7/16/2020 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 outcomes , rather than deficiencies. • Promote active involvement of clients and/or their caregivers. • Explore client’s existing knowledge and readiness for change . 1
7/16/2020 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. 2
7/16/2020 5.03 NE at CERT/RECERT • Local agencies must provide drug and other 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 3
7/16/2020 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. 4
7/16/2020 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 5
7/16/2020 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 6
7/16/2020 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 7
7/16/2020 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 8
7/16/2020 • Schedule of the NCRD appointment Acceptance of the RD services • Registered Dietitian‐WIC checked as referred on the Referral screen offered is documented by: • CPA documents in the Problem List tab • 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 Declining the RD offer counseling • Check “ RD Counseling Declined ” if the client declines NCRD and is not must be documented: 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 9
7/16/2020 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 5.06 Follow‐Up tab. Nutrition Services • If CPA assessment indicates care plan resolved, CPA must discuss care plan closure with RD. for High Risk Clients 10
7/16/2020 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 obsolete or no longer applicable. 11
7/16/2020 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 12
7/16/2020 CEV CEVAL Appt. Pr L Appt. Process ocess 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 13
7/16/2020 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 14
7/16/2020 Next Up: Client Centered Service Client Centered Service What does this mean to you? Providing WIC services with emphasis on CLIENT needs and concerns. 42 15
7/16/2020 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 ou 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… 43 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 44 16
7/16/2020 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 45 So What Does This Mean for You? • Y ou are a “change agent.” – As a change agent, you use many different tools to help people change. • What YOU do matters! – Y our “ presentation” – Y our demeanor – Y our interaction – Y our approach to the conversation • Think about your favorite teacher and/ or mentor, how did they communicate? ? ? 46 17
7/16/2020 “ 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 our 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 18
7/16/2020 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. 50 19
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