1. 2015

2.   Taking nutrition assessment to the next level! Providing Quality Services ENACT WIC staff making connections

3.  Assessment What is it? Why is it important?

4.   A = Anthropometrics  B = Blood tests  C = Clinical (health)  D = Diet (nutrition)  E = Environmental Key Components of Nutrition Assessment

5.  Completing a diet assessment How do I know when a diet assessment is complete? What can get in the way of completing a full diet assessment?

6.   1. Ask about feeding behaviors  Attitudes  Actions  Supplementation  2. Use PCE skills & probing questions to learn more  3. Assign dietary risks  4. Use critical thinking to review information  5. Document in TWIST 5 steps for a complete diet assessment

7.  Ask questions to go deeper instead of just skimming the surface

8.  Engaging a participant Card Sort Activity

9.   Set the stage : Acknowledge that feeding children can be both challenging and rewarding  Offer a set of cards : Note that they contain some common concerns related to their child’s age  Ask the parent to sort the cards into two piles : One for things that are going well and one for areas that are challenging  Celebrate the successes : Affirm things that are going well  Address the challenges : Ask which cards have been the greatest challenge, ask clarifying questions, consider NE options  Offer education and support : What would it take to move one challenge to the pile of things that are going well? Card Sort Instructions

10.   When would using this tool be helpful?  How could this tool help explore a parent’s feelings about feeding their child?  What does it look like when a parent is engaged?  What would happen if a parent put all the cards into the “no challenges” pile and says “everything is fine”? Card Sort Discussion

11.  Using PCE skills to engage participants https://www.youtube.com/watch?v=ILEh5SlH_4w&index=2&list=P LDD1C70B55714C447 Watch for PCE skills in the assessment section of the following video:

12.   What PCE skills were demonstrated in the video?  How did those PCE skills help with assessment?  What might the parent have said went well or did not go well? Would she return to WIC in the future? Video Debrief

13.  OARS review Underline Open ended questions Circle Probing questions Checkmark Affirmations Place a star next to Reflections Draw a box around Summaries

14.   What are the advantages of using reflections during assessment?  Practice reflections…  The doctor said my child was overweight.  I don’t know much about prenatal nutrition.  I didn’t think mealtime would be like this.  My baby is really picky. Reflections

15.  Reflecting is something to practice many times until it becomes a part of your way of being with other people. - Molly Kellogg Reflections

16.   What are the advantages of using summaries during assessment?  Practice a summary…  What are the key points of this in-service so far?  How can that information be used to identify what more needs to be addressed and help us transition to the next section? Summaries

17.  Putting it all together Planning for Practice and Observations

18.  Updated TWIST questionnaires Local agency staff recommended changes to help support quality assessment

19.   What is the same?  One questionnaire for each category  Many questions remain the same Health History

20.   What is new? For all:  The risk number is being added after each question that could generate risk  Several existing questions were reworded for clarity  The “medical conditions” question is now mandatory  The “smoking inside of your home” is no longer mandatory  For Women:  The confusing “previous pregnancy” question on the women’s questionnaire was removed  Screening for drugs and alcohol is now mandatory  For Children and Infants:  A question about dental health was added for children  A question about infant growth was added for infants Health History

21.   What is the same?  Breastfeeding questions remain mandatory  What is new for Infants and Children?  Age appropriate questionnaires have been added to address specific needs at different ages from birth to five years  For Infants:  Birth to 5 months  6 to 9 months  10 to 12 months  For Children:  13 to 23 months  24 to 35 months  36 to 60 months Diet Assessment

22.   What is new for Children?  Topic categories called Prompts have been added on the children’s questionnaires to help guide conversation. Sample questions under each prompt are related to the age of child.  What is new for All?  The “Risks assigned?” question has been removed and the first question on each questionnaire will be mandatory in addition to the breastfeeding questions  A food safety question has been added  Several existing questions have been reworded Diet Assessment

23.  Next Steps  Changes in TWIST questionnaires implemented on August 1  Updated Nutrition Risk and Dietary Risk training modules available on the Oregon WIC website by June 1  Coming next year…focus on providing nutrition education!

24.   Talk with your training supervisor  Contact your state nutrition consultant  Contact Vernita Reyna: 971-673-0047 or vernita.d.reyna@state.or.usvernita.d.reyna@state.or.us Questions?