Program performance is measured against several short-term health status indicators among the women, infants and children enrolled in WIC, FCM or both programs. Measures include:
- Enrollment in both WIC and FCM
- First trimester enrollment in WIC and FCM
- Initiation of breastfeeding in WIC
- Three or more well-child visits to FCM infants before age 1
- Fully immunized infants and two-year-olds in WIC
- Health insurance coverage of infants and children in WIC
- Developmental screening of infants and children in WIC and FCM
- Face-to-face contacts and home visits for pregnant women and infants in FCM
The Department uses its maternal and child health management information system, Cornerstone, to generate quarterly reports on these performance measures. Agency performance provides the basis for ongoing technical assistance. These reports are for provider and public access.
The Department also provides administrative and financial rewards to high performing agencies. The top two-thirds of agencies on the ranking report receive a WIC/FCM certification visit every two years and an annual review of their high-risk infant follow-up procedures. The lower third receives an annual evaluation of the entire MCH programming protocol in addition to the certification visit. Regional staff focus technical assistance activities on the agencies in the bottom third. In the spring of each year, the Department uses performance data from the first three-quarters of the fiscal year to determine which agencies will require more frequent visits.
Trend data, supplemented with a discussion of the significance of each indicator for improving the health of women and children, are presented below.
Integrated Service Delivery
The graph below displays the proportion of clients in one program who are also enrolled in the other program. For example, the line labeled 'WIC' shows the proportion of WIC clients who were also enrolled in FCM. At the end of Fiscal Year 2010, 92.6 percent of WIC participants were participating in FCM and 95.9 percent of FCM participants were receiving WIC services.
An evaluation of the WIC and FCM programs in 1998 found that Medicaid-eligible women who participated in WIC and FCM during pregnancy in 1996 had substantially lower rates of premature birth and infant mortality. Armed with this knowledge, the Department launched a concerted effort to integrate the delivery of these two programs across the state. Department staff helped local grantees to redesign the flow of patients through clinics, cross-trained staff and took other steps to ensure that patients were enrolled in both programs.
First Trimester Enrollment
Enrollment in FCM/WIC services during the first trimester of pregnancy is essential to ensure maximum impact on the health of the mother and the newborn infant. The graph below shows that there has been a gradual upward trend over several years in the proportion of program participants who enrolled in the programs during the first trimester of pregnancy.
Local WIC and FCM agencies use a variety of strategies to reach low-income families in the communities they serve. These may include door-to-door canvassing, distribution of printed materials and use of mass media, as well as nontraditional methods that may be necessary to identify potential participants in hard-to-reach populations, such as persons who abuse drugs or engage in prostitution.
The Department also takes advantage of its computer technology to increase the proportion of Medicaid-eligible pregnant women who enroll in WIC and FCM and to improve the proportion of women who enroll in the first trimester of pregnancy. Local WIC and FCM service providers are indirectly linked to the Department's Family Community Resource Centers through an electronic data exchange. Each month, information about pregnant women who have enrolled in the Medicaid program is transferred from the Client Information System used by the Family Community Resource Centers to the Cornerstone system. The information is then distributed to local service providers and is ultimately used to conduct targeted outreach efforts.
Initiation and Duration of Breastfeeding
The graph displays the proportion of women who participated in the WIC program during pregnancy and began to breastfeed their infants right after giving birth.
The rate of breastfeeding at hospital discharge has increased among WIC participants from 53 percent in 2002 to 67.5 percent for SFY 2010. Since the early 1990s, the rate of breastfeeding among WIC eligible women has more than doubled from 26 percent in 1992 to 67.5 percent.
The American Academy of Pediatrics (AAP) states that infants should be breastfed for at least the first year of life and adds no limit for duration. In 40 local agencies, breastfeeding peer counselors are part of the WIC team, promoting breastfeeding, educating women on the "how-to's" of breastfeeding and supporting breastfeeding mothers when they deliver and begin breastfeeding. WIC participants' peer counselors are women from the community who have successfully breastfed their own infants. They receive specialized training to serve as peer counselors. Representing diverse cultural backgrounds, they offer encouragement, information, and support to other WIC mothers.
Additional activities of the WIC breastfeeding program include providing breastfeeding education and training for WIC, FCM and other MCH providers. In the past five years, over 1,300 staff have received specialized breastfeeding training through workshops, conferences and seminars. Additional training is provided at biennial statewide conferences which bring together community partners and other breastfeeding advocates.
Each year WIC programs develop special breastfeeding promotions to coincide with World Breastfeeding Week and Illinois Breastfeeding Promotion Month. Activities are designed to meet the AAP recommendations to "promote breastfeeding as a cultural norm and encourage family and societal support for breastfeeding." Activities such as Breastfeeding Walks and Fairs, breastfeeding displays in local libraries and the "Mobile Nursery" at local and state fairs help the public to perceive breastfeeding as the norm and promote better understanding of the role breastfeeding plays in the health of our citizens.
WIC administers a state breast pump distribution program through their local agencies. As active community partners and collaborators, WIC promotes breastfeeding and advocates for participants with local hospitals, schools and employers.
Through the Physicians' Breastfeeding Network of Illinois (PBNI) WIC maintains a collaboration with medical groups to promote continuing breastfeeding education for physicians and the need for increased breastfeeding education and training in medical schools.
The Cornerstone system collects data on breastfeeding practices for the U.S. Centers for Disease Control and Prevention's Nutrition Surveillance Systems.
The graph below displays two performance measures and groups of children in the WIC program:
(Effective in the first quarter of 2007, the 3:2:2 report was modified to allow the WIC and FCM programs to use the same age range criteria of 12 to 18 months.)
- The line labeled "3:2:2" shows the proportion of children between 12 and 18 months of age who were active in the WIC program and had received:
- 3 doses of diphtheria, pertussis and tetanus vaccine;
- 2 doses of oral polio vaccine; and
- 2 doses of Haemophilus influenzae type B vaccine.
- The line labeled "4:3:3:1" shows the proportion of children between 24 and 36 months of age who had received:
- 4 doses of diphtheria, pertussis and tetanus vaccine;
- 3 doses of oral polio vaccine;
- 3 doses of Haemophilus influenzae type B vaccine; and
- 1 dose of measles, mumps and rubella vaccine.
Since 2000, the proportion of fully-immunized one-year-olds (3:2:2) increased from 70 percent to over 85 percent and the proportion of fully immunized two-year-olds (4:3:3:1) increased from 56 percent to almost 79 percent.
The graph displays the proportion of children in the WIC program who were covered by public or private health insurance.
Health insurance is essential for access to health care services. Virtually every child on WIC is, by definition, eligible for the State of Illinois' All Kids program. The Department has been working with the IDHFS to increase the proportion of WIC-eligible children who also are enrolled in All Kids if they are not covered by their parents' health insurance. Local WIC/FCM agencies have been trained and certified by the IDHFS as "All Kids Application Agents." Local WIC program staff assist eligible families in applying for coverage through All Kids.
When this project began in September 2000, a total of 86 percent of WIC enrolled infants and children were documented in the Cornerstone system as having All Kids or private insurance coverage. Due to the continued efforts of local WIC agency staff, this proportion has steadily increased; by June 2010, almost 96 percent were documented as having health insurance.
Well Child Visits
The Department monitors FCM agencies to ensure that participating infants receive at least three well child visits during the first year of life. The graph displays the proportion of infants who met this standard.
The American Academy of Pediatrics recommends routine well child visits. Providers monitor a child's growth and development, provide preventive health care services (i.e., immunizations), screen for potentially serious health problems (i.e., lead poisoning or problems with vision or hearing) and inform parents through anticipatory guidance. The Academy recommends six such visits during the first year of life, to occur at one month, two months, four months, six months, nine months and twelve months of age.
The graph displays the proportion of 12-month-old children in WIC or FCM who had been screened for developmental delay at least once in the prior 12 months. Beginning in FY10, the data for 12-month-old children in WIC was eliminated and only the data for 12-month-old children in FCM was used to measure this particular performance indicator.
Infants and young children should be screened routinely for evidence of delays in cognitive, linguistic, motor, social and emotional development. Through routine screening, developmental delays can be promptly identified and therapy initiated.
The Department monitors the proportion of infants in the FCM program who have been screened for problems with physical or cognitive development at least once a year.