1. Missouri WIC Program Implementation: May 5, 2014

2.  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

5.  Guiding principles

6. 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

7. 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

8. 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 427.1 & 427.4

9. 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

10. 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 341-362

11. 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

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

13.  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

14.  #2 Revised  Tell me about any changes in your eating habits since delivery? (Select all that apply.)  No changes  Improvements  Concerns  Other/Comments

15.  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 427.1 & 427.4

16. 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 341-362 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

17. 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

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

20. Reference 425.4 & 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

21.  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

22.  #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 341-362  #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

23.  #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

24.  #6 Revised  Optional Documentation:  Full name and WIC title of person completing the nutrition assessment - required

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

27.  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

28.  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

29.  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

30.  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

31.  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 411.10, 411.11 Nutrition Training Manual – Infant Section

32.  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 411.10, 411.11 Nutrition Training Manual – Infant Section

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

34.  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

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

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

37.  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

38.  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

39.  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

40.  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

41.  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

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

43.  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

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

48. 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

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

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

52. Infant Done at 9 through 11 months of age Children Between 12 months of age and prior to their second birthday, recommended at 15-18 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# 2.02800

53. 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

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

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

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

57. 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#2.06400 Effective Nutrition Education: Standards, Participant-Centered Goals, Delivery Methods and Documentation

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

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

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

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

62. MOWINS Participant List Window

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

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

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

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

72. 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