UHP mascot with young visitor at WIC Breastfeeding Expo 2019 (Bronx, NY). Photo by Romina Hendlin.
The COVID-19 pandemic has had an unprecedented impact on communities globally and nationally. Especially in low-income and high-risk communities, widespread illness was compounded by increases in unemployment and food insecurity Prior to the COVID-19 pandemic, the food insecurity in the United States had reached its lowest point since the government began to measure it in the 1990s.1 But the pandemic quickly reversed this trend. While unemployment benefits and stimulus checks were credited with helping families stay afloat, in March 2021 nearly half of all families with children in the New York Metro area (46%) reported difficulties in paying for their normal household expenses such as rent, food, and transportation.2
The Special Supplemental Nutrition Program for Women, Infants, and Children, a federal program started in 1972 and administered by the USDA, provides nutritious food, nutrition education and breastfeeding support or formula to low-income pregnant or breastfeeding women, infants and children up to age five. The program has long offered at-risk families basic food security. However, after peaking in 20103 both WIC eligibility and WIC enrollment declined over the course of the decade, although participation trends varied by state and region. In New York, while the number of WIC participants remained well below the number eligible, participation in the WIC program was fairly steady. The pandemic brought new needs, and an increase in enrollment: between February 2020 and March 2021,WIC participation increased 2.1%.4
While many different organizations provide WIC services, Community Health Centers often offer WIC programs as part of their community-focused mission, especially in areas where nutritional risk is great. One such organization is Urban Health Plan (UHP), a health center serving many New York City neighborhoods.
Urban Health Plan was founded in 1974 by the late Dr. Richard Izquierdo, a life-long resident of the South Bronx and a practicing pediatrician and family doctor. From the start, its mission was to provide basic and specialty medical care—comparable to those found in local hospital outpatient clinics—to the community’s predominantly Hispanic and medically underserved residents. UHP is designated a NYS Preferred Primary Care Provider, Prenatal Care Assistance Provider, an HIV Primary Care Provider – and a WIC provider. I spoke with WIC Director Michelle Downer, and Nutrition Director Elvira Rella to learn more about UHP’s WIC program, and other food security initiatives and how the health center has responded and adapted its program to the changes caused by the COVID-19 pandemic.
Urban Health Plan initiated WIC services in 1996, and has maintained the program as part of its comprehensive community-focused program of care, with stable enrollment. COVID-1 9 necessitated changes to many aspects of the health center’s services. Ms. Downer explained that as the pandemic began and community members lost their jobs, many of the health center’s WIC participants, “had to stay home because jobs were no longer available and, in many cases, because they had to homeschool their children giving them no other choice.” This meant that the health center had to adapt to new needs with different practices.
Pandemic relief enacted through the Families First Coronavirus Response Act in March 2020 both added support for WIC services and waived the requirements that WIC recertification be conducted in person5, and allowed providers to conduct nutrition assessments by phone or video calls. Some health assessments were deferred as part of the COVID relief program and others were adjusted. For example, parents could weigh a child at home and report the weight to the health center, rather than taking their child to the health center for this assessment. Additional program support and flexibilities were also added as part of the American Rescue Plan Act in March 2021. Despite some initial concerns over how transitioning to remote services would work, the program flexibilities increased participant retention. UHP had 8,330 participants enrolled in WIC in March 2020, with 2,377 participants receiving services in March. One year later, in March 2021, there were 8,430 participants enrolled, with 3,402 people receiving services remotely. Downer explained that “participants felt safe because they didn’t have to come out and expose themselves.” In June 2021, as prices of fruits and vegetables skyrocketed, New York State announced a temporary increase to the fruits and vegetables benefit, to $35 dollars a month per participant, so that families could still afford groceries.6 This program will continue through September.6
The need to pivot to using technology, commented Ms. Downer, “opened up [our] eyes to evolving technology and has allowed [us] to think outside the box.” Many of UHP’s participants found telehealth services more convenient and easier to fit into their schedules. Transportation costs were also a barrier for some clients that was alleviated by the use of telehealth. She explained, “technology has increased access to our services. That’s 1,000 more families that have access to good food, and don’t have to go into what little money they have.” Downer stressed that this success was in large part thanks to Urban Health Plan’s existing policies and procedures and relationships with community members, emphasizing that, “in every sense we are a community health center.”
Urban Health Plan maintains an on-site food pantry, and prior to the pandemic, food insecure patients were immediately referred to the pantry. The nutrition department participated in outreach events to promote the health center’s food pantry and encourage people to utilize it. Grant money was earmarked to provide food directly to seniors in the community. When the pandemic rendered these in-person services impossible, the health center pivoted again. Rella worked directly with a local supermarket to set up for food insecure seniors. Seniors could place their food order directly with the market in the morning, for delivery by the late afternoon. While this was a unique solution to a problem directly caused by the pandemic, Rella hopes to continue these types of collaborations in the future. In-person cooking classes were replaced by 30-minute virtual bilingual (Spanish / English) classes that covered a variety of topics including the nutritional needs for pregnancy, growing children and diabetes, Many participants found these cooking demos useful and enjoyable.
For the last 15 years, UHP has also worked very closely with the NYC The New York City Department of Health and Mental Hygiene (NYCDOH) to distribute “health bucks,” coupons for fruits and vegetables that can be redeemed at all farmers markets citywide. Historically, the Center’s nutrition staff would visit the farmers markets with patients, and offer nutrition education as part of the shopping experience. Since this was not possible during the pandemic, Urban Health Plan purchased the fruits and vegetables directly, and health center staff bagged and distributed the produce outside the health center. The health center conducted about 20 of these events; each one served about 100-150 patients and community residents. This year the process for the farmer’s market walks and health bucks distribution had to be modified yet again. To comply with NYCDOH recommendations, patients will be given health bucks so they can visit the market on their own to choose fruits and vegetables. Health bucks will be distributed the same day the farmer’s market is open to encourage same-day use. Some educational services will be offered at the community center site when health bucks are distributed.
As Downer and Rella look forward to how services will be offered in the future, they both stress the importance of giving patients a choice. Rella commented that while some patients found telehealth difficult, others preferred being reached by telephone. Seniors, especially, found the calls welcoming during the winter when it is already more difficult to get outside. The state is currently evaluating WIC requirements will remain remote as pandemic restrictions lessen. Said Downer, “there has been a realization that we can continue to provide these services without participants coming into the health center each time.” Downer was pleasantly surprised that even with remote peer-counseling. 90 percent of the health center’s WIC patients who gave birth initiated breastfeeding within 48 hours of delivery.
While pandemic restrictions are lifting, the arrival of new COVID-19 variants is a reminder of how both safety and policy remain in flux. Both women stressed that future plans must meet patients and participants where they are, and Downer said that “post pandemic we can’t return to pre-pandemic ways.” A best-practice hybrid system would allow Urban Health Plan to continue providing services in person as well as remotely and offer more options to their participants and patients. For Urban Health Plan, whose mission is focused on ensuring access and improving the quality of life in the communities they serve using best practices, addressing food security is part of the bigger picture.
-Irene Bruce, August 2021