Performance

The Reduction of Infant Mortality in Illinois
2012 Annual Report

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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:

1. Enrollment in both WIC and FCM
2. First trimester enrollment in WIC and FCM
3. Initiation of breastfeeding in WIC
4. Three or more well-child visits to FCM infants before age one
5. Fully immunized infants in WIC
6. Health insurance coverage of infants and children in WIC
7. Developmental screening of infants and children 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 can be found at https://www.dhs.state.il.us/page.aspx?item=31152 for provider and public access.

1. Enrollment in Both WIC and FCM

Since 1998, DHS has pushed for the integration of FCM and WIC services. An evaluation of Medicaid-eligible women found that those who participated in WIC and FCM during pregnancy in 1996 had substantially lower rates of premature birth and infant mortality.

The graph below displays the proportion of clients in one program that are also enrolled in the other program. For example, the line labeled 'WIC' shows the proportion of WIC clients that were also enrolled in FCM. At the end of Fiscal Year 2012, 93 percent of WIC participants were participating in FCM and 95.4 percent of FCM participants were receiving WIC services.

Source: Cornerstone

2. First Trimester Enrollment in WIC and FCM

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.

Source: Cornerstone

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.

3. Initiation and Duration of Breastfeeding in WIC

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.

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 63 percent in 2006 to 70.3 percent for SFY 2012.

Source: Cornerstone

4. Three or more Well-Child Visits to FCM Infant before Age One

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 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.

Source: Cornerstone

5. Fully Immunized Infants in WIC

The graph below displays two performance measures and groups of children in the WIC program:

Source: Cornerstone

(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 that 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.

Since 2000, the proportion of fully-immunized one-year-olds (3:2:2) increased from 70 percent to over 85 percent.

6. Health Insurance Coverage of Infants and Children in FCM

Health insurance is essential for access to health care services. Virtually every child on FCM 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 FCM-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 and FCM program staff persons assist eligible families in applying for coverage through All Kids.

Source: Cornerstone

The graph displays the proportion of children in the FCM program who were covered by public or private health insurance.

7. Developmental Screening of Infants and Children in WIC and FCM

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.

The graph displays the proportion of 12-month-old children in WIC or FCM that 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.

Source: Cornerstone