DHS Secretary Dennis Smith. Photo courtesy of Wisconsin Department of Health Services.

Health chief defends approach, says system should be nationwide

By Bill Lueders
Wisconsin Center for Investigative Journalism

Advocates for Wisconsin’s Women, Infants and Children nutrition program want the state to reconsider its decision not to seek nearly $9 million in federal grants to make the benefits more convenient and less open to fraud.

The decision by Dennis Smith, secretary of the Wisconsin Department of Health Services, will  “diminish the capacity to serve the 120,663 participants currently enrolled,” Barbara Sheldon, chairwoman of the Wisconsin WIC Association, said in a letter sent Aug. 12 to Smith.

Earlier this year, Smith rejected a proposal from Patti Hauser, who directs the state WIC program, to submit an $8.9 million grant application to the U.S. Department of Agriculture to convert to an Electronic Benefit Transfer (EBT) system — a swipe card — as all states are required by federal mandate to do by 2020.

The WIC program is for low-income women who are pregnant, nursing or who have children up to age 5. For example, a family of three earning up to $34,281 a year is eligible.

Program recipients in Wisconsin receive paper checks that they present at the grocery store to obtain staples including milk, cheese, eggs, cereal and peanut butter. The new system, already in place in several other states, would allow these purchases to be made using a swipe card.

Unlike paper checks, which can be traded or sold for non-eligible purchases, the cards create an electronic record for each transaction, making fraud easier to detect, according to the USDA.

A sample WIC check, made out to Jane Doe.

Smith, an appointee of Republican Gov. Scott Walker, said he rejected the grant request because there are still too many technological and policy problems that the USDA needs to work out. He added that “the most cost-efficient, best way to do this procurement is at the national level.”

“People want to boil it down to, we turned away money,” said Smith, adding that the funds would not have gone to Wisconsin but to “one of the vendors who do EBT benefits.” He said the decision would have no impact on the current state budget.

But Sheldon, whose association represents the state’s 71 county and tribal WIC programs, sees the state’s failure to seek the $8.9 million as a potential lost opportunity.

“This money is available now,” said Sheldon, who works with the WIC program in Winnebago County. “It may not be available in the future. It may have to fall to the state to pay for this.”

A spokeswoman for the USDA said the agency is making $13 million in grants available this year to help states convert WIC programs to the technology. The awards are expected to be completed by mid-September.

Last year, USDA awarded $30 million to help 23 states begin or continue their conversion to the electronic system.

Sheldon’s letter to Smith says prompt filing of the state’s grant application “puts Wisconsin in the line-up for implementation funding. Once the line-up is full, the federal funding will no longer be available.”

Hauser’s grant proposal summary, obtained by the Wisconsin Center for Investigative Journalism through an open records request, said that “with one or two other states applying,” the full $8.9 million would not likely be awarded at one time. She indicated that if Wisconsin were to receive initial funding, however, it would be in a better position to compete if additional money becomes available.

According to Hauser, the new system could be operational for WIC recipients by 2014. Smith said he considers that timeline “optimistic,” and that his priority as secretary is “doing things that help people today.”

Sheldon said switching to an EBT card, which is already used in Wisconsin for food stamps, would improve program efficiency, “be less cumbersome for grocery stores” and make the program more appealing to participants.

“It’s more in step with how people shop these days, and there would be less stigma to using a swipe card than the paper checks,” she said.

Suzanne Oehlke, advocacy chairwoman for the Wisconsin WIC Association, said some program participants are uncomfortable using the paper checks. They feel stereotyped as poor by cashiers and other shoppers — a reaction she’s also encountered while doing compliance buys in Portage County, where she works. “We know that keeps people from using the WIC program,” she said.

This is not the only federal grant that Smith, a former senior fellow at the conservative Heritage Foundation think tank, has declined to pursue. He also initially refused to support applications by agencies including the Milwaukee Health Department and University Health Services for about $30 million in federal grants over five years to promote healthier lifestyles and prevent disease.

After Smith’s decision was widely criticized, the department changed its stance and sent letters in support of several agencies seeking these grants.

Sheldon’s letter to Smith asks for a meeting to discuss how the state can meet the 2020 deadline to convert to the swipe cards. Smith, through a spokeswoman, said he would be “happy to meet” with the WIC organization.

Bill Lueders can be reached at blueders@wisconsinwatch.org. The nonprofit and nonpartisan Wisconsin Center for Investigative Journalism (www.WisconsinWatch.org) collaborates with Wisconsin Public Television, Wisconsin Public Radio and the UW-Madison School of Journalism and Mass Communication and other news media. All works created, published, posted or disseminated by the Center do not necessarily reflect the views or opinions of UW-Madison or any of its affiliates.

For a list of local WIC programs in Wisconsin, see: http://www.dhs.wisconsin.gov/wic/localproject/localprojects.htm

The decrease from 2008 wasn’t huge — only 17 fewer reports than the year before — but it fits a trend of decreasing reports that the state has seen over the past three years, OJA said. The largest decline was seen in 2008, when there were 531 fewer reported sexual assaults than the year before.

Statewide, OJA said there were 4,633 sexual assaults reported in 2009. Sixteen percent of the reports involved male victims.

A 2008 Centers for Disease Control and Prevention report said 2.5 percent of women and 0.9 percent of men experienced unwanted sexual activity in the previous 12 months, although not all such incidents are necessarily assaults.

Kelly Anderson, executive director of the Dane County Rape Crisis Center, said it’s unlikely that a county would have zero incidents of sexual assault. In addition, she said reports to law enforcement aren’t necessarily a good gauge of the actual number of sexual assaults. The value of the OJA report is it pinpoints counties and communities that are successful in encouraging reporting while highlighting low-reporting communities, she said.

Earlier this year, the Wisconsin Center for Investigative Journalism released a report that found estimated rapes outnumbered reports by a margin of 17 to 1 on University of Wisconsin campuses. The report was produced in collaboration with the nonprofit Center for Public Integrity, which conducted a year-long investigation of the problem across the nation’s campuses.

Some victim service providers in Wisconsin have seen as much as a 400 percent increase in the number of sexual assault service requests from the year before. Of those who sought services, 69 percent did not report their assaults to law enforcement, the OJA said.

The Dane County Rape Crisis Center has also seen a rise in service requests over the last few years. But Anderson is hesitant to say this means an increase in actual sexual assaults.

“We work with victims for counseling whose experiences could have been in the last hour or 20 years ago,” Anderson said. “An increase in the services we provided in the last year could be from people under stress, maybe financial stress or a job loss, which causes them to need support for an assault that maybe happened a long time ago.”

Victims often don’t report such attacks to police due to low rates of prosecution of perpetrators and fear of reliving a traumatic experience, UW-Madison Health Services Violence Prevention Specialist Carmen Hotvedt said.

Valenti spoke during National Sexual Assault Awareness Month and after a recent report by the Wisconsin Center for Investigative Journalism on the underreporting of sexual assaults on campuses that found estimated rapes outnumber reports by a margin of 17-1 at UW campuses. The report was produced in collaboration and with support from the nonprofit Center for Public Integrity, which conducted a year-long investigation of the problem across the nation’s campuses.

The rape culture that Valenti describes is based on the idea that women should be responsible for preventing rape, a mindset that she said absolves blame from the perpetrator. Society points to drinking, dressing scantily or staying out late as a woman’s choice to put herself in danger, Valenti said.

She noted that men are much more likely to be a victim of violent crime and are more likely to be assaulted, injured or killed when alcohol is involved.

If we use that same mindset for men, she said, given those statistics, we’d be telling men to stay home from the bars.

Nearly 200 people attended her speech at the Pyle Center, which was presented by Promoting Awareness Victim Empowerment (PAVE) and All-Campus Party.

–Sara Jerving, reporter

University of Wisconsin-Madison graduate Abby Panozzo says she was raped at an off-campus party in 2006. Read her story and hear her account in her own words by clicking the photo. WCIJ/Andy Hall

By the Wisconsin Center for Investigative Journalism

At University of Wisconsin campuses, sexual assaults remain seriously underreported and many women still face barriers to notifying authorities. Most victims do not report crimes. The statistics are inconsistent. And most rapists go free.

The Wisconsin Center for Investigative Journalism today launches Suffering in Silence: Sexual Assaults at the University of Wisconsin, an investigation that examines how UW is tackling sexual assaults on its 13 four-year campuses. The multimedia project, which includes audio clips and a searchable database of campus reports, is the result of dozens of interviews the Center’s reporters conducted with rape victims, UW officials, advocates, researchers and others.

Reactions to the investigation began even before the stories were published. As a result of our reporting, on Tuesday, Feb. 23, the UW System acknowledged its annual summary of sexual assaults — required by the Legislature — should be more accessible and posted it on a new Web page. Two days later, UW-Madison Dean of Students Lori Berquam issued a statement saying that “reading these stories reminds us of the importance of the work we are doing to try to prevent these horrible acts, to respond in victim-centered ways and to seek accountability from those who would perpetrate them.”

Berquam added, “We are deeply sorry that the women identified in these stories were assaulted and then experienced challenges in obtaining assistance that they sought.”

The Center produced this investigation with support and collaboration from the Center for Public Integrity, and published it in coordination with other reports on campus assaults from colleagues in the Investigative News Network.

The links that follow will send you to the separate site we’ve created for this project. We invite you to share your reactions with us by posting comments on the stories or by writing to Andy Hall, the Center’s executive director, at ahall@wisconsinwatch.org.

MAIN STORY
Suffering in silence: Campus sexual assaults underreported

At UW campuses, estimated rapes outnumber reports by a margin of 17-1. That means nearly all rapists go unpunished, whether by schools or the criminal justice system. Victims tell us how tough the system is on them, and why they don’t want to file reports.

SIDEBAR: THE STATS
Data draw murky picture of sexual assaults on Wisconsin campuses

No one contests that campus sexual assaults are underreported. But even nailing down how many are reported at a campus is a challenge. At UW-Madison in 2008, either one, five, eight or 44 sexual assaults were reported — depending on which report you consult.


SIDEBAR: UW’S DISCIPLINARY SYSTEM
How will recent changes affect rapists and rape victims?

In a controversial move, the University of Wisconsin System last fall revised its campus conduct code. Some experts say the changes could make it easier to punish rapists, while others worry that one change could intimidate victims.


SIDEBAR: PROMISING PRACTICES
Teaching students to intervene in acquaintance rape

Rape whistles are out, and there’s evidence some campuses are tailoring prevention programs to the most recent research on college rapes. Given the vast underreporting, it may seem like there are countless rapists out there. In reality, a small minority of men — undetected serial rapists — perpetrate many of the crimes. New “bystander intervention” programs aim to teach students to identify and prevent predatory behavior.


By Sara Jerving

Wisconsin Center for Investigative Journalism

Not again.

That was the dread that hit 18-year-old Bianca Lewis when she learned she was pregnant with her second child, less than a year after her daughter was born.

The depression that had troubled the single mother during her first pregnancy intensified after the birth of her second child.

Lewis, of Sun Prairie, frequently cried.

She fell into fits of screaming rage.

She abused alcohol.

She even broke ceramic plates over the head of the father of her children.

More than 65 percent of depressed mothers don’t get adequate treatment for depression, according to a nationwide study released this fall by the UW-Madison School of Medicine and Public Health. The study of 2,130 women found that black, Hispanic and other minority mothers were among the least likely to be helped. Women with health insurance were more than three times as likely to receive adequate care compared to uninsured mothers, the study found.

“Expanding health insurance coverage to mothers with depression is a critical step in

helping them get the care they need,” said lead author Whitney Witt, assistant professor of population health sciences at UW-Madison.

Nationally, depression that develops during the pregnancy and up to a year after giving birth afflicts up to 15 percent of women, a condition that can cause long-lasting problems in children. Although women of all income levels and backgrounds can suffer from perinatal depression, for women living in poverty, it’s twice as likely to strike, according to the Wisconsin Association for Perinatal Care.

Solutions to the problem of perinatal depression in Wisconsin remain elusive.

Consider that:

• Few health care professionals specialize in perinatal depression, meaning not many women are screened for it, physicians may overlook depressive symptoms and there are few places for treatment if they’re diagnosed.

• Women living in poverty are especially vulnerable because they are often already under excessive stress.

• Some women may avoid treatment because of the stigma of feeling depressed at a time that’s supposed to be among the most joyful in their lives.

• Some who qualify for state-sponsored health insurance while pregnant may lose the coverage after the baby is born because of more-restrictive income requirements for women who aren’t pregnant.

Some symptoms of perinatal depression include feelings that persist for two or more weeks — being overwhelmed, a lack of energy, sleep disturbances, difficulty attaching to the child, loss of concentration and, in severe cases, a desire to hurt themselves or their baby. Postpartum depression can make a woman unable to pick up her child when it needs her or respond appropriately to other cues.

“The attachment that can very quickly rupture when a mother has postpartum depression is potentially devastating,” said Jenny Grether, program coordinator of the Early Childhood Initiative of Dane County, a local home visitation and employment program.

The majority of women suffering from perinatal depression will suffer in silence, and the harm to their children can be profound, experts say, including delays in the child’s cognitive and language development, behavioral problems or other psychological issues.

Mothers and children can also be at physical risk. The most extreme form of perinatal depression, perinatal psychosis, may cause a mother to hate her unborn baby or infant, have thoughts of suicide or of harming the child. While this type of perinatal depression is extremely rare, several cases have made national headlines. In 2008, Alisa Lorraine Evans of Milwaukee was found not guilty by reason of mental disease after she killed one of her twin infant sons and injured another after she was diagnosed with perinatal psychosis.

Insurance limits are tight

On top of the natural stress of being a new mother, poor women struggle, often alone, with how to feed their children, a lack of adequate transportation, child care, employment and health insurance.

The Early Childhood Initiative works in the low-income neighborhoods of Allied Drive, Russet Road and Wexford in Madison, as well as the town of Sun Prairie. Women who are pregnant or have a child under 1 year old can participate in the program.

While its main mission is help children and create self-sufficient families, the program has become one of the primary screening tools for perinatal depression in low-income areas of Dane County. The program finds that just over half of the new mothers and pregnant women screened in low-income areas of Dane County had depressive symptoms at levels warranting further evaluation.

For many low-income women, a lack of adequate health insurance remains a significant roadblock to getting help. For those who do have state-sponsored insurance, finding therapists who charge on a sliding scale, or who accept patients receiving Medicaid, is difficult, said Birdie Meyer, president of Postpartum Support International.

BadgerCare Plus, the state’s health insurance program for low-income residents, has a special eligibility standard for pregnant women, offering state-subsidized coverage, for example, to a family of four making up to $66,144 a year.

Following the birth, the mother will still be covered for at least 60 days and the child is still eligible for BadgerCare Plus, but the income eligibility for his or her mother tightens to $44,100 a year to qualify for BadgerCare Plus.

Sixty days after the birth, women who don’t meet the income-level requirements are dropped, according to the Wisconsin Department of Health Services. Some cases of postpartum depression don’t show up in the first two months, meaning a woman could be dropped from coverage before the condition is identified or treated.

“I am stable now”

For Bianca Lewis, the path toward wellness has been rough.

Lewis moved from Houston to Dane County to live with her baby’s father in 2006. But things didn’t work out, Lewis said, because he was involved with two other women, and he’d already fathered two children with one of the women. A few months after the birth of her first child, Lewis found herself alone with her baby daughter at a homeless shelter.

She’d just had her gall bladder removed and was preparing her seven-month-old daughter for surgery to repair a congenital defect when she found out she was pregnant again.

She felt miserable, overwhelmed — and depressed.

“So here I go all over again,” Lewis said. “Not knowing if he’s going to be there or not. And I’m going to be sitting here with two kids … “

Lewis got help from the Early Childhood Initiative, where she was referred by her landlord after her first child was born. She’s been seeing a therapist, has been on and off medication and has developed a support network to help her through episodes of depression. Throughout her apartment are handwritten reminders to “Take your meds!”

Since she qualified for state-subsidized health insurance and was connected to treatment by the Early Childhood Initiative, Lewis didn’t have to worry about access to care. Even without this stress, however, Lewis felt burdened with other problems that make it hard to cope with depression.

“Mentally, I am stable now, but I still have three bodies to worry about,” Lewis said. “I have to make sure that we have enough food at the house and that everyone gets to their doctors’ appointments … I just want everything to be like the classic normal family — have a perfect home, the kids can have a father-figure, a picket fence house, all of that.”

Access improves, yet stigma persists

Access to treatment for women in Wisconsin suffering from perinatal depression has improved over the past 10 years, said Ann Conway, executive director of the Wisconsin Association for Perinatal Care. Women and health care providers are more aware of the problem, which has boosted the number of women getting screened for perinatal depression. And a growing amount of research has focused on the effects maternal depression on infants, children and families, she said.

Still, many women with perinatal depression aren’t getting help, Conway said.

“Some of the things that have remained the same include the stigma associated with a mental illness; the fear of prescribing selected antidepressant medications for pregnant and breastfeeding women; and a lack of mental health providers, ” Conway said.

Jennifer Doering, assistant professor of nursing at the University of Wisconsin-Milwaukee, agreed a stigma persists.

“In society, there is the idea that you can’t be a good mom and have a mental disorder,” she said. ” The two, for whatever reason, wrongly seem to be on the opposite ends of the spectrum.”

The depression itself can be a significant barrier to getting help, Doering said.

“Simply making the phone call when you are depressed to seek help is, for many women, a severe and almost insurmountable burden, ” she said.

Should screening be required?

Rebecca Cohen, a mental health program analyst for the state Department of Health Services, believes all pregnant women and new mothers should be screened for depression. She said identifying women suffering from perinatal depression would help knock down some of the barriers to getting help. The Wisconsin Association for Perinatal Care recommends women be checked for depression twice during pregnancy and twice after the child is born, once at six weeks after birth and another time before the child is 1 year old.

Some states have passed legislation dealing with perinatal depression, including New Jersey, which requires health care providers to screen all new mothers for the condition. Earlier this year, a bill was introduced in the U.S. House of Representatives that would ensure new mothers are screened and treated for postpartum depression. The bill also calls for increased funding for research on postpartum depression.

Still, most women like Lewis who do find treatment do so by accident, said Lisa Hebgen, Wisconsin state co-coordinator of Postpartum Support International. She said there are few support groups in Wisconsin aimed at women with perinatal depression, who may feel alienated in regular new-mother groups.

Hebgen, who suffered from postpartum depression after the birth of her son, found Dane County had few health care providers versed in the problem. Nowhere in her birthing classes or doctor visits did she hear about perinatal depression. Hebgen said when she began experiencing symptoms of depression, her concerns were ignored.

Said Conway of the Wisconsin Association for Perinatal Care: “The most common lament we hear … is the lack of services for mental illness, especially for pregnant women with mental illness.”

The nonprofit Wisconsin Center for Investigative Journalism (www.WisconsinWatch.org) collaborates with its partners — Wisconsin Public Radio, Wisconsin Public Television and the UW-Madison School of Journalism & Mass Communication — and other news media. This report is part of All Together Now, a community-wide collaborative journalism project, with all coverage available at www.ATNMadison.org.

What is perinatal depression?

A majority of new mothers may experience the ‘baby blues’ where they feel tired, have no energy and are overwhelmed by both joyful and depressive emotions. The postpartum blues may last up to 10 days and normally go away naturally.

But symptoms of perinatal depression, which afflicts pregnant women or new mothers, are more serious and last longer than the ‘baby blues.’ Some of the symptoms include depressed mood, lack of interest in activities, an inability to sleep, decreased concentration, a lack of energy to respond to the baby’s needs, emotional detachment from the child, feelings of guilt about that detachment and thoughts of harming oneself or the child.

Researchers have long thought that perinatal depression is caused by hormonal imbalances. However, many recent studies have found that other risk factors may have a stronger impact on perinatal depression. Those include recent stressful events like a job loss, financial difficulty, relationship problems or divorce or a general lack of social support.

The Centers for Disease Control and Prevention has found that reports of postpartum depression are high among teenage mothers, victims of physical abuse, low-income patients, smokers and mothers with less than 12 years of education.

The most serious and rare form of perinatal depression is perinatal psychosis. Women with this disorder can have delusions, paranoia and hallucinations, including hearing voices and having thoughts of harming their babies or themselves. Women with these symptoms should seek medical help immediately.

Women with perinatal depression can experience anxiety disorders such as panic disorder or obsessive-compulsive disorder in addition to their depression. Postpartum obsessive-compulsive disorder can cause a mother to have persistent thoughts about harm to her baby, causing her to excessively protect her child.

Perinatal depression can last several months to a year or longer if left untreated. Extended maternal depression can damage a mother’s relationship with her child but also result in delays in the child’s cognitive and language development, behavioral problems and other psychological issues. Some of the treatment options include therapy and medication.

Key facts about perinatal depression

If you need help

• UW-Madison Postpartum Depression Treatment Program, 608-263-5000
• Postpartum Support International, Lisa Hebgen, Wisconsin state co-coordinator, 608-929-7629, http://postpartum.net/
• Maternal and Child Health Hotline in Wisconsin, 800-722-2295, www.mch-hotlines.org