Missouri WIC Program Implementation: May 5, 2014

 Identify the four guiding principles of participant-centered communication  Recognize the revisions to the follow-up questions  Understand the implementation of the extended certification periods  Identify the procedures required at the Mid-Certification Assessment (MCA) appointment

 Guiding principles

Guidance Ask during a face-to-face session Responses are used for documentation. The responses are not meant to be read to the participant Counseling staff will evaluate the questions to determine if it meets a risk factor criteria Manually assign the risk factor

Prenatal Follow-up Questions  #1 No change  What have you heard about breastfeeding?  #2 Revised  Tell me about the changes in your eating habits since becoming pregnant? (Select all that apply)  No changes  Improvements  Concerns  Other/Comments

Prenatal Follow-up Questions  #3 Revised (question/responses)  Tell me about the minerals or herbal supplements you take besides prenatal vitamins? (Select all that apply.)  None  Calcium  Folic Acid  Iron  Iodine  Herbal  Other/Comments Reference & 427.4

Prenatal Follow-up Questions  #4 change in the responses  What concerns do you have about providing, preparing and/or storing food for your family? (Select all that apply.)  No concerns  Insufficient food sources  Food preparation (new ideas/doesn’t know how to cook)  Inadequate kitchen appliances  Other/comments

Prenatal Follow-up Questions  #5 New question  What health or medical issues do you currently have or have had?  Open text box  Allows staff to access for clinical/medical conditions  Risk Factors

Prenatal Follow-up Questions  #6 Revised Question  How would you like to improve your eating and/or physical activity habits? Reminder: Establish a new goal and/or follow-up on a previous goal.  Open text box  You can document the goal here or indicate “see notes” if you want to place them in the general/SOAP notes

 Prenatal Follow-up Questions  #7 Revised  Optional Documentation:  Full name and WIC title of person completing the nutrition assessment - required

 Breastfeeding Women Follow-up Questions  #1 Revised (responses)  What concerns related to breastfeeding do you have? (Select all that apply.)  No Concerns  Milk Production  lack of milk production, engorgement, etc.  Anatomical Breast issues  recurrent plugged ducts, mastitis, flat/inverted nipples, tenderness, etc.  Other/Comments

 #2 Revised  Tell me about any changes in your eating habits since delivery? (Select all that apply.)  No changes  Improvements  Concerns  Other/Comments

 Breastfeeding Women Follow-up Questions  #3 Responses revised  Tell me about the minerals or herbal supplements you take? (Select all that apply.)  None  Prenatal/Multi vitamin  Calcium  Folic Acid  Iron  Iodine  Herbal  Other/Comments: Reference & 427.4

Breastfeeding Follow-up Questions  #5 New question  What health or medical issues do you currently have or have had?  Open text box  Allows staff to access for clinical/medical conditions  Risk Factors Breastfeeding Women Follow-up Questions  #4 change in the responses  What concerns do you have about providing, preparing and/or storing food for your family? (Select all that apply.)  No concerns  Insufficient food sources  Food preparation (new ideas/doesn’t know how to cook)  Inadequate kitchen appliances  Other/comments

Breastfeeding Women Follow-up Questions  #6 Revised Question  How would you like to improve your eating and/or physical activity habits? Reminder: Establish a new goal and/or follow-up on a previous goal.  Open text box  You can document the goal here or indicate “see notes” if you want to place them in the general/SOAP notes

 Breastfeeding Women Follow-up Questions  #7 Revised  Optional Documentation:  Full name and WIC title of person completing the nutrition assessment - required

Reference & 428 Question #1 - Tell me about your child’s eating habits, appetite, and how the foods are prepared. (Select all that apply.)  Eats well  Picky eater  Eats age appropriate food and uses age appropriate utensils  Does not eat age appropriate food and/or does not use age appropriate utensils  Other/comments

 Question #2  How do you feel about your child’s height and weight?  Just fine  Too little  Too big  Other/comments Reference RF 113, 114, 134, 135

 #4 New question  What health or medical issues do you currently have or have had?  Open text box  Allows staff to access for clinical/medical conditions  Risk Factors  #3 change in the responses  What concerns do you have about providing, preparing and/or storing food for your family? (Select all that apply.)  No concerns  Insufficient food sources  Food preparation (need ideas/doesn’t know how to cook)  Inadequate kitchen appliances  Other/comments

 #5 Revised Question  How would you like to improve your child’s eating and/or physical activity habits? Reminder: Establish a new goal and/or follow-up on a previous goal.  Open text box  You can document the goal here or indicate “see notes” if you want to place them in the general/SOAP notes

 #6 Revised  Optional Documentation:  Full name and WIC title of person completing the nutrition assessment - required

 System displays the infant questions based on:  Feeding status – health info tab  Age  Certification vs. Mid-Certification

 Question #1 - Tell me about breastfeeding your baby.  no concerns  feeding on demand  less than 8 feedings in 24 hours if less than 2 months old  less than 6 feedings in 24 hours if between 2 months and 6 months old  proper storage of breastmilk  breastfeeding concerns (sore nipples, etc)  other/comments  Feeding Status: Fully breastfeeding and breastfeeding/formula

 Question #2 - Tell me about formula feeding your baby. (Select all that apply.)  no concerns  formula properly mixed and stored  adequate amount of formula and feedings  fed on demand  other/comments  Feeding status: breastfeeding/formula only Reference 411.4, 411.6, 411.9

 Tell me more about your decision to supplement with formula. (Select all that apply.)  Health Care Provider  Low supply (actual or perceived)  Personal choice  Other/comments:  Feeding status: breastfeeding/formula only

 Tell me about your baby’s wet and dirty diapers.  no concerns  black and sticky  brownish to greenish  green and foamy/frothy  yellowish and seedy  firm  hard and pebbly  watery  other/comments  Feeding status: Fully breastfeeding and breastfeeding/formula

 Tell me about any supplements or vitamins you give your baby.  None  Infant multivitamin  Vitamin D  Herbal supplements, remedies, teas  Iron  Fluoride  Other/comments  Feeding status: All feeding options Reference , Nutrition Training Manual – Infant Section

 Tell me about any supplements or vitamins you give your baby.  None  Infant multivitamin  Vitamin D  Herbal supplements, remedies, teas  Iron  Fluoride  Other/comments  Feeding status: All feeding options Reference , Nutrition Training Manual – Infant Section

 Tell me about any supplements or vitamins you give your baby.  None  Infant multivitamin  Vitamin D  Herbal supplements, remedies, teas  Iron  Fluoride  Other/comments

 Revised Question  What feeding goals do you have for your baby? Establish a new goal and/or follow-up on a previous goal.  Open text box  You can document the goal here or indicate “see notes” if you want to place them in the general/SOAP notes

 Revised  Optional Documentation:  Full name and WIC title of person completing the nutrition assessment - Required

 Breastfeeding only = 4 questions  Breastfeeding & formula = 6 questions  Formula only = 4 questions

 Tell me about breastfeeding your baby.  No concerns  Feeding on demand  Proper storage of breastmilk  Breastfeeding concerns (sore nipples, etc.)  Other/Comments  Feeding status: Fully breastfeeding and breastfeeding/formula

 Tell me about formula feeding your baby.  no concerns  formula properly mixed and stored  adequate amount of formula and feedings  fed on demand  other/comments  Feeding status: breastfeeding/formula and formula only Reference 411.4, 411.6, 411.9

 Tell me more about your decision to supplement with formula.  Health Care Provider  Low supply (actual or perceived)  Personal choice  Other/comments:  Feeding status: breastfeeding/formula only

 Tell me about the foods you are feeding your baby.  None  No concerns  Age appropriate foods  Proper feeding methods  Other/Comments  Feeding status: All feeding options Reference 411.4, 428

 Tell me about any supplements or vitamins you give your baby.  None  No concerns  Infant multivitamin  Vitamin D  Herbal supplements, remedies, teas  Iron  Fluoride  Other/comments  Feeding status: All feeding options

 Tell me about playtime for your baby.  None  No concerns  Age appropriate activities  Other/Comments

 Revised Question  What feeding goals do you have for your baby? Establish a new goal and/or follow-up on a previous goal.  Open text box  You can document the goal here or indicate “see notes” if you want to place them in the general/SOAP notes

 Revised  Optional Documentation:  Full name and WIC title of person completing the nutrition assessment - required

Certification Periods Infant: To the last day of the month the infant turns one year old Breastfeeding Woman: To the last day of the month in which her infant turns one year old or until the woman stops breastfeeding Child: Yearly ending with the last day of the month in which the child turns five years old

 New certs for  Infants  Children  Breastfeeding women  Infant is fully breastfeeding  Infant partially breastfeeding < max

Complete Assessment Anthropometric Measurements Bloodwork based on bloodwork schedule Nutrition Assessment – including oral assessment Immunization Screening (if applicable) Category/Age Appropriate Nutrition Education Referrals

Infant Done at 9 through 11 months of age Children Between 12 months of age and prior to their second birthday, recommended at months of age. Required for the 2-year old certification Children 24 – 60 months of age must be taken at least once every 12 months. Refer to ER#

Components: Review last nutrition assessment & health information tab Address new concerns raised by the participant Identify new medical diagnosis Identify changes in eating pattern/food intake/food package Identify changes in physical activity behaviors

Agencies may choose an option 1. Initial and follow-up questions 2. Initial and mid-certification questions 3. Mid-certification questions only

 Three different sets of questions  Initial Questions  Follow-up Questions  MCA Questions

Complete Assessment Anthropometric Measurements Bloodwork based on bloodwork schedule Nutrition Assessment – including oral assessment Immunization Screening (if applicable) Category/Age Appropriate Nutrition Education Referral

Nutrition education must be offered at the equivalent of one contact for each three months (quarterly) 2 face-to-face contacts 2 secondary contacts Approved Nutrition Education Methods ER# Effective Nutrition Education: Standards, Participant-Centered Goals, Delivery Methods and Documentation

Complete Assessment Anthropometric Measurements Bloodwork based on bloodwork schedule Nutrition Assessment – including oral assessment Immunization Screening (if applicable) Category/Age Appropriate Nutrition Education Referral

Must be at least six months old and before the last day of the infant’s 11 th month

60 days prior to her MCA date No later than the last day of the certification period

Up to 60 days prior to the MCA date Before the last day of the certification period

MOWINS Participant List Window

When a pseudo cert is created the system is dropping off several risk factors Dietary Risk Factors Risk Factor 121 Short Stature

Risk Factor 142 Premature When a pseudo cert is created the system is dropping this risk factor Not assigning at certification

Staff orientation regarding MCA Are staff members able to apply new skills learned in training to their daily routine?

When to schedule the participants for their MCA Determine how many WIC employees a participant sees during a WIC appointment.

Who will be involved in the MCA appointment as it relates to the Nutrition Assessment tab Agencies may choose an option Initial and follow-up questions Initial and mid-certification questions Mid-certification questions only