVE VITI: By September 30,~~~~, continue to target WIC services to the homeless in Fulton County. EYAIJIATION DFSIGN: Monitor caseload participation of WIC benefits for the eligible homeless population. Action Steps Activities/Methods ReSOJlrces Milestones I. To provide on-site WIC assessments, certifications and voucher issuance to homeless individuals in various shelters located in Fulton County via the ACHPH mobile health vans. Local Agency On-going 2. To maintain two positions, a WIC nutritionist and a paraprofessional, who provide WIC certification, voucher issuance, and nutrition education as part of the ACHPH mobile health team. Local Agency On-going 3. To supply three (3) health site with necessary hematological and anthropometric equipment for conducting WIC assessments. Local Agency On-going 4. To integrate WIC with other health services provided by the ACHPH mobile health vans, Fulton County Health Department and Grady Memorial Hospital. Local Agency On-going 5. To develop and deliver a specific nutrition education plan that will meet the specific needs of the WIC homeless population. NPC (2) Local Agency On-going STATE WIC PLAN- - 30 - OFFICE OF NUTRITION Action Steps ActivitieslMetb ods 6. To ensure that accountability and audit trails are maintained through use of clinic code 628. 7. To ensure the continuation of WIC services when subsequent voucher issuance occurs. 8. To monitor the specifically tailored food packages which meet the unique needs of the homeless WIC population. 9. To provide participants with food packages via computerized vouchers and direct food distribution. ReSOJlrces Local Agency Local Agency NPC (2) Local Agency Milestones On-going On-going On-going On-going STATE WIC PLAN- - 31 - OFFICE OF NUTRITION NEEDS ASSESSMENT IX In order to properly assess the eligible homeless participants for WIC services, enumeration of these individuals throughout all local agencies in Georgia will be conducted. Identification of these eligible homeless women, infants and children will allow the provision of WIC benefits with tailored nutrition education delivery to this very needy population. " STATE WIC PLAN- - 32- OFFICE OF NUTRITION OBJECTIVE IX: To provide specifically designed nutrition education services to homeless WIC participants by September 1119. EVALUATION DESIGN: Implementation of specifically designed nutrition education services for homeless WIC participants in each district. Action Steps ActivitieslMetbods ReSOllrces Milestones I. To provide technical assistance to local agencies related to analyzing the homeless needs assessment. NPC (2) 9/30/96 2. To monitor the compliance of USDA Homeless Regulations within all local agency programs to include: NPC (2) 9/30fljp (Conditions Applicable to Homeless Facilities and Institutions) a. Program must benefit participant not homeless facility or institution. b. WIC foods must not be used in communal feeding. c. Homeless facility/institutional proxies may not, as a standard procedure, pick up WIC food instruments for all program participants in their respective facilities to transact the food instruments in bulk. STATE WIC PLAN- - 33 - OFFICE OF NUTRITION Action Steps ActivitieslMethods d. No restrictions or constraints can exist relative to program participation. 3. To contact and maintain a status report from all homeless sites serving women, infants and children for compliance to conditions applicable to Homeless Facilities and Institutions. 4. Develop criteria for certification of homeless and migrant WIC participants per USDA regulations. 5. Resources NPC (2) NPC (2) NPC (3) NPC (3) Milestones 9/30/~~ 9/30/~~ 10/1/95 10/1/95 STATE WIC PLAN- - 34- OFFICE OF NUTRITION BlmGET xE The FY budget for nutrition education services is approximately $ilIjpQQ!Q~ for state and local operations. Funds have been allocated to the following categories: State Level Nutrition Education Budget Personnel Regular Operating Per Diem and Fees/Contracts Travel Computer Supplies/Material Equipment Local Agency Nutrition Education Budget The procedure to assure that annual nutrition education expenditures are at least equal to one-sixth of the State agency's total administrative expenditures is explained in WIC Federal Regulations, Section 246.14 - Program Costs. State I.evel Breastfeeding Activities Budget $~.OO State Agency Local Agency STATE WIC PLAN- - 35 - OFFICE OF NUTRITION