Mom-child aid program finds home in county

Snohomish Health District officials are learning quickly what it takes to run the county's Women, Infants and Children (WIC) program, which provides food, nutrition counseling, and health- and social-service referrals to low- income pregnant women and mothers with young children.

Since deciding to take over the program previously run by the nonprofit Pregnancy Aid of Snohomish County, the health district has assembled a WIC staff that can speak Spanish, Russian, French and Ukrainian, and can contact interpreters if other language needs arise. The district also is working to provide better and safer access to its remodeled office in Everett, addressing concerns about parking and bus stops with city officials.

After more than a year of discussions, planning and renovations, health-district officials are confident that smoother days are ahead and that the program will be able to serve more women and young children in need. The state Department of Health is looking to increase WIC participation in the county by about 50 percent.

Officials also hope that linking WIC with the district's existing First Steps and immunization programs will enable it to provide a more holistic approach to health benefits to those most in need. First Steps also serves pregnant women and new mothers.

"The vision always has been on working toward integrating our services to pregnant women and young families," said Donna Larsen, the district's community-health director, who oversees the three programs.

The health district agreed to take over the WIC program at the request of the state Health Department, which publicly announced in February 2004 that it would no longer contract with the program's longtime provider, Pregnancy Aid of Snohomish County, citing questions over financial audits.

WIC programs were started by the federal government in 1977, and the state Health Department distributes about $100 million in federal money annually to WIC programs throughout Washington.

Money worries

Initially, the health district's governing board had little interest in taking over the program, fearing that any future loss of federal funding would force the district to use local money.

At the time, district officials were working to shore up a $2 million budget shortfall, and the threat of cutting funding to existing programs was a real concern.

"The board made it very clear that it did not want to pay for [WIC]," said Dr. Ward Hinds, the health district's medical officer.

With about $1 million in federal money, the program's projected costs were estimated at just above that amount. But by linking WIC with the county's First Steps program, which helps pregnant mothers stay healthy and teaches them parenting skills, the health district believes it can make up the difference without spending additional money. The First Steps budget is about $2.5 million.

State and federal funds were used to renovate the health district's Everett office, which is now open to WIC clients. Money from those sources also will be used to remodel the Lynnwood office, which is expected to offer WIC services by early next year.

"So far, we've used no county money," Hinds said.

Once funding issues were settled, the next step was to find a director, Larsen said. An internal search quickly led to Cheryl Combest, a five-year health-district employee with international experience.

Serving overseas in the Peace Corps and other agencies, Combest helped create nutrition programs in Sierra Leone, Niger and Madagascar.

"We knew this was a huge program that needed good managerial skills, but it also needed someone who understood nutritional-type programs," Larsen said. "Cheryl has both skills."

Combest was first hired to tackle the health district's prevention and intervention projects, including a tobacco-cessation program. She had wanted a WIC job, but none was available at the time.

"While working in other countries, I was really struck by how much nutrition affected morbidity rates," Combest said. "The impact of nutrition on these countries with a lot of diseases was large."

Though disease rates are lower in the United States than in African countries, studies regularly show the importance of nutrition on healthy birth weights, growth and development, Combest said. Knowing this, the health district decided the best approach would be to connect its pregnancy and youth services with WIC, giving WIC clients a chance to use other programs the district already offered and funded.

"This is not a pure WIC program," Larsen said. "We've hired WIC nutritionists and certifiers, some from Pregnancy Aid, but we've also hired public-health nursing staff."

One-stop approach

Families that use WIC will make occasional visits to health-district offices — monthly, bimonthly or four times a year — and see a WIC nutritionist. Clients also will receive checks, based on need, that can be used to buy food.

Combined with First Steps and the district's immunization program, families also will have a chance to talk with registered nurses about other health needs.

While WIC focuses on offering mothers and children food checks and nutrition advice, First Steps teaches pregnant moms how to care for themselves and their children. At the immunization clinic, the goal is to keep children and adults updated on recommended vaccines.

"As the three programs we're bringing together become more established, we hope to bring in other specialty and prevention programs," Larsen said.

Those could include anti-tobacco programs, oral- and dental-hygiene services, and injury prevention, Larsen said.

State health officials, who have worked with the Snohomish Health District for more than a year to transfer the WIC program from its previous provider, say the model already has been shown to work in other counties.

"We introduced [health-district officials] to other county WIC programs around the state so they could talk with their peers and see what works and what doesn't," said Cathy Franklin, a nutrition coordinator for the Washington WIC program. "We have high hopes that braiding these services will be beneficial for both First Steps and the immunization program."

Though the health district hasn't forecast what increase to expect, national data show participation levels increasing across the board when such programs are combined with WIC, said Rita Mell, the director of the health district's immunization clinics. The key, she said, is providing access to programs that mothers hadn't known about.

When a mother comes for a WIC appointment, she can meet with a clinical nurse to discuss other health needs that WIC doesn't cover. If allowed, health-district staff members will collect immunization data and determine whether children are up to date for vaccines.

At the district's Everett clinic, mothers can cross the hall for immunizations, and the same convenience is planned for the Lynnwood location. For First Steps, nurses can meet with mothers in the WIC office and schedule home visits as needed.

There's no fee to participate in the First Steps program, and WIC participants most likely will qualify for free or reduced-cost vaccines, Mell said.

State health officials say women view WIC as an accessible, nonthreatening program, which allows health officials to talk to them about other issues. But Franklin warned that being too energetic can be seen as a turnoff.

"It's tempting to latch a whole bunch of stuff onto [WIC]," Franklin said. "But we've cautioned them not to dump everything into that WIC visit because people can only absorb so much."

Many languages

The health district has faced a few immediate challenges in taking over the WIC program.

The county's growing minority population led the district to seek out multilingual staff members. In May, almost 450 WIC clients visiting Pregnancy Aid's Everett location expressed the need to communicate in Spanish, state data show. An additional 225 clients spoke Russian. Though only 18 asked to speak in Arabic, that number is expected to grow, officials said.

To meet those needs, the health district hired staff members who can speak fluent Spanish, Russian and Ukrainian. Combest also speaks French. Interpreters in other languages can be contacted by telephone.

The district also is working with Everett officials to provide better and safer access to its facility for clients. Parking at the Everett location is limited to a small lot, and a bus stop at Pacific and Rucker avenues requires clients to cross a busy street.

Already, Everett officials are responding to those concerns, city spokeswoman Kate Reardon said. "We're really at a beginning stage, but we're looking at the situation at the intersection now."

City transit and engineering staffers have visited the location twice and plan to meet again with health-district officials to consider options. The city staff also is providing bus-route information and schedules to the district.

"We want to work with them and make things as convenient for their clients as possible," Reardon said.

Broadening the reach

Though the WIC program now serves 9,100 women and children, state officials believe as many as 4,000 more currently qualify for WIC benefits that the previous county provider could not accommodate.

State health officials say they expect new families living in Everett and Lynnwood to utilize the health district's services in those cities. Existing and new families in outlying areas of the county are likely to be served through satellite offices. The state Health Department is seeking contractors for those offices and locations.

Pregnancy Aid operated seven locations throughout the county, but staffing issues prevented it from offering WIC benefits to everyone eligible under the program, said Franklin, the coordinator for the state WIC program. Only higher-risk categories were served.

In recent years, nonbreastfeeding, postpartum women eligible for six months of WIC benefits and children ages 3 and 4 did not always receive program aid, Franklin said.

"We will be able to reach these [woman and children] by having more-robust programs available in the county," Franklin said.

Health-district officials, who opened their Everett office last week to WIC participants, already are offering benefits to the full range of eligible women and children.

To make the transition smoother, Pregnancy Aid has agreed to keep its offices open until the end of the year.

"Initially, we expect the caseload to shift and merge between offices and locations," Franklin said. "It's going to take finessing over a six-month to one-year period."

State health officials are working to ensure there are providers in outlying areas for families that can't travel to Everett or Lynnwood. In August, they sent letters of interest to prospective WIC providers, but insufficient information from those responding has the state sending out another round of requests.

Getting established

Still considered a pilot project, WIC services through the health district will be reviewed again about a year from now, said Hinds, the district's medical officer. It will take time to transition clients from Pregnancy Aid.

"We're betting we're going to have a really strong program that provides efficiencies not only to us but to our clients," Hinds said.

It also could take a year to make sure the program is financially sound, he said.

Already, though, state health officials are pleased with the district's efforts and expect a successful program.

"I think that as painful as this has been at times, ultimately, this will work out for the best," Franklin said. "The health district has been very thorough and very conscious of details for the clients. They're going to have a really nice program."

Christopher Schwarzen: 425-783-0577 or cschwarzen@seattletimes.com

Get in touch

To contact the Snohomish Health District about its WIC and First Steps programs, call 425-252-5303. For immunization information, call the Everett office at 425-339-5220 or the Lynnwood office at 425-775-3522. Information on all of the Snohomish Health District's programs can be found at www.snohd.org.

Source: Snohomish Health District