1. Nutrition Services Updates Training WIC & Nutrition Services Implementation April 1, 2015

2. Training Overview Part I –Final food rule changes –USDA Management Evaluation Part II –Nutrition Services Documentation Missouri FY14 top nutrition findings

3. Part I After completing this training, staff will be able to: Identify the changes to WIC approved food items. Understand your role related to food packages changes. Identify dairy alternatives (yogurt) and the exchange. Understand direct shipment and the formula process. Apply their critical thinking skills when reviewing the nutrition assessment for risk factors. Understand the documentation needed for assessment and assigning of risk factors.

4. Non-fat Goat Milk

5. Standard Milk Package WIC Certifier Women and children (24-59 months) –Standard food packages which can be issued are: All milk and the supplemental foods OR One pound of cheese/fat-free evaporated milk and the remaining supplemental food

6. Standard Formula Package WIC Certifier Infants fully formula fed Standard contract formulas which can be issued are: –Enfamil Infant / Enfamil Premium Infant Powder or concentrate –Enfamil Gentlease Powder –Enfamil ProSobee Powder or concentrate

7. Lactose Free Milk

8. Cultured Buttermilk

9. April 1 st Changes Fruits and Vegetables –Participants will be able to pay the difference when their fruit and vegetable purchase exceeds the CVV value

10. Fruit & Vegetable Check Participant can choose to pay the difference by any of these methods –Cash –Check –Credit/debit card –SNAP EBT card

11. Fat-Free Refried Beans Bush’s Best –16 oz. –Fat free

12. Low-fat Yogurt Approved brands and varieties Size: 32 oz. Approved: plain, vanilla and blended flavors –Not approved: fruit on the bottom, Greek and whole (fat) yogurt Approved for women and children 2 years of age and older –Not authorized for children 12-23 months

13. Low-fat Yogurt Approved for: –Children 2 years of age and older –Women Milk substitute –For participants who might not otherwise drink sufficient amounts of fluid milk due to lactose intolerance or other reasons

14. Yogurt Nutritional Profile Compared to milk, yogurt is –Similar in calcium –Similar in protein –Similar in vitamins and minerals –Low in fat –Widely available (low-fat)

15. Dairy Substitutions

16. Low-fat Yogurt Maximum monthly allowance of yogurt –One quart Additional amount above the one quart is not authorized –Exchange rate 1 quart of yogurt = 1 quart of milk

17. Cheese Exchange Total amounts which can be issued One pound - Food Packages IV, V & VI Two pounds - Food Package VII Substitution exchange –One pound of cheese = 3 quarts of milk

18. Tofu Exchange Children (12 – 59 months of age) CPA is authorized to determine the need. Reason for issuance (e.g. milk allergy, lactose intolerance, vegan diet, etc.) Must document the reason for issuance Women - No CPA documentation needed Four pound max can be issued

19. Maximum substitution for a combination of cheese, yogurt or tofu: No more than 4 quarts –Children Food Package IV –Women Food Package V & VI No more than 6 quarts –Women Food Package VII

20. Complete the case studies (Sophia, Joe and Rosa)

21. Allowance of Standard Infant Formula for Infants Infants 6 – 12 months of age may receive additional standard contract infant formula in lieu of infant foods –Same maximum monthly allowance as infants 4-6 months of age WIC-27 required Refer to the reference sheet, “Issuing Standard Contract Formula”

22. Approved Food List Changes: –Page 2 –Page 4 –Page 8 –Page 16 This will depend on the final proof

23. MOWINS Update March 31 st

24. Management Evaluation (ME)

25. Management Evaluation Over Issuance of Formula Finding #11 Definition of Direct Ship –Special formula is sent to your agency from the manufacturer –Formula issued from the LWP’s storage cabinet –Formula from another LWP’s storage cabinet

26. Management Evaluation Over Issuance of Formula (Cont.) LWP shall accept return of non-expired –Standard formula –Exempt formulas –WIC eligible nutritionals Established check in process when receiving returned formulas

27. Management Evaluation Over Issuance of Formula (Cont.) From your storage cabinet: –Formula used before it expires –Check stored cans routinely for dents and bulges –Rotate the stored cans older formulas used first –Discard formula in a way that no one can retrieve the cans for use

28. Management Evaluation Over Issuance of Formula (Cont.) No replacement formula issued after the benefit expiration date Document in the record the return formula and the reason for issuance of a different formula Returned formula may be issued to other WIC participants

29. Management Evaluation Over Issuance of Formula (Cont.) Proration of formula when shorter benefit period remains –CPA may determine when proration for shorter benefit period is needed –Document in the record the reason for the proration

30. Agency Resources ER# 2.07400 Return and Replacement of Standard Formula, Exempt Formula or WIC Eligible Nutritionals rev 10/14 MOWINS December 2013 - Direct Shipments & Extra Formula Documentation Hot topics Food & Formula Reference Guide: Guidelines Food & Formula Reference Guide: Formula Listing

31. Critical Thinking - Applied to Assessment & Assignment 1.What is the purpose of meeting with this participant? 2.What data or information do I need? Evaluate what you know about the participant Past history Paper work submitted about participant Data gained from discussion 3.How am I going to get the needed information? Create questions to gain the information needed. 4.Ask the questions you have developed.

32. Risk Factor Assessment & Assignment Finding #19 –Staff shall identify and assign risk criteria based on nutrition assessment Prematurity (RF 142) was not assigned –Auto and manually assigned One of the top ten FY14 nutrition monitoring findings was; manually assigned risk factors (RF) are not appropriately assigned

33. Complete the case studies (Peggy Sue Jones and Casey Smith)

34. Agency Resources Risk Factors Policies –USDA Justifications Risk Factor Definitions Table –web or MOWINS Nutrition Assessment and MCA Training –Training portal > LWP staff > Program Updates