Episode Transcript
[00:00:00] Speaker A: Presented by Feed Matters with host Jacqueline Peterson and Dr. Haley Estrom.
Feeding Does Matter.
[00:00:15] Speaker B: Hi, welcome to the Feeding Does Matter podcast and our ongoing series of It's Not Picky Eating.
[00:00:24] Speaker C: Hi, Haley.
I am excited today because we are talking, talking with Darlena Burch, who joins us from the National WIC Association.
And Darlina, you joined our project team for the PCORI Consortium research Consortium project team to really bring a perspective that we don't often have on a lot of committees. So I'm really interested if you could just share kind of your background and just your perspective kind of coming in. I would love to just have everybody learn more about you.
[00:00:56] Speaker B: And could you share what WIC stands for too?
[00:00:59] Speaker C: Oh, I'm sorry. Sorry, Haley.
[00:01:01] Speaker A: Yeah, happy to do so. So, hi, I'm Darlena Burch, senior manager of Public Health nutrition at the National WIC Association. WIC stands for the Special Supplemental Nutrition Program for Women, Infants and Children. So that's the federal title in legislation. We call it WIC for short because the program, like the name says, is for women, Infants and children. So my whole career has actually been in wic. I, when I was, I'm a registered dietitian by training. And so when I was an undergrad at the University of Arizona and studying nutrition, I knew that like, when I became a dietitian, I did not want to do clinical dietetics.
Clinical dietitians, which is where most dietitians go in, is very important. You know, working in hospitals, providing those services, education to patients. But for me personally, I just felt like if I could get in like earlier versus like having to sit in a patient's room and give them diabetes education, which if they had more information or more knowledge, probably would have been able to prevent the conditions onset sooner. I just knew like, it was important, but not for me. And so when I was going through my internship and even when I was still studying in undergraduate, I knew that I either wanted to do sports nutrition because I was a college athlete or I wanted to pursue a career in public health nutrition. Or like, they also referred to community nutrition. It was either I would be working with a subset of a population that is really eager and has the resources to like, obtain the information and carry it through both in like finances and motivation, or it was going to be a population that needed and wanted information but would not necessarily have the means in terms of finances or access, like what have you. So when I finished my dietetic internship, I reached out to my academic advisor at the University of Arizona, ended up working in a rural Agency on the Arizona New Mexico border. So it was the smallest, most rural town I ever lived in. The entire county population for the county I worked for was 8,600 people. The town that I lived in was actually closer to like 30 or 40,000 people. So the town was bigger. And then I had to drive like 30 to 40 miles to my job, which that county was at 8,600.
And so when I would be given like these policies from the state office, I would think, like, wow, like, these policies make sense for like an urban suburban environment. But some of these policies are like, hard to enact in a rule setting where you have fewer staff.
I, my agency only had two staff, me and one other person. And even then we were technically overstaffed for a caseload because we had like less than 200. Basically 250 participants per month was our caseload. And so, like, you're not. You're supposed to have like roughly one staff member for around that number back then. I don't know what it is now or if it's changed.
And so, yeah, just kind of having that perspective of being like, oh, well, this is kind of like not as easy to enact in a rural agency. And so when I was thinking about my next move, I knew I wanted to move up to have more like, say in like the policy and procedure. So from there I went to the state of Arizona. So I moved to Phoenix. So big urban, suburban environment and learned that, like back then the state of Arizona was in the western region. It is now in the southwest region, but it was in the western region. And so the policies and procedures that were coming down to the local agency came from the state at the behest of the Western Region office of usda. You still had more say than a local agency, but only so much say, provided USDA wasn't going to tell you you had to do X, Y and Z.
So from Arizona, I moved to the state of Maryland. I worked as a training center nutritionist, and we moved into now like Maryland's in the Mid Atlantic region. So I learned like, I got to see two different USDA regions and then from there went to the National WIC Association. And I've been with NWA for eight years. So, yeah, it's just been like a national trek across the nation in terms of trying to like, move upwards, have more sane impact on the program. By the time I got to the National WIC Association, I learned it was Congress that was like, really had the final say. And I was like, well, I don't plan on running for office. So I guess I'm just going to be here like at the National WIC association, so. So that's like a five minute history on my career.
[00:05:29] Speaker C: Anyway, no, thank you for sharing that because I feel like it's so important to kind of see how the system works in a way that like you, you see the front lines and whatever front lines that looks like. But then as you did in your career, kept trying to like make the improvements from a policy perspective and that pushed you in different places and further and further and further away from the front lines very often.
So I feel like your story is a good example of how challenging that can be.
[00:06:01] Speaker B: How many regions are there for WIC right now?
[00:06:04] Speaker A: Seven. There's seven regions for wic. So there's the Mid Atlantic region, the Northeast region, the Southeast region, the Southwest region, Mountain Plains, the Midwest region, and Western. I think I said all seven. I was trying to go across the US in my mind. So yeah, those are the seven regions. And then like in WIC we have, it's actually like 88 or 87 state WIC agencies, which always confuses people. But there's a state agency for every state in the US Then we have like five US territories. So that's going to be Puerto Rico, the US Virgin Islands, Guam, the Commonwealth of the Northern Mariana Islands, which is abbreviated cnmi, and then American Samoa. And when I worked for the State of Arizona, I actually went to American Samoa for work because we were helping implement a new MIS system at the National WIC Association. I've been able to visit like Puerto rico and the US Virgin Islands. So I've managed to see three of the five US territories. And then on top of the five US territories, there's a District of Columbia and then 33 Indian Tribal Organizations, abbreviated ITOs. So yeah, that's how you get to that number of like 88.
[00:07:13] Speaker C: Yeah, that's way more than I would have thought.
[00:07:16] Speaker A: Yeah. Yeah.
[00:07:17] Speaker C: Interesting. Well, I'm, I'm excited to dive in because today you're here to tell us a lot of different things.
But what was kind of top of mind for you as you came into the consortium and came in with your perspective and what the consortium is trying to do?
[00:07:35] Speaker A: Yeah, I think just knowing that, you know, the work of the consortium is really to focus on like pediatric feeding issues and, and I think something that I often, you know, consider in wic, even though it's been some time since I've been at the local agency providing direct service, is like the importance of being able to Help parents navigate the public health system, the WIC program, and how, like helping them understand how they can access the same resources that for lack of better terms, parents with more financial means are able to granted, like there is, there's more paperwork involved, I would imagine, you know, not having gone through the process myself. And so yeah, I just think it was important for WIC to be represented and to participate, you know, at the end of the day just to get like more exposure to increase understanding and knowledge of the WIC program.
And I think there's like a lot of, you know, misconceptions about wic, a, about who can participate, about how you qualify, et cetera. So yeah, I just thought it was a really important voice to bring to the table because regardless of whether, you know, there's, there's parents in WIC that have children that do have like food allergies, pediatric feeding disorders, and they do need that help and that support. And so. And in a lot of ways, maybe even more so because, you know, it is an income qualified program. So like the financial barriers that, that of parents in WIC are larger.
[00:09:08] Speaker C: That's so true. Well, so that's a great point. In terms of people not always understanding the program. Do you want to maybe give us like an overview of the program and the different components?
[00:09:20] Speaker A: Yeah, I would love to. So like I said, WIC stands for the Special Supplemental Nutrition Program for Women, Infants and Children. We exist in 88 states, state WIC agencies, and I don't have like the caseload information at the top of mind, but just under like, I would say around like 43% of infants born in the nation are like qualified for wic.
So it's a pretty big number that people don't necessarily realize.
[00:09:49] Speaker C: That's way more than I expected.
[00:09:51] Speaker B: Under 40, just under 43%.
[00:09:54] Speaker A: Around 43%. It used to be 50. Yeah, it used to be like 50, like 47. And they just recently updated the number and so I believe it's like closer to 43%, but it's not too far away from half of infants born in the US Qualify for wic. And then. Yeah, so infants qualify for the like can participate in the program. Children up until their fifth birthday can participate in the program. And then pregnant women, postpartum women and breastfeeding women can also participate in the program. Um, if you're breastfeeding, it's one up to one year postpartum. If you're postpartum not breastfeeding, it's six months and then, yeah, pregnancy. And so those are the categories that the WIC program serves.
And one of the biggest things is like WIC was first piloted in 1972. And I guess to kind of give more history on why the WIC program even started was because back in like the 1960s, there was still a lot of, like there was a lot of attention being brought to hunger in America. There was a lot of attention being brought to the fact that there was still a lot of Americans that were basically suffering from malnutrition. And so these legislators, like went to the Mississippi Delta, realized that there was children that were faced with like iron deficiency anemia and, and like whether they were breastfeeding or formula feeding, like, there was just this massive iron deficiency anemia being presented among the children, infants and the women.
So WIC was piloted in 1972 in Kentucky, by 1974, as written in legislation, which makes 2024 its 50th birthday. And that's kind of like one of the big things that WIC does is like when you come into the clinic and you get your like anthropometrics taken, your height, your weight, they'll do a finger poke to screen for iron. And sometimes when we get a lot of questions about the food package, like, to this day, which it makes sense, like, it seems off kilter or like, why is juice in the WIC food package? Like, all it is is sugar. And when you consider the context of the WIC food package today, where you have fresh fruits and vegetables, it is true that juice is not necessary. But when WIC first started, there wasn't fresh fruits and vegetables in the program. And juice had vitamin C, and vitamin C helps your body absorb iron. So there's a lot of things that like, you know, that we're, we're making adjustments to. And the reason why I also brought up 2024 is because back in April, USDA dropped the updated, like, revisions to the WIC food package, which is meant to better accommodate like food allergy, cultural preferences, like, to really just make the food package more flexible. So it's also a cool thing that USDA did for the 50th anniversary. And so, yeah, that's just kind of like a high level background. And I think I just kind of jumped into food packages without giving much background. But I was going to say how.
[00:12:36] Speaker C: Did, yeah, like what is the process for as someone comes into. Because you also talked a little bit about how they are evaluated, how families are evaluated or how that works, how can they get the access that they need?
[00:12:51] Speaker A: Yeah, so we always say, like, wic, I think it operates on like four or five pillars. There's like, there's pillars to the program. So one is the nutrition education it provides. Two is the prescriptive food package. So the food package is based on the nutrient requirements of the life stage. So, so if you're a woman, your feed package is different than if you're an infant versus a toddler. And then there's also the breastfeeding nutrition, the breastfeeding education and support that WIC provides and also referrals to health and social services. So those are the four pillars that WIC like really stands strong on. And so when you come into the clinic and you want to enroll in wic, basically what you're going to do is like you, you make an appointment or you can show up. It depends on the state and the local agency. But many local agencies will like go by appointment but also take walk ins.
So you can go to your local WIC clinic and they're going to ask you to bring in or you can just call if you need to make an appointment. Right, whichever is easiest. And at the National WIC association we do have, if you type into your URL signupwic.com you can go to that website and type in your zip code and it will locate the closest WIC clinic to you and it'll provide like the clinic information like the phone number, et cetera, so you can call them. So they're going to tell you to bring in like various pieces of information, one being proof of address because you need to, you can't, you know, like if you live on like I don't know, the West Virginia, Maryland border, you have to participate in west, like if you live in West Virginia, you participate in West Virginia you can't cross state lines. So they need proof of address just so that they know that you're in the state and that so they can enroll you. They're also going to need proof of income and I'll go back to proof of income and then they're just going to need your id. So like, and even those three items alone can be like a lot of paperwork you bring in. So one way that we navigate like the proof of income burden because it requires pay stubs is if you participate in an adjunctively eligible program. And what that means is like if you participate in Medicaid, snap, which is like more widely known as food stamps, tanf, which is like Temporary Assistance for Needy Families, fdpir, which is one that happens more on like reservations, like there's just Various programs that, that qualify as adjunctively eligible. If you participate in those programs, you automatically meet the income qualification for wic. The reason being that approval? Yeah, yeah. Because those programs have tighter income guidelines than wic. So if you can hand over your card and they look it up and can confirm you're an active participant in that program. Cool. Like you don't need to bring in your pay stubs. Like you're fine, you're fine for like the duration of that certification cycle. And so yeah, like, so you're going to go in, you're going to provide all your paperwork and then when they like they call that stuff like intake, right? So intake is completed, they're going to go take you to like get your anthropometrics done. So they'll take your height, they'll take your weight, they'll do a finger poke like you know, and then from there they put the information in the system, ask you some questions depending on your category, right. Like if you, or if it's your infant, how many like wet and dirty diapers like does your infant have? And like I don't remember if it's a day or a week, but they're asking for certain things. And then from there like they'll have a conversation with you and just kind of figure out like what your priorities are and provide like nutrition education based on that. They call it like Veena and WIC where it's like Value Enhanced Nutrition Assessment. And the idea is like providing participant centered education. Right. Versus like trying to like look at the system and be like, well this is what I think you need. You, you talk to the participant to ask them what they would like to talk about.
[00:16:36] Speaker C: Yeah, I love that.
[00:16:39] Speaker A: Yeah, yeah. And so you, that that part hits on like the nutrition education piece. There are like um, and then like we also have breastfeeding peer counselors in wic. And so breastfeeding peer counselors have been really helpful in terms of like increasing breastfeeding initiation and duration for wic. And so breastfeeding peer counselors like often like they breastfed themselves. They come from the communities that like you know, like the same communities as the WIC participants. So it just provides like that peer to peer model that makes it easier for WIC participants to open up about the breastfeeding struggles. And so if you are a breastfeeding participant coming in, that's another benefit. You can also get access to breast pumps through with various other like breastfeeding support tools and education.
And then after that like they'll you know, prescribe your food. And like I said earlier, that food package is tailored to your specific life stage. But then also like if you have a food allergy, there's a lot, there's more flexibilities.
Now granted the new food package rule that dropped in April 2024, state agencies have until I believe April 2026 to implement. So like it might not be an immediate change. Yeah, it'll be like they have two years to push it through.
And so but like with the new food package changes, like there's more flexibilities for like even if you're like a vegan participant, here are your alternatives that are given to you versus like, you know. Yeah, like Latino participant or like an African participant. Like there's more flexibilities there. So you're given like the food package, they go through it with you like the food list. Because every state has a different food list. And then they'll eventually at the end they'll give you referrals to education, social and health services. Right. So like say you come in and you're not on Medicaid, but you know, they'll give you the referral to like go see if you qualify for Medicaid. So just different things like that where.
Yeah, like that's like the entire process. And then after that, like first like what I went through is like an initial certification cycle. So like that certification appointment, then you touch base with the WIC clinic like at three months you might have to like follow up at one or two months. But like the longest you can go before you need to touch base again at the WIC clinic is three months. And then at the six month marker there's like a mid certification and then at the nine month marker another like just check in where they're coming in just to kind of see that like everything's okay. Like do you need any additional support? And then like if you're an infant then you get recertified again, you know, at like one now you're like you're.
[00:19:18] Speaker C: As your nutrition might be.
[00:19:20] Speaker A: Yeah, you're a toddler. You're like like a different category now. So it changes.
[00:19:25] Speaker C: Okay.
I love the ongoing touch points and thinking about a family's experience holistically in terms of really trying to bring in multiple systems that could, could also assist a family and the allergy piece. So if a family has like, if a child specifically has particular allergies, kind of, how is that handled by WIC offices now? I mean, I guess now it's going to be a little bit Easier.
[00:19:58] Speaker A: I'm not actually it. Yes and no. Like, so there are updates that were provided regarding formula that provided like more flexibility for like women who are partially breastfeeding in terms of like now you can access hypoallergenic formulas in wic. It.
[00:20:16] Speaker C: So that was gonna be one of my questions.
[00:20:19] Speaker A: Yes. And so one of the things with like WIC is like we employ a sole source contracting model for wic and what that means is like infant formula companies have to bid to get into a contract with WIC state agencies. Some state agencies will like go in together as a consortium, like as a group, and then infant formula companies will bid with them and then they get the contract for like whatever states are in that consortium. Other states do it individually. Right. But basically what they're doing is saying give us like your rebate price. And like, you know, so basically like WIC gets formula at a lower price and that's really just to like protect the program and save money. So it's a, it's a money saving like technique that the program uses because of that though and because you know like money has to be watched and like formulas are expensive. If you have like a child that has of a food allergy, what ends up happening is you need to have like a prescription form, like basically a formula request form. Every state agency calls it something different, but there is a form generally speaking that exists that needs to be filled out by your healthcare provider that states like the diagnosis and the requested formula. And that's how a lot of states handle issuing the non contract formulas. So like one example would be like you know, similac elementum. Like it needs like a diagnosis. And one thing that a lot of agencies will try and tell their participants is like colic tends to be used as like a vague diagnosis that a healthcare provider will put down to try and get like their, the WIC participant the formula they're asking for. Yeah, like colic does not count as a diagnosis. And I feel like that's universal across all WIC state agencies. But I've only worked in two and of the two I was in, you could not put down colic and get your requested formula. It needed to be like a diagnosis. Like yeah, like you know, amino acid, not that like elemental is specific to this but like you have a like an issue metabolizing amino acids or like gastrointestinal disorder, food allergy, like to like a milk protein or something. And now you need like the similar elementum and so you can get it but it is an additional form that needs to be like sent over to the doctor's office and they need to send it back to get access to it. And again it is because these are non contract formulas, they cost more money for the program. And so this is the process that multiple state agencies, if not all of them utilize to get you that like hypoallergenic formula.
[00:22:59] Speaker C: Sure.
[00:23:00] Speaker A: And the same goes for tube feedings as well. If you need like an enteral formula will provide it. Yes. So WIC provide it. But also like yeah, yeah, some local agencies are also like a lot of WIC agencies actually are really good at like being able to kind of like navigate Medicaid a little bit. So they might be like hey, if you want this formula, like I know one state agency like I was like in preparation for this looking at like different forms that states use and one had like the request for the enteral formula and the form was like one was for if you're asking from Medicaid. And so like the form was different than if you were asking from a healthcare provider. And so like and I even know with like breast pumps, like if like participant like you know, wants a breast pump or like some type of breastfeeding support. Although WIC does provide breast pumps but like you know, just say like they need some additional breastfeeding support. Wic, state and local agency staff are semi savvy like with Medicaid and will know like okay, well you can ask for this through this program and this is what we can do for you through wic. And so there's also like if you are identically eligible or participating in Medicaid as well, you can also access like the entrail formulas. It seems like the request like because the state agencies form I was looking at I didn't work for but based on what I could see see was that like you could request the enteral formula through wic but they were going to send it over to Medicaid to get like the approval.
And so yeah, like you can get your hypoallergenic formulas, you can get your enteral formulas. But at the end of the day like yeah, it's a, you know, call your local agency and see what options are available to you.
More likely than not though, like it's going to require additional paperwork, which is additional paperwork. And yeah.
[00:24:51] Speaker C: Would a WIC office help someone walk through that additional process?
[00:24:56] Speaker A: Yeah. And honestly I think the bigger frustration isn't even so much with the participant, it's with the doctor's office. Like in my experience like you know, the doctor's office sends it back but they didn't sign the form. Like just like, you know, like not being clear or like they missed a section of the form. And so, you know, I don't know what, what all like what clinic staff are doing when they're providing the education or explaining to the participant. But in my experience usually they're like faxing it directly to the doctor's office and asking for X, Y and Z. So if things are left off, it is more so often like the office itself has not.
[00:25:31] Speaker C: Yeah, yeah, yeah.
[00:25:34] Speaker A: It's not so much that like you're like we expect the participant to know but that's why we like, you know, WIC staff member might be like do not let your doctor write down colic because the participant's not going to know that call. It gets them nowhere.
[00:25:47] Speaker C: Yeah.
[00:25:48] Speaker A: So like, you know, points out a.
[00:25:49] Speaker C: Really good point about colic in general as to it. I mean that's a whole different like.
[00:25:55] Speaker A: Oh yeah, yeah.
[00:25:56] Speaker C: But yeah, that's really interesting that that's not a diagnosis that would, I mean it's not diagnosis but it wouldn't unlock any sort of specialty formula. Because I think that's what happens is we, we see something.
Try this.
[00:26:08] Speaker A: Yeah, yeah, yeah, exactly.
[00:26:10] Speaker C: Have a real reason for trying something or.
[00:26:12] Speaker A: Yeah. And, and like, yeah. And there are times where like they will like in my experience like they will also like, you know, they might eventually move you over to the form but there's like a whole like I guess like decision tree too on the back end. Right. They're going to try multiple different formulas before they get you to that one. And that can also be very frustrating for parents. Yeah, yeah. But it's like, it's like I, you know, it's the process and I really couldn't give, you know, like I don't really have like a super thorough explanation other than like these are non contract formulas that are being given and like, you know, a lot of times it is because there's a medical need or like the infant isn't tolerating the formula. There's also times where like you know, parents was like this is the formula that was given to my child in the hospital, so this is the formula I want to keep. Yeah, yeah. So just things like that. And we are looking into ways to really like even revamp the way we contract formula in wic because I'm sure we all know about like the infant formula crisis that hit. And so like that really like, you know, that was a lot of state WIC programs that were impacted. And a lot of waivers and flexibilities were given issued by USDA so that, you know, parents could still get their infants, like a safe formula. You know, that's why it's safe formula, not like, yeah, a homemade formula or like, what have you, like, diluting formula, things we don't want you to do with your formula.
[00:27:42] Speaker C: Now, on the education side, one thing that I know that we've tried to figure out is how can we get more information about pediatric feeding disorder not only to individuals that are like in WIC offices and providing that education, but also to families and participants that may be using WIC for their nutrition. Do you have any ideas there?
[00:28:08] Speaker A: Well, I think that's where this partnership comes in so handy and helpful because just like having like the National WIC association and a little bit more about NWA Because I realized I didn't really talk about that.
[00:28:17] Speaker C: Yeah, we didn't really talk about NWA Tell us about NWA and then we'll get into it.
[00:28:22] Speaker A: No worries. I, I want to talk about NWA because I think it'll make like it more clear. Right. So I worked at a local agency, two state WIC agencies, and now I work at the National WIC Association. So we're a national member based nonprofit organization that represents the larger WIC community. So the vast majority of our members consist of state and local WIC agencies. With that being said, we are not usda, which is the federal agency that oversees the WIC program. So we don't write legislation we can't create, we can't enforce. We are just the national nonprofit that represents the, or the WIC community. So we do a lot of advocacy and lobbying to ensure WIC gets adequate funding every year. We provide conferences and education opportunities for our members. And so why I say that is because, like, while we're not a federal agency, we do have, every state WIC agency is our member. We have like 12,000 local agencies across the nation that are our members that attend our conferences. And so when we have partnerships like this where like, we want to make more nutrition education information available as regards to like pediatric feeding disorders, food allergy, et cetera, like, this is one great partnership that can help with that because we have conferences, like, we can, we can give like, you know, present a session, we can share resources through our, like every week, the National WIC association on Monday sends a Monday update. All our members receive it so they can see. And that's like state and local agencies. We also have association updates that they're not necessarily on a set Schedule, but, like, you know, big updates that we want to let the WIC community know about. We'll send those out. I think we have, like, you know, most weeks we have at least one association update on top of the Monday update. We also have, like, Instagram, Facebook, Twitter, like LinkedIn. So we have, like, social media. And so, like, partnering with the National WIC Association, I think, is one excellent way to really just like, bringing more attention and access to, like, education and awareness regarding.
[00:30:29] Speaker C: Yeah, like, just general awareness of it, too, I think.
[00:30:32] Speaker A: Yeah. And then from there, if, like, you know, like, you attend a national WIC association conference or whatnot, you get exposure to state agencies, you'll get exposure to local agencies. And so you'll also have, like, you know, like, a partnership that's made with them, and then you can from there, like, you know, I think, like, a lot of times, like, in most states, nutrition education handouts that are given at the local agency level will often have to go through a screening process from, like, the state.
And so, like, that's where I was like, well, like, definitely partnering with the state agency if you have materials that you want to share with them, and then they can let you know, like, what their guidelines are or if they would need to, like, adapt it or get approval for it. One thing I did also want to share was that when I was looking at the USDA website, they actually have, like, a lot of resources specific, more so to food allergy education resources. So, like, USDA has resources for, like, staff in terms of handling food allergy.
There's one where FNs, like, so the Food and Nutrition Service of USDA. There are office of Food Safety works collaboratively, collaboratively with the Institute of Child Nutrition to develop and provide, like, food safety resources. And that includes, like, food allergy training and things like that. So, like, USDA does also provide some things. I saw, like, USDA has something called the WIC Works Resource System, and that's for WIC staff. And so they have, like, information on how to, like, nutrition tailoring for participants with food allergy. And I know I'm talking specific to food allergy when it comes to, like, pediatric feeding disorder specifically. I don't. I don't know, Like, I don't think that's like, a particular, like, verbatim category.
[00:32:21] Speaker C: Yeah, I wouldn't imagine it would be. I mean, it's still a really new diagnosis. And I think even some of the improvements I'm hearing in the food allergy side are great for accommodating any sort of feeding difference.
And so I. I do love that, and I think we'll just. We just need more advocacy and awareness and education for pfd, and we'll get there.
[00:32:43] Speaker A: Yeah, absolutely. Absolutely. So, yeah, you know, we do address, like, various aspects of PFD in wic. It looks, like, different from the way we do it as a consortium, but, yeah, like, at the end of the day, parents do have access to, like, the hypoallergenic formulas or the enteral, like, the tube feedings. They do have access, like the nutrition education. And if WIC can't provide that direct access at the end of the appointment, like I said, there are referrals to health and social services.
And so we are able to, like, touch on it in some way, shape or form and give parents, like, the support that they and the resources that they need. But, yeah, for, like, every case, it's going to look a little bit different.
[00:33:22] Speaker C: Yeah, no, that makes a lot of sense. Well, thank you, Darlena. This has been, like, so amazing to kind of dive into and learn more about. And I know that we're just at the beginning of our partnership together because of you joining the project team, but I'm so excited to see where it can go.
Haley, I realized I asked all the questions just now. Did you have any questions that we didn't get to.
[00:33:45] Speaker A: I just.
[00:33:46] Speaker B: No, it's been nice. It's been nice to learn more about just the structure of. Of WIC and the National WIC Association. So I research studies where I talk to families, parents of babies coming out of nicu, like, for the first couple years, or I do. I do a lot of qualitative research with families of kids that are feeding their babies and their kids.
And during. During one study in particular, I was talking to moms of babies that were NICU graduates over their first two years of life. I would check in with them and. And a lot of them talked about WIC as a resource that had helped them.
So.
[00:34:26] Speaker A: So glad to hear that.
[00:34:29] Speaker B: And that's in North Carolina.
[00:34:31] Speaker A: Oh, that's great. Yep. We do what we can. Yeah.
[00:34:35] Speaker B: I mean, it was. It was a really important thing for several families.
[00:34:39] Speaker C: It's a really meaningful program, and I love that NWA is there to support all of the programs that are out there, too.
[00:34:45] Speaker A: Yeah. Yeah. And especially, like, lately with, like, we've really been trying to, like, use a health equity lens. And that was something I also wanted to touch on, was like, yeah, the equity issues that come with, like, families, you know, because food allergy is expensive, like, finding, like, you know, Substitutes that are safe cost more money. Like, they just cost more money regardless of what your like income bracket is. And so when you are a participant in, in WIC and you know, like you are facing like those income, like, you know, you're just facing financial hurdles. Like it is like, like acknowledging that like there are equity issues that come with food allergy or just like pediatric feeding disorders, like it is more expensive to tackle these issues. And so even just trying like, you know, we, yeah, like we, we are very aware of that. And, and we do what we can to like really just try and like lessen that burden because it's burdensome on any family regardless. Um, but yeah, you just add in.
[00:35:44] Speaker C: Like, you know, just an added layer of complexity to it.
[00:35:48] Speaker A: Yes.
[00:35:49] Speaker C: Yep. Lots of different appointments on top of trying to figure out the nutrition side.
[00:35:53] Speaker A: Exactly, exactly. And, and you think about all the doctor's appointments on top of the WIC appointments, on top of the paperwork. And if you're participating in more than one federal nutrition program. So we're always trying to find and explore opportunities for streamlining too, because it's like if you participate in Medicaid and Wiccan, like you're bringing in a lot of duplicative paperwork, like same first snap, you know. So yeah, like we, we also recognize that there's a lot of opportunity for like growth and streamlining and just making like the certification process smoother and easier for participants.
[00:36:26] Speaker C: Yeah, well, I love that it's already, already there is like an automatic qualifying if you've been through one agency, like you qualify with, with wic. So I even love that that's a place to start on that.
[00:36:38] Speaker A: Yes, definitely.
[00:36:39] Speaker C: Were there things that we didn't get to that you wanted to bring up?
[00:36:42] Speaker A: I don't think so. Nope, nope, I did. Like I said, I made the note specific about like the hypoallergenic formulas and.
[00:36:49] Speaker C: The tube feeding piece of this.
[00:36:51] Speaker A: Yeah, yeah. And I think I discussed everything I wanted to discuss. So thank you so much for giving me this opportunity.
[00:36:58] Speaker C: Yeah, no problem. Darlena, we have one question. It's the question that we ask everybody as we leave. And I think for your perspective, you'll have both your dietitian background and then like your knowledge of local agencies and then what's happening at the federal level. But what do you think? What are the barriers to family centered research? Because I think so often what we're looking at is a lot, a lot of research is happening, but it's not always keeping families at the center of it. And so what Are some barriers that you see or even what are some solutions that you see in this work that might be needed?
[00:37:29] Speaker A: That's an excellent question. And one of the things that I didn't talk about with the National WIC association is we have a lot of committees. And so we actually do have like an evaluation committee and that is comprised of WIC researchers. And we also, like, publish.
I'm blanking on what it's called, but it's basically like a research needs assessment. So we periodically publish a research needs assessment where we let researchers know what, like, we would like them to research. Because when it comes specific to wic, like, we are actually very proud, popular, like, program to research because we have a defined population.
[00:38:10] Speaker C: Sure.
[00:38:11] Speaker A: So, yeah, it makes it very appealing. My understanding, not as a researcher, but as someone in my understanding is that researchers love to study WIC because it's defined population for a defined set of time. So, like, a lot of the variables are like, accounted for.
[00:38:24] Speaker C: Our researcher is acknowledging that. Darlene.
[00:38:27] Speaker A: Great. Yeah, yeah. So we have this evaluation committee full of WIC researchers because we actually do have a lot of PhD researchers in WIC. And so in like. So we do have that community. And like, I guess I say all that to say, like, it's hard for me not being a researcher to kind of think of like, the barriers or opportunities or how we can like, pursue more research related to PFD with a family centric focus. But, like, I do know that research exists out there. Like, you said that like, just like, studies the WIC population from this lens. And so I made it more connection.
Yeah, that's what I was thinking. I was like, it might just also be more about, like, strengthening those partnerships, like, between the National WIC association and the consortium and like, making, you know, like, touching base on our monthly evaluation committee meeting and kind of asking, like, what they see on the landscape. And that's where like, the cool thing about like the National WIC association is, even if it's not my area of expertise, we have a committee or task force somewhere, like, made like the comprise of that specific subset of WIC staff that really understand that landscape very well, that can like, give us more information. So, yeah, related to your question, Jacqueline. Like, I think, like, for me the best answer I have is like, the way to keep families more at center is like, strengthening partnerships between, like, the consortium and the National WIC association, the consortium and other state agencies just to increase that awareness. And then, like, you know, one of those outcomes will be strengthening partnerships with researchers and understanding, like, what the needs are when a state, like when PFD or food out, like anything related to that subset is being studied. Like, like, you know, discussing with these groups as well. How can we keep families at the center?
[00:40:10] Speaker C: Oh, I love that.
It's amazing work. Well, I just have really enjoyed this conversation and learning more from you and really excited about how we can strengthen this partnership because I think it's so important for so many of our families and also for the work you all do. You know, it's important to know about pft. And so it just, it feels like we're on the right, we're on the right road, I guess.
Thank you so much, Darlena, for joining us today. Bye, everyone. Feeding Matters Infant and Child Feeding Questionnaire was developed as an evidence based tool to promote early identification of feeding disorders. Developed by internationally recognized feeding experts, this online questionnaire, available in both English and Spanish, can help you better understand your child's feeding differences and needs. Take it online for free today@questionnaire.feedingmatters.org that's questionnaire Feeding Matters. Org or type ICFQ in your search bar.