1. Fresh Choices Finale! 2014 Food Package Changes Adapted from OR WIC Program 1

2. After this in-service, you’ll be able to… 2  Describe an overview of key Final Food Rule changes being implemented this year.  List the change to the standard milk assigned to older children and women starting 10/1/14.  Identify when it’s appropriate to assign 2% milk.  Understand a medical documentation form will no longer be required to issue soy milk. OBJECTIVES

3. Why are things changing now? 3

4. The wheels of government turn slowly… 4  Idaho implemented USDA’s “Interim Food Package” rule in 2009 (included lower fat milk, fruit and veggies, whole grains, baby foods, medical documentation requirements, etc.).  The interim rule allowed time for public and staff comment.  USDA considered the comments and decided which suggested changes to include.  The result is the “Final Food Package” rule which makes some changes and gives time lines for implementation.

5. This is just the first phase! 5  Other changes will be happening over the next 12-24 months:  This is due to some changes that are optional or require more time to implement.  For the full Final Food Package rule: http://www.fns.usda.gov/wic/final-rule- revisions-wic-food-packages http://www.fns.usda.gov/wic/final-rule- revisions-wic-food-packages

6. $8 CHILDREN’S CASH VALUE VOUCHER (CVV) Started June 2014 6

7. Children’s Cash Value Voucher Increased from $6 to $8 - started with June 2014 vouchers Food package codes assigned didn’t change - the value of the CVV in the packages increased. 7

8. Vendor Update Starting 10/1/14, vendors must allow all participants the option to pay the difference if their purchase is over the CVV dollar amount. (If the participant prefers, they can still put an item back.) Most vendors already give participants this option. 8

9. Changes to Milk Assignments 9

10. 10 Change #1: Standard milk for children 2-5 and all women will be fat- free (non-fat/skim) or 1% only.  Starting 10/1/14

11. Why this change? 11  This helps align WIC with national standards being used by most feeding and nutrition programs. What impact might this have on WIC families?

12. How will this work? 12  Starting 10/1/14, standard vouchers will be for 1% or fat- free/skim.  The food package codes assigned won’t change – the milk types printed on the voucher will change.  This change will be with regular cow’s milk and lactose reduced/free milk (not acidophilus).

13. Wording on vouchers 13  Different brands use various wording: 1%, skim, fat-free, non-fat.  Remind participants they need to buy what is written on the vouchers. This milk must be purchased in gallon containers. Half gallons and quarts are only allowed if they are listed here. The store will allow the participant to buy one of these types of milk.

14. Possible confusion factors? 14  Different stores/brands may have different milk names.  Milk cap colors are not consistent between stores.  1.5% milk isn’t allowed (may be in State border areas).  How will you make sure participants know which milk is okay to buy? Fat-free? Non-fat? Skim? Fat-free? Non-fat? Skim? Whole? Vitamin D? Homogenized? Whole? Vitamin D? Homogenized? Note: Voucher milk descriptions have changed to make it easier to understand.

15. Let participants know what’s happening! 15  Inform participants as soon as you can to give those using 2% as much time as possible to switch to 1% or fat-free.  Review vouchers before you hand them to participants and let them know what’s changed.

16. Will you use the card from the state? 16 How might you use this to notify participants? Note: These are available in Spanish.

17. Use PCS skills to help participants switch 17 Possible messages:  Children attending Head Start are served fat-free or 1% milk.  USDA-supported child care also provides fat-free or 1%.  Taste tests show many people have a hard time telling the difference between 2% and 1%.  What else?

18. What education materials are available? 18  Idaho/National Dairy Council resources  Nutrition Matters NuBites  WIC Connects counseling guide  Milk Matters NE Group Class  FNS Core message website http://www.fns.usda.gov/core- nutrition/milk http://www.fns.usda.gov/core- nutrition/milk

19. Talk about it… 19  How will your agency help participants make this change?  How will you notify those affected?  What nutrition education might help?  What materials will you use, if any?

20. 20 Change #2 Children 2-5 and women may be given a food package with 2% milk in certain situations.  Starting 10/1/14

21. When can we assign 2% milk to older children and women? 21  Food packages with 2% milk may be assigned when:  A relevant risk is assigned, assessment indicates need and an RD approves  No relevant risk is assigned, but assessment indicates a probable need and an RD approves  The certifying staff (or RD) must document why 2% milk is being assigned.  2% milk cannot be assigned simply because of preference or parental request.

22. Which risks are relevant? 22  101 – Underweight Woman  103 – Underweight or at Risk of (ages 2-5)  131 – Low Maternal Weight Gain  132 – Maternal Weight Loss during Preg.  134 – Failure to Thrive (children 2-5)  Selection of one of these risks may serve as documentation of why 2% milk was issued.

23. What other issues may apply? 23  During an assessment, staff may learn of an issue that has the potential to impact weight or weight gain, such as:  Family history of underweight (e.g., mother or father is underweight);  Growth pattern shows a trend of poor weight gain (e.g., the growth plotting shows a drop across percentile lines not explained by recent illness like the flu);  Participant’s health care provider requests 2% because of a health or growth concern;  Participant has severe dental problems, making eating difficult.  Other unusual circumstances identified by staff.  The reason for assigning 2% must be documented in the assessment and/or care plan.

24. 24 Starting 10/1/14, to select 2% milk in WISPr:  In Add food package click the RD Approval checkbox  Under What type of milk would you like? click the 2% Milk checkbox Food Package Selection

25. 25 Transition Plan: The purpose of having a transition period is to prepare participants, vendors & WIC staff for the milk changes.  Starting 7/1/14

26. Transition period 26  To support the transition process for the upcoming Oct. milk changes, food packages for older children and women during July, Aug. and Sept. will print with low-fat and fat-free/skim milk.  Participants may purchase 2% milk during this time but the vouchers will just refer to low-fat (which includes 2% and 1%) rather than specify 2%.

27. How we will transition 27  Use your PCS skills to help the participant or parent/caregiver develop a plan to gradually switch to 1% milk.  This is similar to the past when WIC transitioned from whole milk to 2%. What ideas have you offered to other parents? What strategies have you heard have been successful with WIC families? What ideas have you offered to other parents? What strategies have you heard have been successful with WIC families?

28. Use your critical thinking skills 28  Staff will need to consider all relevant information to facilitate helping a participant or parent/caregiver develop a successful plan for transitioning from 2% milk to 1% or fat-free. What things should be considered? Other dairy products? How much milk? Health issues? Family history? Growth pattern?

29. What would you do? 29 Dad brings in his 3 year old daughter for a recertification. Her health and BMI are normal for her age. The certifier explains the change in milk. Dad is adamant his family only drinks 2%. If you were the certifier, how would you respond? What action steps would you take? If you were the certifier, how would you respond? What action steps would you take?

30. 30  Starting 10/1/2014 Change #3 Soymilk doesn’t require a medical documentation form

31. When will soy milk be given? 31  For children age 1 or older: When an assessment indicates a reason and an RD approves (the health care provider should be consulted as needed)  Staff need to offer relevant education and when appropriate include a discussion about the nutritional differences between cow’s milk and soy milk.

32. What about documentation? 32  Staff need to document the reason soy milk was issued in the assessment and/or care plan.  Staff need to document the relevant nutrition education discussed in the care plan.

33. Assigning Soy Milk Note: Brand Change: 33  The medical documentation requirements for soy changes in October.  Staff will no longer need to click the MD Doc Status box in WISPr at that time. Until then, continue to use the same assignment and med doc process.  Starting 8/1/14, soy milk options will include Silk, 8 th Continent and Pacific Ultra Soy.  The brand choice must be made at the clinic, stores cannot allow substitutions.

34. Use your critical thinking skills 34  Possible reasons for soy milk: milk allergy, lactose intolerance, vegetarian diet or cultural food practices.  What probing questions might staff ask to determine if soy milk is appropriate? Other dairy products? How much milk? Health issues? Family history? Physician request? Cultural practices?

35. What would you do? 35 Mom and Dad bring in their 18 month old to be enrolled. The parents express concerns about Aiden being diagnosed with a milk allergy and they’ve been giving him rice milk. What steps would you take to determine what food package to assign? How would you connect this to the nutrition education offered? What steps would you take to determine what food package to assign? How would you connect this to the nutrition education offered?

36. 36 Questions? Contact the State Office Questions? Contact the State Office