Nutrition Services Policy 5.0 & Beyond 5.01 Nutrition Services - - PDF document

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Nutrition Services Policy 5.0 & Beyond

5.01 Nutrition Services Overview

Nutrition services must:

• Be conducted in an environment that is

friendly, supportive, accommodating, respectful, and welcoming.

• Have a positive approach based on health
• utcomes, rather than deficiencies.
• Promote active involvement of clients

and/or their caregivers.

• Explore client’s existing knowledge and

readiness for change.

7/16/2020 2 5.01 Nutrition Services Overview Continuity of Care

• The client and CPA must cooperatively

develop a NE plan at CERT/RECERT and IEVAL/CEVAL to provide continuity of care to the client.

• NE documentation reflects what was

provided during a NE contact. This supports continuity of care by enabling staff to follow‐up and support previous NE.

5.03 NE at CERT/RECERT & Policy 2.01 Eligibility/Cert of Clients

5.03: The WIC Program Explanation must be verbally provided to clients as part of a client centered assessment process.

• The WIC Program Explanation is

summarized on the printed Nutrition Education Plan. 2.01: Local agencies must provide a verbal explanation of the WIC Program purpose, key functions, and benefits to clients and/or their caregivers.

• The Program Explanation must be

documented in MIWIC.

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5.03 NE at CERT/RECERT

• Local agencies must provide drug and
• ther harmful substance abuse

information, including local counseling/treatment resources, to new clients at their first certification appointment, and thereafter as needed.

• A newly certified infant is considered a

new client and this requirement applies.

• Providing the client with a printed

Nutrition Education Plan is considered reinforcement of this message.

Nutrition Education Documentation

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Cert/Recert Documentation

CPAs must:

• Provide NE
• Document Date and Method agreed

upon by the client and staff in the NE Plan for the Current Cert Period.

• At recertification, follow‐up on previous

NE

I/CEVAL Documentation

• CPAs must do the following:
• Follow‐up on previous NE
• Provide NE
• Document Date and Method agreed upon

by the client and staff in the NE Plan for the Current Cert Period.

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Interim NE Documentation

• Internet
• Date, Topic, Method, and Behavior Change/Goal

Note (Auto‐populate)

• Individual
• Date, Topic, Method, and Behavior Change/Goal
• Education Mall/Self‐directed education
• Date, Topic, and Method. Document Behavior

Change/Goal when appropriate (by a CPA).

• Group
• Date, Topic, and Method (Auto‐populate)
• Document client’s attendance in MI‐WIC Classes

screen.

Resource: 5.05A NE Documentation Grid

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Nutrition Education Plan

High Risk Determination

• System generated by High Risk codes
• Manually assigned
• Clients on Class III Formulas
• MAR Tool
• CPA or RD assessment (critical thinking)

Heart Icon turns from GREY to RED

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Manually Assigned Risk (MAR) Tool

Manually Added Risks

If a client has multiple risks:

• Pregnancy at a young age
• Abusive boyfriend
• Living in a food desert
• Poor Transportation

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Category Change

• When client status changes during a cert period,

current risk status will display as “Category Change.”

• The prior risk codes will display under the History Tab

Questions about a Risk Code?

Risk Help Document

• Nutrition & Health Summary Screen:
• Select the Risk Help icon
• Select Help => Risk Help

7/16/2020 9 Acceptance of the RD services

• ffered is documented by:
• Schedule of the NCRD appointment
• Registered Dietitian‐WIC checked as

referred on the Referral screen

• CPA documents in the Problem List tab

Declining the RD offer must be documented:

• Check “RD Counseling with Non‐WIC RD” if client is scheduled or has

received counseling from a non‐WIC RD for their high risk condition(s) and declines WIC nutrition counseling.

• Document any relevant information client provides from non‐WIC RD

counseling

• Check “RD Counseling Declined” if the client declines NCRD and is not

receiving alternate RD counseling.

• Document reason for declining RD services.
• A second offer for RD services will be sent by the MI‐WIC system to

clients who decline NCRD.

• Registered Dietitian‐WIC checked as discussed on the Referral screen

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5.06 Nutrition Services for High Risk Clients

5.06 Nutrition Services for High Risk Clients

• ICP Follow‐up:
• CPA must review and assess open care plans at

next scheduled appointment.

• Documentation of relevant follow up information

by the CPA or RD is required in the Care Plan Follow‐Up tab.

• If CPA assessment indicates care plan resolved,

CPA must discuss care plan closure with RD.

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5.06 Nutrition Services for High Risk Clients

ICP Closure:

• A RD is the only staff able to close a care plan.
• RD closes care plan by clicking Care Plan Closed

and documenting rationale on the Care Plan Follow‐Up tab when:

• The client’s desired outcomes have been

satisfactorily met, and/or;

• The client’s planned behavior changes are
• bsolete or no longer applicable.

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Mid Mid-Cer Certif ifica ication A ion Appointment pointment I/CEV I/CEVAL

 Mid-Cert Assessment Screen

 Can only be saved by CPA during scheduled

CEVAL Appointment type

Child Child Mid Mid-cer certif tifica cation V tion Visit

Update Family Info, if needed Height & Weight Head circumference (for children under 24 months) Immunization assessment Bloodwork – use the current schedule Brief Update of Health and Dietary Assessment Nutrition Education Referrals and Food Package changes, if appropriate Add Assessment Note

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CEV CEVAL Appt. Pr L Appt. Process

• cess

 Review of certification appt. data

 Track the client’s footprint  Clicking on the icon pops up the

client’s Certification Information report

Mid-Certification S creen

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What to Include?

Wha What Does T Does This Mean F is Mean For Staf r Staff?

Front Desk

More Time for:

 Customer S

ervice

 Follow up Reports  Making Appointments

CPAs

More Time for CCS:

 Finding out what

clients really need

 Individualizing

Nutrition Education and other services

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Next Up: Client Centered Service

Client Centered Service

What does this mean to you?

Providing WIC services with emphasis on CLIENT needs and concerns.

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How do I get my client to tell me what she wants to know…

• “ Any concerns that you have

about your pregnancy… baby… child… ? ”

• Y
• u seem to be having a concern

about…

• It’s wonderful that you are

breastfeeding, what kinds of questions do you have about…

• Circle chart to suggest topic by

status…

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Benefits of CCS

 For WIC staff:  Use their limited time to collect

relevant nutrition assessment information

 Use client concerns and critical

thinking skills to link assessment information to a client’s individual needs

 Provide client centered nutrition

education

 Engage the client in discussion

and goal setting

 Weave nutrition and diet as the

common thread throughout the assessment process

 Use client interest to plan next

steps

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Benefits of CCS

 For WIC clients:

 Experience a positive

encounter

 Receive information and

services related to their needs and concerns

 Feel involved in goal

setting to improve their family’s health

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So What Does This Mean for You?

• Y
• u are a “change agent.”

– As a change agent, you use many

different tools to help people change.

• What YOU do matters!

– Y

• ur “ presentation”

– Y

• ur demeanor

– Y

• ur interaction

– Y

• ur approach to the conversation
• Think about your favorite teacher and/ or

mentor, how did they communicate? ? ?

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“ S ix months is such a long time in the life of a child! How do you feel about taking a minute to look back at the notes from the last time she saw the nutritionist? We can decide if those things are still important, or if you might want to focus on something new this next 6 months.”

Thinking in CCS: NE Follow-up

S tory Questions

• Being “ assessed” feels intrusive and

disrespectful if done through a series of “ prying” questions.

• Asking about a participant’s life in a way

that feels like you are getting to know them will get much more information, more quickly

• Tell me about a typical day in your

daughter’s life. Would you mind including what she usually has for meals and snacks and her favorite activities?

• Y
• ur daughter seems fussy and you look
• tired. Would it help you to tell me how

life as a mom is for you?

• What makes your daughter happy?

Thinking in CCS: Nutrition Assessment

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Helping Styles

 Directing- Teaching,

explaining, telling what to do

 Following- Listening, giving

space, using open ended questions

 Guiding- Exploring limits,

affirming, asking about consequences

People change because…

 They want to change or want

the outcome of the change.

 They think they can do it and

they will be supported.

 Barriers to the goal are

acknowledged and can be addressed.

 They have resources,

knowledge, and skills needed to make the change.

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The Wisdom of CCS

 No one ever changed, and sustained

that change, because they were

• pushed. We tend to fall after a
• push. Not very motivating…

.

 People change because doing so will

help them live more in alignment with their own personal values

 “ What is important enough to you

that it is worth changing for?

CCS

• Core Principles

 Individualize  Respect  Motivate  Empathize

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Importance of Building Rapport

 What is rapport?

 “ Relationship, especially one of mutual trust or emotional

affinity.” (American Heritage Dictionary, 2000)  What words best describe rapport building to you?  Why is it important?

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Thinking in CCS

Hi I’m Monica, your nutrition counselor for today. WIC is here to help you improve your family’s health through providing nutrition education, healthy foods and referrals when your family needs something we can’t provide. I am hoping I can help you in one or more of those areas. What are you most interested in? * * Allowing the client to direct the focus, right from the beginning

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Barriers to Building Rapport

 Language  Cultural  Environmental  Appearance/ Dress  S

• cio-economic

 Non-Verbal Cues  Others?

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Breaking Down Barriers

 What are some

communication barriers you have experienced?

 How did you overcome them?  What did you learn?

5 6

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Motivation:

 Importance  Confidence  Readiness

“You can’t move people to action unless you first move them with emotion- the heart comes before the head.”

• Mark Dantonio, Michigan State Football Coach

The Flexibility of CCS

It’s ok if the client wants to focus on something other than what you have talked about or provided education for. It is ok for them to abandon a previous goal. “Participant states that she did not work on the previous goal

• f increasing activity. Participant states she would like to try

to reduce intake of caloric beverages and complete an online GE this period.”

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Motivation ~ Behavioral Science Guys



How to Change People Who Don't Want to Change



https:/ / youtu.be/ 9ACi-D5DI6A

Stages of Change



Precontemplation



Contemplation



Preparation



Action



Maintenance



Termination/ Relapse

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The Gentleness of CCS

When it comes to goal setting ~ affirm, affirm, affirm. Remember thinking about something is a goal. Remember, if it ain’t broke don’t fix it! – Meaning affirm and support continuing whatever is working! “You know what you need! What would be the first step? …Then try to make it S.M.A.R.T.

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Empathy

Brené Brown on Empathy

Qualities of Empathy

 Perspective talking  S

taying out of judgment

 Recognizing emotion in

• ther people

 Communicating that

emotion

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CCS Skills

 Open ended question  Affirmations  Reflective listening  Anticipatory Guidance

Tell me if I am understanding. Y

• u feel your

daughter eats well, but it seems like she gets fussy after she eats and has tantrums at

• times. S

he seems constipated often and isn’ t as active as your other children. Y

• u’ re tired

because she takes a lot of energy and is sick

• r fussy a lot. Did I understand you correctly?

I know it isn’ t easy to be a mom. Would you be interested in some strategies

• ther moms have shared that have helped

their children be easier to deal with?

Thinking in CCS: Skills

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Thinking in CCS: Skills

Tell me if I am understanding* You feel your daughter eats well, but it seems like she gets fussy after she eats and has tantrums at times. She seems constipated often and isn’t as active as your other children. You’re tired because she takes a lot of energy and is sick or fussy a

• lot. Did I understand you correctly? I know it isn’t easy to

be a mom.* Would you be interested in some strategies other moms have shared that have helped their children be easier to deal with? *

* Asking for feedback, affirmation, asking permission

Putting It All Together

 Figure out where THE CLIENT is & build from there.  Have an empathetic, respectful approach.  People need to be empowered & set their own goals.  How can we help them build upon what they know

and are already motivated to do?

 How can they be CENTRAL to the learning

experience?

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… All Together

 Remove barriers – real and perceived.  Build confidence – in your client and in

WIC as a reliable support system.

 S

tart with small steps & build.

 Support is key – foster support & help

create supportive environments.

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Client Centered Services Resources

• Rethinking How We Listen and Respond in WIC
• CCS Essential Skills: Communicate to Motivate
• CCS Skill Building (Webcasts for all roles)
• CCS Support (Mentoring)
• Workbooks
• Feedback Form
• Mentor Video
• Intro to CCS Video

https://www.michigan.gov/mdhhs/0,5885,7- 339-71547_4910_19205-448628--,00.html

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Resources

USDA’s WIC Works

https:/ / wicworks.fns.usda.gov/

https://wicworks.fns.usda.gov/wic-learning-online

USDA sponsored website for WIC staff

Nutrition Care Manual

www.nutritioncaremanual.org Username: wic@michigan.gov Password: Partner 19

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Client Centered Conversation Starters

Thanks to Texas WIC VENA Team

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Pregnant

• 1. Regarding your pregnancy or health, what are you most

interested in learning about today?

• 2. Regarding your baby, what are you most interested in

learning about today?

• 3. What have you heard about breastfeeding?

How long do you want to breastfeed your baby? How confident do you feel about your ability to breastfeed your baby?

• 4. What do you feel your greatest challenge will be after you

have your baby?

• 5. What kind of activity have you been getting during your

pregnancy?

• 6. How do you feel about your overall eating?

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Breastfeeding

• 1. How is breastfeeding going for you?

What questions do you have about breastfeeding?

• 2. How are things going for you at home right now?

How much assistance do you have? What are your greatest challenges in getting through the day?

• 3. What do you feel your greatest challenges will be in the

next few weeks or months?

• 4. How confident do you feel about your ability to care for

your baby?

5.

How confident do you feel about your ability to care for yourself?

• 6. How do you feel about your overall eating?

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Postpartum

• 1. What is the greatest concern you have about your health today?
• 2. Regarding your health, what are you most interested in learning

about today?

• 3. How are things going for you at home right now?

How much assistance do you have? What are your greatest challenges in getting through the day?

• 4. What do you feel your greatest challenges will be in the next few

weeks or months?

• 5. How confident do you feel about your ability to care for your

baby?

• 6. How confident do you feel about your ability to care for yourself?
• 7. How do you feel about your overall eating?

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Infant

• 1. What is the greatest concern you have about your baby today?
• 2. Regarding your baby, what are you most interested in learning

about today?

• 3. What are your biggest challenges in feeding your infant?
• 4. How are things going for you at home right now?

How much assistance do you have? What are your greatest challenges in getting through the day?

• 5. What do you feel your greatest

challenges will be in the next few weeks

• r months?
• 6. How confident do you feel about your

ability to care for your baby?

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Child (1-5 years)

• 1. What is the greatest concern you have about your child’s health

today?

• 2. Regarding your child’s health, what are you most interested in

learning about today?

• 3. How do you feel about your child’s overall eating?

What are your biggest concerns and challenges in feeding your child?

• 4. Describe mealtimes for your child/ children for me…
• 5. What do you do when you have little time to prepare meals?
• 6. Tell me what activities your child likes?

How much time does he/ she spend doing the activities each day? How often do you participate in physical activities as a family?

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