Performing Department
(N/A)
Non Technical Summary
There are significant opportunities to increase the health and wellbeing of pregnant women, infants and children in the U.S. WIC provides invaluable support to this population, however, there is a noted enrollment and retention gap among those who are benefits-eligible. This is a strategic gap that WIC is trying to close by exploring ways to recruit, equip, and retain a more diverse and competent workforce that is representative of the WIC populations being served.This RFP recognizes opportunities for improvement in WIC implementation, including through localized hiring and upskilling of PPs, and acknowledges challenges due to differences in program design. These differences allow for innovation and adaptation to best meet local needs (e.g., differences in participant needs and demographics), and provide an opportunity for real-time evaluation of implementation models that can inform standards of practice. Drawing on our expertise with WIC, public health workforce development and workforce competency research, our mission is to help WIC increase the diversity and cultural competency of the WIC workforce and address barriers to recruitment and retention of WIC staff by documenting promising approaches and strategies, diffusing innovation to accelerate adoption at a local agency level, and informing more standard guidance and tools from a federal level. As a part of this, our aims are to identify practices that (a) build capacity among locally recruited staff, equipping them to be skilled PPs who can support low-risk individuals, and (b) create working conditions that entice trained WIC staff to stay, serve, and grow in their roles.
Animal Health Component
50%
Research Effort Categories
Basic
(N/A)
Applied
50%
Developmental
50%
Goals / Objectives
Our mission is to help WIC increase the diversity and cultural competency of the WIC workforce and address barriers to recruitment and retention of WIC staff by documenting promising approaches and strategies, diffusing innovation to accelerate adoption at a local agency level, and informing more standard guidance and tools from a federal level. As a part of this, our aims are to identify practices that (a) build capacity among locally recruited staff, equipping them to be skilled PPs who can support low-risk individuals, and (b) create working conditions that entice trained WIC staff to stay, serve, and grow in their roles.The overall goal of our project is to explore and test comprehensive and sustainable solutions to address regional WIC workforce needs through a focus on understanding the various training and staffing models being used across WIC, particularly as they relate to paraprofessionals. Our team has vast experience with WIC, workforce development initiatives (including projects with paraprofessionals (PPs), and workforce competency research), and effective social need screening and referral systems supported by PPs.We will partner with WIC agencies, the USDA/FNS/WIC Workforce Evaluation and Technical Assistance Center (WETAC), and other key partners to support applied research, and the translation of evidence into action.Objective 1: Document current paraprofessional staffing models and related competencies for those roles by the end of Year 1.There is a need to document how PP roles are used at WIC, in order to standardize them. Using best practices in community-based participatory research (CBPR), we will build an applied research advisory team (ARAT), and will use mixed methods to conduct a national landscape and job task analysis to describe qualifications, scope of work and training opportunities for PPs at WIC, and a Delphi survey to develop consensus on key competencies expected for each role.Objective 2: Explore the assets and limitations of current paraprofessional staffing models being used across WIC and other related public health programs by the end of Year 2.Making PP positions ones that are sought after (i.e., supporting both recruitment and retention) involves understanding what is valued in these roles. We will conduct a Photovoice project with PPs and their supervisors both at WIC and other public health programs to understand the issues faced by PPs and to identify best practices in supporting PPs' career development.Objective 3: Evaluate promising strategies by the end of Year 4 that USDA/FSN may propose as a standard of practice to recruit and retain paraprofessional WIC staff. Capacity building methods, including training of both PPs and their supervisors, can equip staff with the knowledge and skills needed to complete their job duties and can also support retention. In Years 2-4 we will develop, deploy, pilot, and evaluate benefits and challenges of at least two 'promising approaches' that address capacity needs (as identified by Objectives 1 and 2), with a suggested focus on rural WIC agencies in New York State (NYS).
Project Methods
Methods forObjective 1: Document current paraprofessional staffing models and related competencies for those roles by the end of Year 1We will pursue three activities: (1) Within 3-months of funding, we will work with USDA/FNS/WIC leadership to develop and engage with a representative and inclusive applied research advisory team (ARAT) to ensure diversity of representative programs, perspectives and voices in every step of our work. We will partner with our project office WIC's WETAC to co-develop outreach plans for engaging with WIC State and local agencies, Indian Tribal Organizations and territories, Tribal Colleges and Universities, and Minority Serving Institutes, and community-based entities working to support nutrition access and outcomes (e.g., SNAP-ed, EFNEP, PRx) to build national and representative collaborations and to build our ARAT. The ARAT will be composed of at least 12 members representing: USDA/FSH/WIC; all 10 of the HRSA Regions; and demographic diversity, including rural and urban experiences and lived experience with WIC. During monthly meetings, the ARAT will help seed and refine research questions and build a network of WIC staff and organizations we can reach out to in our applied research.(2) In Year 1 with guidance from the ARAT, we will use mixed methods to conduct a national landscape and job task analysis to determine how WIC agencies are using the PP job category to deliver services. We will survey 89 WIC state/territorial agencies and 1,900 local agencies, pending ARAT guidance, to explore job titles, qualifications and roles associated with PPs and to capture training opportunities for PPs at WIC. We will conduct a document review of publicly available resources/policies and of policy/recruitment/training/promotion documents submitted via the survey. We will work with the ARAT to refine the list of PP jobs and expected qualifications, tasks, and trainings. (3) By the end of Year 1, we will use the Delphi technique, a multi-stage survey methodology used to develop consensus on key competencies associated with each PP role used at WIC, as identified in the preceding activity. We will elicit survey responses from an expert panel of individuals at local and state/territorial agencies.Methods for Objective 2: Explore the assets and limitations of current paraprofessional staffing models being used across WIC and other related public health programs by the end of Year 2.We will pursue the following activity: (1) In Year 2, we will conduct a Photovoice project. Photovoice is a community-based participatory research method that uses photographs to promote critical dialogue about issues faced by a community in order for members of that community to advocate for action and policy change.We will work with ARAT (described in Objective 1) to identify and recruit PPs and supervisors from WIC and other relevant public health agencies [e.g., community health workers, nursing programs, Expanded Food & Nutrition Education Program (EFNEP), etc., to capture experiences from other public health sectors where PP models are garnering success]. As part of the Photovoice Project, we will conduct focus group discussions with WIC clinic managers and PP staff, and with managers and PP staff at other public health programs. We will ask participants to record strengths and concerns faced by PPs, including those related to training opportunities, career advancement, professional development, etc. Using photographs to guide focus group discussions, we will document (a) the perceived benefits and limitations of PP positions; (b) workforce recruitment and retention challenges; and (c) solutions they have explored. This work will be used to describe key barriers to recruitment and retention of PP roles, trainings used to upskill staff, challenges implementing WIC policies, and promising practices.?Methods for Objective 3: Evaluate promising strategies by the end of Year 4 that USDA/FSN may propose as a standard of practice to recruit and retain paraprofessional WIC staff.We will achive four activities: (1) In later Year 2, we will work with the ARAT to build on outputs from Objective 1 (PP competencies) and Objective 2 (existing 'promising' capacity building assets) to define the focus and priorities of training materials such that they focus on the key competencies not adequately addressed by existing WIC training materials. (Note, focus may be on functional WIC tasks rather than job titles; intervention will have a supervisor component to support/seed staff recruitment and retention, including, for example, leadership development). (2) At the end of Year 2, we will use HCD to co-design two capacity building interventions to test comparative effectiveness. Intervention A will comprise asynchronous online training materials (e.g., a lower-cost model, considering scalability); Intervention B will include broader capacity support components (e.g., mentoring, hands-on activities, community of practice). Both interventions will be competency focused, and both will include materials for PP staff and supervisors, to support recruitment, upskilling, and retention.The ARAT and affiliates will help co-design Intervention A and B which may include: translating or adapting promising training resources identified in Objective 2 to test acceptability, adoptability, fidelity, and impact (e.g., WIC-focused leadership development programs being used in California, and in demand by other states); developing new training resources; adopting and adapting existing materials to wrap WIC trainings (e.g., adopting elements of our team's promising foundational public health training to give the WIC PPs broader skills, including community engagement, trust building, social drivers of health, diversity equity and inclusion, cultural competence, behavior change strategies); and/or partnering with grantees selected to Project Areas 5 and 6 to pilot new training materials or new training models identified.(3) Near the end of Year 2, the ARAT will help build a pilot sampling frame, ensuring diversity of sites and staff. Pending ARAT support, we suggest focusing on rural counties in NYS, a geographically and demographically diverse state with 44 of its 64 counties being rural.In Year 3 we will sample and enroll up to 30 sites (up to 150 eligible staff, including new and existing PP, and supervisors) into one of three 'treatment groups' following a stepped-wedge study design. To start, sites will be provided with resources to help with local PP staff recruitment (where feasible) and will be randomized to one of three groups: (i) no additional trainings from the team (control), (ii) Intervention A (i.e., asynchronous online training), or (iii) Intervention B (i.e., enhanced capacity building through activities such as mentoring). All participants will complete a baseline skills gap assessment upon enrollment and at the end of the capacity-building phase (~6-8 mo).(4a) Across Years 3 and 4, as Interventions A and B are piloted, implementation science methods will be used to monitor site adherence, and to understand the barriers to and facilitators of intervention adoption and integration, informing the potential for translation to other sites, and adoption as national or regional guidance. Further, (4b) across Years 3 and 4, rigorous pre- post- and post-post assessments will evaluate training completion, competence development, changes in skills gaps, retention of skills, and ways in which gained competencies are translated into WIC-related actions. This will be supported through surveys and focus groups with PPs and their supervisors.