OWENSBORO, Ky. (AP) — After more than 40 years of providing education and vital food to Americans, the Special Supplemental Nutrition Program for Women, Infants and Children, with its iconic mother and child logo posted across the aisles of grocery stores, may seem as recognizable as Social Security or Medicaid.
But despite widespread use, participation in WIC has declined in Kentucky and across the nation for several years, inspiring local public health authorities to take a different look at how participants use and think about the program.
The Green River District Health Department has hired two health educators to act as "WIC navigators" as part of a pilot project funded by the Kentucky Department for Public Health to better understand the barriers participants may have in requesting and maintaining their benefits.
Leah Lewis, of Owensboro, and Brad Conrad, of Henderson, have been on the job for nearly a month, training and basically creating their roles for a position that could be replicated in different health districts. They have a year to improve WIC participation across GRDHD's seven-county area by 5 percent, a task they take seriously.
"I want to be able to increase participation, but we are also making sure people are receiving the education and help they need from other programs," Conrad said. "We work for the department and the community, not just WIC."
Conrad, who recently graduated from University of Southern Indiana, has experience in business administration and public health, as well as a background in health marketing through his family's pharmacy business.
Lewis, who graduated from Western Kentucky University in 2015 with a degree in public health and nutrition, said she hopes to use her experience as a health educator with Owensboro Health to give participants someone they trust.
"I'll be focusing on talking to people in the community to give them all of the knowledge they need to hopefully take the opportunities available to them," Lewis said. "I'm really excited to represent myself as a resource for them."
The team will work as educators and caseworkers, speaking to potentially eligible people and helping them meet appointments for continued enrollment.
Merritt Bates-Thomas, nutritional services supervisor for the GRDHD, said some of the biggest obstacles the department has with helping people is the time spent trying to find clients.
"We receive a lot of returned mail," Bates-Thomas said. "Participants face a lot of barriers like keeping stable phone numbers, housing and transportation. Our navigators will be working on ways to help them pass those barriers."
Bates-Thomas said GRDHD has experienced declines in participation for the past two years.
WIC has declined by 16 percent nationally since 2010, its peak enrollment year, according to the U.S. Department of Agriculture Food and Nutrition Service, which administers and funds the program. Between 2015 and 2016, enrollment dropped by 4 percent.
Some USDA studies suggest enrollment has adjusted as families rise above the eligibility of 185 percent of the poverty level. There were 23,487 fewer people in poverty between 2015 and 2016, the lowest since 2011, according to data from the Census Bureau.
The 2014 WIC Participant and Program Characteristics study reported only 6.5 percent of WIC participants were between 150 and 185 percent of the poverty level that year. The majority of participants, 74.2 percent, were below 100 percent of the poverty level, meaning they earned below $24,000 a year for a household of four.
While economic factors are improving for adults, children in Kentucky are still at risk. Over 25 percent of all children in Kentucky are in poverty, one of the top five most severe rates in the country. With qualifying applicants of WIC being in severe poverty before receiving benefits, experts worry that barriers to access are contributing to participation decline more than economic improvements.
Bates-Thomas said the WIC navigators will have to be flexible in reaching the community.
"We may find eligible people are receiving offers for benefits elsewhere, but are they receiving the education and resources as well?" Bates-Thomas said. "They don't have to use all the benefits but we want to make sure they know they can rely on us for resources, referrals or just health advice."
Deborah Fillman, former director of GRDHD, said when she began talking to the state about the WIC project, she had reliability in mind. Fillman has been working with WIC since she began at the department as a nutrition educator. She said the program has changed very little since then.
"The program is over 40 years old and people's lives have changed a lot in that time," Fillman said. "The program has still remained very important to me, but we have to make sure people are still using the educational portion of WIC."
WIC was designed to provide women, infants and children proper nutrition, promote breastfeeding, educate on healthy lifestyles and improve health outcomes across the early development period of children. Some studies from the USDA have shown a connection between WIC program enrollment and reduced rates of obesity and chronic illness associated with children in poverty.
These benefits led the program to extend use to children up to age 5, but according to USDA data, the majority of declining caseloads came from children while women and infants declined only slightly.
Lewis and Conrad will work throughout the year to connect people with resources and learn about what people really need from WIC. Their roles and ideas may change during that time, but the impact they hope to have for their clients seems concrete.
"We are letting participants know we are here and we care," Conrad said. "We are listening to what they like and dislike to bridge the gaps between perspectives."