1. Oct. 1, 2014

2.  361 Depression  381 Oral Health Conditions  411 Inappropriate Nutrition Practices Infants  New 334 Lack of or Inadequate Prenatal Care 2

3. Updates Include:  A title and category change  Expanded definitions, justifications, clarification  Additional references  Assessment questions change  A new risk criteria 3

4. to  Risk number  Risk priority  RD referrals  Manually assigning risks 4

5.  Your packet includes:  Handouts summarizing the risk updates  Handouts with supplementary guidance  Assessment forms  We’ll review the handouts for each risk and discuss the questions… 5

6.  What qualifies as depression?  What participant categories apply? 6

7. All forms of clinical depression apply such as:  Atypical Depression  Bipolar Disorder (aka Manic)  Dysthymia (Chronic Depression)  Major Depressive Disorder  Postpartum Depression  Seasonal Affective Disorder 7

8. 8 DEPRESSION:  Has varying symptoms  Is common during the last trimester/postpartum  Is different from the “Baby Blues”  Pregnant teens are high risk  Successful breastfeeding decreases risk  Participants may discuss antidepressant medication benefits/risks with their health care provider.

9.  What services can WIC offer to women diagnosed with depression?  What other risk criteria might apply? 9

10. 10 (Formerly known as Dental Problems) Diagnosis of  Dental caries: cavities, tooth decay  Periodontal diseases: gingivitis, periodontitis (gum/bone infections)

11. Tooth decay is:  common and preventable  caused by bacteria, frequent sweetened foods/beverages, poor oral care  the primary cause of tooth loss What types of foods/beverages contribute to tooth decay? 11

12. Tooth decay or gum disease in a pregnant/postpartum woman increases the risk:  she’ll develop health problems  she’ll have pregnancy problems  her baby will develop tooth decay 12

13.  What education, recommendations and referrals can WIC staff offer to participants? 13

14. 411.9: There are revisions to the definition of inappropriate sanitation in the:  Preparation  Handling  Storage of breast milk and formula. 14

15. 411.9 no longer applies if:  Fresh breast milk is refrigerated over 48 hours.  Breast milk is frozen longer than 6 months. New reasons 411.9 can apply:  Adding refrigerated breast milk to frozen in an amount greater than the amount frozen.  Failure to clean breast pump/bottles per manufacturer’s instructions. 15

16. Wording change to when 411.9 applies:  “Held in the refrigerator longer than 48 hours (concentrate), 24 hours (powdered)." Has been replaced with:  “Held in refrigerator longer than manufacturer’s instruction.” New reason for assigning 411.9:  Using improperly cleaned bottles. 16

17.  What resources are available to help staff better understand the proper preparation, handling and storage of breast milk and formula? 17

18.  New Risk Criterion  Category: Pregnant Woman  Manually assign in WISPr  Medical Referral (No RD Referral) 18

19. Assign 334 when prenatal medical care:  Begins after the first trimester OR  If the total number of visits is less than listed in the table (see 334 handout) 19

20.  The assessment question “Have you seen a medical provider for this pregnancy?” has an added response section for entering “Number of appointments.”  Documentation includes: -Date of first appointment -Number of appointments (or 0 or unknown) 20

21.  How and where will you refer pregnant women who aren’t receiving prenatal medical care? 21

22.  Talk with your Local Agency RD  Contact your Local Agency Coordinator  Contact the State office, Marie Collier  collierm@dhw.idaho.gov or 334-5953 collierm@dhw.idaho.gov 22

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