How this state is using telehealth to connect more mothers and children with healthy food

During the pandemic, dozens of states made it easier to sign up for food benefits online or over the phone. Between 2020 and 2023, more state agencies reported using technology to improve people’s experience with the Special Supplemental Nutrition Program for Women, Infants and Children, or WIC. The effort was, by many accounts, a success. 

“WIC is increasingly leveraging technology to enhance service delivery, with telehealth playing a central role,” Georgia Machell, president and CEO of the National WIC Association, said in an email to Route Fifty. Modernizing how Americans interact with WIC services helps “enhance accessibility, efficiency, and cultural responsiveness for participants and staff … to provide a more convenient, stigma-free experience.”

Machell said WIC programs in Arizona, Florida, New York and Texas have started implementing remote services like virtual nutritional education and support groups. Now Arkansas, which is facing challenges both with staffing and with getting rural residents to health clinics, is turning to telehealth to help serve more of the state’s most vulnerable women and children.

Just under 3 million Arkansans live in poverty, according to American Community Survey data. That includes about 65,000 people who participate in WIC, which serves pregnant and breastfeeding women and households with young children or babies. Half of those participants are considered high-risk due to having a history of inadequate diet and nutrition, being underweight, having anemia or certain pregnancy complications, or other criteria.

The U.S. Department of Agriculture Food and Nutrition Services, which oversees WIC, requires that high-risk clients meet with a registered dietitian within 45 days of enrolling. The registered dietitian helps educate the person on healthier eating and food purchasing habits, and develops a care plan for participants, said Mitzi Fritschen, associate director of administration for the state’s Center for Health Advancement.

But right now, Arkansas has only 13 dietitians among the state’s 90 local health departments to serve the state’s entire WIC population.

To help the small staff effectively serve high-risk WIC participants, the Arkansas Department of Health will develop an online platform for staff to conduct virtual health assessments, counseling and chat with clients in real-time, said Taylor Baughman, WIC state nutrition coordinator at Arkansas’s health department. For instance, staff can evaluate participants’ risk vulnerability using telehealth and provide breastfeeding counseling for new parents.

Last week, the state’s Legislative Council approved using $500,000 in federal funds from the American Rescue Plan Act to build the platform. It will use a HIPAA-compliant telehealth platform developed by the University of Arkansas for Medical Sciences’ Institute for Digital Health and Innovation, Baughman said. A portion of funds will also be used to train about 90 current employees to use the platform, with the potential to onboard more staff after the system’s initial rollout.

The platform will include a real-time chat function for participants to connect with other staff like WIC vendor liaisons, who guide clients as they shop for WIC-approved groceries. Arkansans can also schedule appointments, and send and receive documents through the platform. It will be accessible from a smart device or a computer.

“Because of transportation barriers as well as time barriers, a lot of our families can’t [or] afford to take off from work, so being able to do a telehealth appointment on their lunch break at their convenience could be very beneficial to them,” Baughman said.

The telehealth option is particularly helpful for rural residents, she said, who have a harder time reaching health clinics for the nutrition support and education they need because of geographic barriers.

The virtual system will also help reduce travel time and expenses for WIC staff, allowing them to see more participants in less time, Fritschen said. “We’re bringing the participants to [staff], instead of sending them out,” she said. “It’s a win-win … because we can serve more families in a way that might be more appealing and more helpful to them.”

Arkansas ranks low in overall women’s health outcomes compared with other states, according to health policy research group the Commonwealth Fund, and it has some of the highest maternal mortality rates in the country. Outcomes are not much better for children in the state, as Arkansas ranks No. 45 in overall child well-being, according to a report The Annie E. Casey Foundation released in June.

“We know that we have a lot of work to do in the state regarding maternal and child health … and we know that participation in the WIC program helps improve health outcomes for mothers, infants and children,”  Baughman said. “We definitely think that telehealth could help us reach that mission even further.”

In-person and over-the-phone appointments will still be available to participants who prefer them or lack internet access, she added.

In fact, a report from the National WIC Association released last week highlights the need for states to modernize WIC processes and services to match the growing workload of WIC staff. The association estimates the nationwide caseload of WIC staff grew 5% in 2023, as the number of participants increased from 6.4 million to 6.7 million.

“The modernization of WIC is crucial to ensuring that it continues to effectively serve low-income pregnant and postpartum women, infants and children,” the report stated. “By streamlining enrollment processes, improving technology and service delivery, and making benefits more accessible through remote options, WIC can better meet the needs of busy working families and increase participation rates.”