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HHEALTHEALTH O OUTCOMEUTCOME BBASEDASED WIC WIC NUTRITIONNUTRITION

AASSESSMENTSSESSMENT

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IntroductionIntroduction

The purpose of this module is to explore a model for nutrition

assessment offered as an option for implementing VENA

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IntroductionIntroduction

Supports VENA philosophy by1. Using a positive, holistic approach2. Communicating risks in a positive manner3. Identifying barriers to change4. Using non-judgmental assessment and counseling5. Setting the stage for a more positive and relevant WIC interaction

Provides a way to organize assessment so that focus is on WIC’s goal of promoting good health

Incorporates content and skills learned in previous two modules

This module:

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AssumptionsAssumptionsWIC counselors bring competencies of

• Principles of lifecycle nutrition• Anthropometric and hematological data collection techniques• Nutrition assessment process (in general – VENA-directed changes are still evolving)

Counselors have varied knowledge base regarding VENA and health outcome approach

Environmental barriers (lack of privacy, time, etc.) have been addressed in previous modules

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Instructional ObjectivesInstructional Objectives

Health outcomes are participant centered

H1 Instructional Objectives for Health Outcomes Based WIC Nutrition Assessment

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Nutrition Assessment Changes Nutrition Assessment Changes Directed by VENADirected by VENA

How will (has) VENA change(d) the current nutrition assessment process?

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Summary of WIC Nutrition Summary of WIC Nutrition Assessment Pre- and Post-VENAAssessment Pre- and Post-VENA

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Anticipated Results of VENAAnticipated Results of VENA

State agencies will:• Enhance nutrition assessment process • Empower staff to improve nutrition assessment skills • Enjoy more satisfied staff and participants

Health Outcome Based WIC Nutrition Assessment is sample model or option for accomplishing these

results

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Rethinking the WIC Nutrition Rethinking the WIC Nutrition AssessmentAssessment

View and discuss the video Beyond Nutrition Counseling: Reframing the Battle Against Obesity

Produced by the FIT WIC Project, a collaboration between Children’s Hospital Medical Center in Cincinnati, Ohio and the Kentucky WIC Program with funding provided by USDA

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Video SummaryVideo Summary

VENA and the Health Outcome model are about trying to move beyond what is portrayed in the video ̶ that is, counselors feeling unsuccessful and participants telling counselors only what they want to hear

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Video SummaryVideo Summary (cont’d)This new approach will

• Create the opportunity for dialogue

• Personalize relationship with clients

• Couch risks in a positive, move-forward framework vs. dwelling on the current crisis

Being able to feel good about what we do and empowering the WIC participant to change

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WIC Nutrition Assessment Defined

A WIC nutrition assessment is the process of obtaining and synthesizing relevant and accurate information in order to:

• Assess an applicant’s nutrition status and risk• Design appropriate nutrition education and

counseling with the participant• Tailor food packages to address nutrition

needs for the participant• Make appropriate referrals for the participant

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WIC Nutrition Services ProcessWIC Nutrition Services Process

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A value enhanced WIC nutrition assessment is accomplished by completing a series of five steps

WIC Nutrition Services ProcessWIC Nutrition Services Process

• Collect the relevant information• Clarify and synthesize the information that has

been collected• Identify the pertinent and appropriate risk(s)

and other related issues• Document the assessment• Follow up on previous assessments, as

appropriate

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WIC Nutrition Assessment WIC Nutrition Assessment Process – Tools and ResourcesProcess – Tools and Resources

To determine where the content of these training modules and the VENA guidance document apply, let us look at the process in more detail

Review Handout 2H2 WIC Nutrition Assessment Process –

Tools and Resources

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Health OutcomeHealth Outcome Based Nutrition Based Nutrition AssessmentAssessment

The health outcome-based WIC nutrition assessment is offered as an example of a positive approach to assessment where a desirable health outcome serves as a focal point for collecting relevant information, rather than focusing on deficiencies.Using a positive approach to assessment in which the participant, parent or guardian gains a greater appreciation of how to attain good health and recognizes her own need(s) and/or an infant’s or child’s needs for health improvement can lead to more effective WIC interventions. It also provides an organized, systematic way to perform an assessment.

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Health Outcome Based Nutrition Health Outcome Based Nutrition Assessment Assessment ̶ Sources̶ Sources

The health outcome approach is adapted fromHealthy People 2010: Systematic Approach to Improving Health and

Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents

Primary reference is Appendix C of VENA guidance document.

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Categories of WIC ParticipantsCategories of WIC Participants

• Pregnant woman• Breastfeeding woman• Non-breastfeeding postpartum woman• Infant• Child 12-60 months of age

Health Outcome Based WIC Nutrition Assessment provides guidance for each of the five WIC participant categories

Each WIC participant categories, has six key components of the Health Outcome Based WIC Nutrition Assessment

Categories of WIC Participants Categories of WIC Participants Key Components Key Components

• Desired health outcome• Set of health determinants• Information to be collected for each health

determinant• WIC nutrition risk criteria for each health

determinant• Other information required for individualizing

nutrition

Desired Health OutcomesDesired Health Outcomes

The Desired Health Outcome is the health goal for each of the five WIC participant categories

Desired Health OutcomesDesired Health Outcomes

What is the desired health outcome for each participant category and where do we find

this information?

Appendix C!

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• Pregnant Woman

• Breastfeeding Woman

• Non-Breastfeeding Postpartum Woman

• Delivers a healthy, full-term infant while maintaining optimal health status

• Achieves optimal health during the child bearing years and reduces the risk of chronic disease

• Achieves optimal health during the child bearing years and reduces the risk of chronic diseases

Categories of WIC Participants Categories of WIC Participants – – Desired Health Outcomes Desired Health Outcomes

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• Infant

• Child 12-60 Months

• Achieves optimal growth and development in a nurturing environment and develops a foundation for healthy eating practices

• Achieves optimal growth and development in a nurturing environment and begins to acquire dietary and lifestyle habits associated with a lifetime of good health

Categories of WIC Participants Categories of WIC Participants – – Desired Health Outcomes Desired Health Outcomes

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WIC Health DeterminantsWIC Health Determinants

The health determinants are a set of factors influenced by individual behaviors, past and current health conditions, and the family and social environment that contribute to reaching the desired health outcome

In Appendix C, health determinants are found in the shaded boxes

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Health Determinants for Pregnant Health Determinants for Pregnant WomenWomen

• Receives ongoing preventive health care including prenatal care

• Achieves a recommended maternal weight gain• Remains free from nutrition-related or food-

related illness, complications, or injury• Avoids alcohol, tobacco and illegal drugs• Consumes a variety of foods to meet energy and

nutrient requirements• Makes informed decision to breastfeed infant

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For For EEachach Health Determinant Health Determinant

• Data collection information• Risk factor identification number(s)

(WIC nutrition risk criteria ̶ FNS Policy Memorandum 98-9)

Example for the determinant “Achieves a recommended maternal weight gain” – collect pregravid weight status and maternal weight gain pattern (101, 111, 131, 132, 133)

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Sample of other information that could be gathered for individualizing nutrition services for a pregnant woman

• Oral health care• Physical activity• Food security• Breastfeeding knowledge, support and potential

contraindications• Potential barriers to breastfeeding

OtherOther I Informationnformation RRequired for equired for IIndividualizing ndividualizing NNutrition utrition SServiceservices

Using health outcomes in WIC nutrition assessment is one systematic approach that can be adapted to state and local needs and may lead to positive health outcomes for both WIC staff and participants!

VENA can be implemented without using the health outcome approach; however, the model is suggested for its organization and ease of use.

Health Outcome ApproachHealth Outcome Approach

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Staff Benefits from Health Staff Benefits from Health Outcome Nutrition AssessmentOutcome Nutrition Assessment

Health outcome based nutrition assessment has the capability for

• Emphasizing strengths and healthy practices of the participant and family

• Highlighting accomplishments and/or developmental progress

• Reinforcing the increasing competence of caregivers

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The positive context may help the participant, parent, or guardian in

• Developing a greater understanding of the purpose of WIC nutrition assessment

• Recognizing her/his role in achieving the desired health outcome

• Empowering her/him to decide how (or whether) to alter current behaviors

Participant Benefits from Health Participant Benefits from Health Outcome Nutrition AssessmentOutcome Nutrition Assessment

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ApplicationApplication of Health Outcome of Health Outcome Based Nutrition AssessmentBased Nutrition Assessment

Video Case Study

Group Process: Sharing/Networking

Individual Participant Activities

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Scenario #1 portrays Current system of using food frequency questionnaire to determine eligibility, “rote” questions, no stages of change assessment, etc.

View Scenario #1Stop the video and discuss strategies,

questions, additional data to gather for conducting the same assessment using the health outcome approach

Video Case Study ScenarioVideo Case Study Scenario

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Video Case Study DirectionsVideo Case Study DirectionsScenario #2 portrays health outcome nutrition assessment

using rapport building, critical thinking, stages of change with health outcome terminology ̶ especially desired health outcomes and some determinants

View Scenario #2Stop the video and identify examples of critical thinking,

rapport building techniques including identification of stages of change and health outcome terminology

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Health Outcome Approach Strategies ̶ Scenario 2

• Eye contact – focus on client• Open ended questions• Focus on health outcome goal – ”How has your pregnancy

been going?”• Open body posture• Affirmation• Reflective listening• Conveys respect• Assesses stages of change• Summarizes

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• Use of assessment ruler• Active listening• Helps client enlist support• Nonjudgmental• Supportive• Helping to problem solve• Longer, but still time sensitive – shows effective use of

allotted timeframe for interview• Changes are subtle, but allowed underlying issues of

“fear of weight gain” to surface, client to drive the plan and verbalize health outcome goal

Health Outcome Approach Strategies J Scenario 2