By Dave Thomason, Director, Kansas WIC Program
In practice, pediatricians assess for anemia and elevated lead levels and then, if appropriate, perform a test of the patient’s blood. When you provide care for patients who also participate in the WIC program, questions may arise about the screening for anemia or elevated lead levels performed by WIC or other health department staff. This article will help answer some of these questions and start the discussion to explore solutions to identified problems.
To be certified as eligible to participate in the WIC program both an assessment and screening for low iron blood levels are required no more than 60 days prior to the certification. WIC uses a finger stick or a non-invasive hemoglobin screen for a quick hemoglobin screening. If a client has a very low hemoglobin, they are referred to their PCP for more thorough testing. They are also educated about high iron foods and asking their PCP for an iron supplement recommendation. Individuals who are at low income levels, including those eligible for WIC services, have a higher risk of anemia than those at higher income levels.
Some Kansas health departments also screen for elevated lead levels in blood. The WIC program requires only assessment for elevated lead levels and does not provide screening. Nevertheless, a WIC participant may be screened for elevated lead levels by a WIC staff member with the costs being charged to another program and funding source. Since the client isn’t informed about the funding source, she may understandably believe that the lead screening was provided by the WIC program. If your patient says she or her children were tested for lead during a WIC appointment, understand that it was really not part of the WIC process.
To screen for anemia, the WIC program follows a periodicity schedule as provided by the Centers for Disease Control and Prevention (CDC) in “Recommendations to Prevent and Control Iron Deficiency in the United States.” MMWR 1998; 47(No. RR-3)
In WIC, Infants are screened for the first time between 9-12 months and a second time 6 months after the first screening. In actual practice, the first screening is done at about 12 months and the second screening is done at 18 months.
After the second screening, children are screened once every 12 months. Children 2-5 years of age with a low hemoglobin result must have a blood test at 6 month intervals.
Pregnant women are screened at the earliest opportunity during the pregnancy. Test results are evaluated according to the trimester in which the blood test was taken.
Breastfeeding and Postpartum Women are screened after termination of the pregnancy, usually 2-3 weeks postpartum.
The CDC recommended schedule used by WIC and the schedule recommended by AAP/Bright Futures, seem to be compatible. Why then does it seem that patients are being screened more frequently than necessary? What can we do to reduce duplication or other problems related to blood testing?
Good communication between patients, WIC staff and the medical team is the key. Simple questions such as “Do you participate in the WIC program?” and, “Have you had a blood test of any kind provided by WIC?”, “Have you had a blood test of any kind at your doctor’s office?” Well, as with most issues, simple questions and responses don’t always lead to a good resolution. Further discussion is needed.
At the invitation of the Kansas Chapter of the AAP, the Kansas State WIC office and KAAP are beginning a discussion to make the coordination of testing and the sharing of test results more effective between medical providers and WIC.
Some of the ideas currently being evaluated are:
- Establish a joint work group of KAAP members, WIC staff and other health department staff to discuss the periodicity schedule, coordination of testing and evaluation of the equipment used to conduct blood tests. Discuss developing practices that would reduce fragmentation of care.
- Developing written “best practice” guidance for all parties to reduce or even eliminate any duplication of blood testing. Developing participant focused guidance about the important role that they play in coordinating the care and services they receive from their medical provider, WIC and Health Department services in addition to WIC.
- Developing a standardized form for both WIC and health department staff and medical provider staff to use in recording information and, on the same form, get consent to authorize the sharing of this information. Several forms developed by local agencies in Kansas as well as forms in use by other states are being evaluated.
Specifically, regarding testing for elevated lead levels in blood, WIC agencies are encouraged to:
- identify local health programs, e.g., Early and Periodic Screening, Diagnostic and Treatment Program (EPSDT), or local initiatives designed to address lead poisoning;
- establish referral systems for lead screening with identified programs;
- inquire during WIC nutrition screening if a client has had a blood lead test and make the necessary referral to obtain one, when appropriate;
- provide information about lead poisoning prevention to clients;
- encourage identified lead screening programs to assist WIC by sharing information on blood work that could expedite WIC certification; and
- assist with the development of an appropriate nutrition care plan for those children identified as having a blood lead problem, including the provision of nutrition education and counseling.
The topics above and other ideas are open for discussion. If you are interested in joining the discussion or have any comments or suggestions to make, please contact Chris Steege at firstname.lastname@example.org or Dave Thomason at email@example.com
Dave Thomason has served as the Director of the Kansas WIC program since 1998. In 2016, the Kansas WIC program served a monthly average of 58,955 participants in 37,142 households. There are over 300 Local Agency WIC staff across the state providing services over 100 clinics.
WIC, the Special Supplemental Nutrition Program for Women, Infants and Children, is a federally-funded public health nutrition program that provides nutrition education, healthy foods, breastfeeding education and support, and referrals to health care and social services to low and moderate income pregnant, breastfeeding, and post-partum women, infants, and children who have or who are at risk for developing nutrition-related illnesses. Numerous studies have shown that WIC is effective and helps improve diet quality and consumption of key nutrients, reduces the incidence of premature and low birth-weight babies, and increases access to regular health care.