kansas department of health and environment: nutrition and ... · web viewthe cpa uses the...

2021 Nutrition Services Plan Guidance

1

Table of Contents

Introduction

Nutrition Services Plan Policy link and Nutrition Services Plan Timeline

Nutrition Services Plan Checklist and Instructions

Writing Objectives and Action Steps

Nutrition Services Plan Forms

Cover SheetClinic Staff Summary SheetClinic Operations InformationEvaluation of Previous Year’s Strategic Action PlansSharingBreastfeeding Promotion Needs Assessment 2021 Breastfeeding Promotion Strategic Action PlanClinic Improvement Needs Assessment2021 Clinic Improvement Strategic Action Plan2021 Nutrition Education Offerings

Appendices:Appendix 1 - Statewide and Countywide Breastfeeding Data Appendix 2 – Breastfeeding Strategic Action Plan Sample Objectives and Action StepsAppendix 3 – Clinic Improvement Strategic Action Plan Sample Objectives and Action Steps

2

Introduction

It is strongly recommended that you read the guidance material before you begin and review the checklist of items to include in your Plan before submitting it to the State Agency (SA).

The following guidance describes components of the 2021 Nutrition Services Plan (NSP) and provides directions for completing the Plan.

The Nutrition Services Plan is a part of the process of continuous quality improvement. It is important that local agencies (LAs) take time regularly to evaluate where they are in this process and make adjustments accordingly.

This process includes:

assessment of current practices, identification of areas of improvement, selection of areas for improvement, development of improvement plans, implementation of these improvements, and evaluation of results.

The Nutrition Services Plan process is shown graphically below.

3

The 2021 Nutrition Services Plan (NSP) varies very little from the 2020 Plan, in that the same Standards were chosen for LAs to assess current efforts. The Appendix includes two documents with samples of written Objectives and Action Steps that LAs can use or use as a guide.

Kansas continues to align their LA NSP with the 2013 revision of the USDA WIC Nutrition Services Standards. From the USDA standards, the Kansas SA chose the standards listed below to be the focus of the 2021 LA NSP.

Breastfeeding Education, Promotion and Support: The State and local agency defines and establishes the breastfeeding education plan, policies, procedures and competency-based staff training to ensure the provision of high quality and comprehensive breastfeeding education, promotion and support.

Breastfeeding Peer Counseling: The State and local agency establish standardized breastfeeding peer counseling program policies and procedures and task-appropriate training for staff on the breastfeeding peer counseling program that are consistent with the Loving Support Model for a Successful Peer Counseling Program.

Staff Training: The local agency ensures that staff providing nutrition services adhere to the training schedule to complete a WIC State-approved training program.

Nutrition Education and Counseling: The State and local agency establishes policies to ensure development, implementation, evaluation and dissemination of quality nutrition education materials that deliver accurate, relevant and consistent messages to participants, to achieve optimal health outcomes in relation to their nutritional status and/or their nutrition-related concerns and goals.

Program Coordination: That State and Local Agency coordinate program operations with services of other public and private programs at the local, state, and national level that will benefit participants.

Outreach: There is no specific USDA Nutrition Standard for Outreach. The goal of outreach is to spread information about the WIC program and its many benefits to the public, especially to groups that likely would be eligible for WIC benefits, i.e. Pediatrician’s offices, foster parents, teen parent groups, etc.

Nutrition Services Documentation: The local agency develops documentation procedures that facilitate clear communication between staff as well as a seamless continuum of care for clients.

Agencies will again evaluate their previous year’s Strategic Action Plans. This evaluation will be written and submitted as part of the 2021 NSP. The COVID-19 pandemic may have impacted LA’s abilities to complete their 2020 Strategic Action Plans. Please report any progress on the steps of each 2020 Action Plan in addition to those that were completed.

4

https://wicworks.fns.usda.gov/resources/wic-nutrition-services-standards

LAs will conduct a self-assessment of their agency, based on the previously listed standards. This is an opportunity to step back and consider what your LA is currently doing and what things you might consider changing or beginning. LAs will rate their progress on a continuum for all Focus Area Indicators. Some indicators are beyond required policy so that LAs can focus more on quality improvement. This assessment is not meant to discourage you but to challenge you. No LA should be able to mark all items as completed. This is a tool to help you focus on what you would like to accomplish in the coming year.

For 2021, if an agency’s self-assessment shows they continue to need to work on something identified during 2020, they may repeat or continue any Strategic Action Plans that they were unable to complete in 2020 due to the pandemic. Otherwise, LAs will create two new Strategic Action Plans. One Strategic Action Plan must address Breastfeeding Education, Promotion and Support. The second Strategic Action Plan, the Clinic Improvement Strategic Action Plan, must focus on one of the remaining Nutrition Services Standards.

Nutrition Services Plan Policy

Below is a link to the Nutrition Services Plan policy:

http://www.kansaswic.org/manual/ADM_04_00_00_Nutrition_Services_Plan.pdf

Nutrition Services Plan Timeline

June 2020 – Guidance materials are sent to Local WIC Agencies.

July 2020 – September 2020 – Local Agencies organize meetings/conference calls with all NSP contributors to gather input. Ideally, if a planned change might need WIC funding, the cost would be submitted with the 2021 budget in mid-July. At a minimum, the contributors should include:

WIC Coordinator WIC Nutrition Services Coordinator WIC Breastfeeding Coordinator Breastfeeding Peer Counselor (if the LA has this program)

At least one of the contributors must be a licensed dietitian, working with WIC. If the Breastfeeding Coordinator is not the WIC Coordinator or WIC Nutrition Services Coordinator, the Breastfeeding Coordinator should be the lead for writing the Breastfeeding Strategic Action Plan. Agencies are encouraged to include other WIC Staff, which will strengthen the creation of the NSP and assist staff with understanding the NSP process, as well as the rationale behind the implementation of changes.

5

http://www.kansaswic.org/manual/ADM_04_00_00_Nutrition_Services_Plan.pdf

One person should be designated as the lead person responsible for coordinating and compiling the Plan. This person is often the Nutrition Services Coordinator.

October 2020 – The lead person compiles and finalizes the NSP. If the lead person is not one of the Coordinators listed above, the lead person shares the final NSP with these Coordinators for their approval, before the NSP is submitted to the SA.

November 1, 2020 – completed NSP due to state WIC office. It is preferred that the NSP be submitted electronically. If the NSP is submitted electronically, it is not necessary to also fax or mail it. Submit your agency’s Plan to your assigned State Nutrition Lead, at the email listed below. Lisa Medrow – [email protected] Julie Norman – [email protected] Patrice Thomsen – [email protected]

January 1, 2021 – Implementation date for the 2021 NSP

6

mailto:[email protected]



Nutrition Services Plan Completion Checklist and Instructions

Read through the Checklist and Instructions below. As each item is completed, check it off. Prior to submitting your Plan, review the checklist to ensure that all parts of your Plan are included.

____ Cover Sheet – At a minimum the contributors should include: WIC Coordinator, WIC Nutrition Services Coordinator and WIC Breastfeeding Coordinator. At least one of the contributors must be a licensed dietitian working with WIC. Identify the WIC position of each listed contributor: WIC Coordinator, Breastfeeding Coordinator, etc.

____ Clinic Staff Summary Sheet – If the Local Agency consists of multiple counties with different staff, complete a separate sheet for each county. If there are multiple clinics in a county with different staff, complete a separate sheet for each clinic.

____ Clinic Operations – Complete a separate sheet for each clinic.

____ Evaluations of 2020 Breastfeeding Promotion Strategic Action Plan and 2020 Clinic Improvement Strategic Action Plan – Gather necessary information to write the evaluations, including copies of the 2020 Strategic Action Plans, completed data collection forms and any other data needed.

____ Breastfeeding Promotion Needs Assessment 1. Find the breastfeeding rates for your county/clinic on Appendix 1 and enter that information in the appropriate spaces. 2. Read through the instructions for the Breastfeeding Promotion Needs Assessment.

3. The Needs Assessment table consists of four columns. The first column lists the Indicators for each Focus Area. The next three columns are where the ranking on each Focus Area Indicator is marked. Completed Needs Assessments should be submitted with the 2021 NSP.

____ 2021 Breastfeeding Promotion Strategic Action Plan -All agencies must complete an Action Plan focusing upon breastfeeding promotion and support. Utilizing the information obtained from the completion of the Breastfeeding Promotion Needs Assessment, select an area of focus and develop an objective, and at least three action steps to accomplish that objective. In the Appendix, several sample Strategic Action Plan objectives and action steps have been provided by the SA. If appropriate, LAs may use these objectives and action steps. LAs will need to add their own timelines, staff assignments and evaluation methods. LAs would likely need to revise a sample Plan to suit their agency. LAs are encouraged to write their own Strategic Action Plan with an objective and at least three or more action steps that are needed in order to achieve their objective. Please note: If they pertain to your 2021 Plan, a few of the action steps from the 2020 Plan may be repeated. At least

7

one action step must be new, and should be identified with a * or bolded. (For 2021, if an agency’s self- assessment shows they continue to need to work on something identified during 2020, they may repeat or continue any Strategic Action Plans that they were unable to complete in 2020 due to the pandemic. For LAs repeating their objective and action steps due to COVID-19 interruptions, new action steps for 2021 are not necessary.)

____ Clinic Improvement Needs Assessment – Agencies will complete a Needs Assessment for the remaining Nutrition Services Standards. The Clinic Improvement Needs Assessment is similar to the Breastfeeding Promotion Needs Assessment.

1. Read through the instructions for the Clinic Improvement Needs Assessment.

2. The Needs Assessment table consists of four columns. The first column lists the indicators for each Focus Area. The next three columns are where the ranking on each Focus Area Indicator is marked. Completed Needs Assessments should be submitted with the 2021 NSP.

____ 2021 Clinic Improvement Strategic Action Plan – All agencies must complete an Action Plan focusing on one of the remaining Nutrition Services Standards. Utilizing the information obtained from the completion of the Clinic Improvement Needs Assessment, select an area of focus and develop an objective, and at least three action steps to accomplish that objective. In the Appendix, several sample Strategic Action Plan objectives and action steps have been provided by the SA. If appropriate, LAs may use these objectives and action steps. LAs will need to add their own timelines, staff assignments and evaluation methods. LAs would likely need to revise a sample Plan to suit their agency. LAs are encouraged to write their own Strategic Action Plan with an objective and at least three or more action steps that are needed in order to achieve their objective. Please note: If they pertain to your 2021 Plan a few of the action steps from the 2020 Plan may be repeated. At least one action step must be new, and should be identified with a * or bolded. (For 2021, if an agency’s self-assessment shows they continue to need to work on something identified during 2020, they may repeat or continue any Strategic Action Plans that they were unable to complete in 2020 due to the pandemic. For LAs repeating their objective and action steps due to COVID-19 interruptions, new action steps for 2021 are not necessary.)

____ 2021 Nutrition Education Offerings - For each low risk education offering that your clinic will provide during the 2021 calendar year, list the information in the appropriate box in the table. The SA will be offering a lesson plan on Sugar Sweetened Beverages and the Importance of Water, available late 2020. The lesson will be appropriate for women and children. If interested in this lesson, LAs can include “SA provided SSB and the Importance of Water lesson” in this table.

During any six-month period, clinics should have a low risk education option for each client category. If your clinic only offers individual nutrition education contacts, mark the appropriate box at the top of the table. The rest of the table does not apply.

8

If your clinic offers only individual nutrition education contacts to certain client categories, mark the second box and list those client categories. Then complete the table with the nutrition education offerings you provide for the remaining client categories.

If your clinic offers the online nutrition education option, wichealth.org to your clients, mark the third box and complete the rest of the table.

Writing Objectives and Action Steps

Each objective should include the problem to be addressed, the target audience, time frame and the amount of change expected. These four components are also listed on the Strategic Action Plan tables that agencies complete and submit. Let’s look at some examples.

1. To Increase Our Referrals, is not an adequate objective.

An acceptable objective could still be to increase referrals, but needs to be more specific. For example, Increase the total number of referrals by 20% between 1/1/21 – 8/31/21.

This objective answers all four questions.the problem – clients may not be receiving all appropriate referralsthe target audience – all clientsthe time frame – 1/1/21 – 8/31/21the amount of change expected – the total number of referrals will increase by 20%

Note: As you are developing your Strategic Action Plans, think about how you will evaluate your results. For example, the Referrals To and From report in KWIC should be used for this Plan. Compare the total referrals from the December 2020 report to the August 2021 report. As a short-term evaluation, compare progress by looking at the March 2021 report. Although not a part of this objective, the variety of referrals could also be assessed by looking at the actual programs listed on the report.

2. For another example, To make pregnant women aware of their Medicaid benefits is not an adequate objective.

LAs could format their objective as a list under the Objective column, with each part clearly identified along with the content of that part of the objective: problem, target audience, time frame and change expected. This is what the text would look like in the Objective column:

9

https://wichealth.org/

the problem - Pregnant and breastfeeding women on WIC are unsure of their benefits through their Medicaid card.the target audience - Pregnant and Breastfeeding womenthe time frame - January 1, 2021 – December 31, 2021the amount of change expected - Pregnant and breastfeeding women are aware of and fully utilize all benefits afforded them with MedicaidThis is an actual objective from one of our WIC agencies and was written in this way on the table. One improvement could be to specify an amount of change expected. For example, staff will discuss with at least 50% of pregnant and breastfeeding women their Medicaid benefits and encourage them to use the benefits.

Note: This objective is harder to measure as there is not a Report that could be used to measure results. For this type of objective, the evaluation might be whether each Action Step is completed. Or conduct a before and after survey with clients.

3. Another example, To increase our breastfeeding incidence rate, would not be an acceptable objective.

A more specific objective might be: To increase our breastfeeding incidence rate by the end of the 3rd quarter of 2021 from 66.7% (in 2020) to 70 %. Target prenatal women from January 1, 2021 through September 30, 2021.

This objective answers all four questions.the problem – increase breastfeeding incidence ratethe target audience – prenatal womenthe time frame – 1/1/21 – 9/30/21the amount of change expected – increase the incidence rate from 66.7% (2020 rate) to 70% in the 3rd quarter of 2021

Note: the change expected for this objective can be measured through the KWIC Breastfeeding Guided Ad Hoc report.

4. One more example, To increase the visibility of WIC in our community, would not be an acceptable objective.

A more specific objective might be: To hold a Family Fun Fair in the parking lot of our clinic in August 2021 in order to make WIC more visible in the community and to make potential WIC clients aware of WIC.

This objective answers all four questions.the problem –people in the community and potential clients may not know about WICthe target audience – families in our communitythe time frame – 1/1/21 – 8/31/21the amount of change expected – people in our community will learn about WIC, which may result in clients who are eligible for WIC will apply for WIC

10

Note: This is another example that might be hard to measure. The agency might measure it by whether each Action Step is completed on time. The Referral From function in KWIC could be used if new clients are asked how they heard about WIC. In order to do this, the Fair would need to be added in KWIC as a choice for where the client heard about WIC.

Once the objective has been written, then the action steps need to be written. Make the action steps specific so that you have a step-by-step plan showing how you will achieve your objective.

Based on example #2 preceding, these are some action steps that the agency could use to accomplish their objective.

Action Step #1: Contact representatives from each Medicaid provider and invite them to have a table in the WIC Waiting Room to discuss services offered.

Action Step #2 – Determine a date that would work well for your clinic and the Medicaid providers. Make sure all WIC staff mark the date on their calendars and discuss specifics at a staff meeting.

Action Step #3 – Assign someone to oversee making all arrangements for the day – tables and where they will be set up, get table covers, designate a WIC staff member to stay with tables/providers in case of WIC questions.

Action Step #4 – promote your Medicaid information day at the clinic. Use posters, cards to hand out, etc.

Action Step #5 – create a very short questionnaire for clients, who visit the tables, to find out if they learned anything new.

11

Nutrition Services Plan Forms

12

2021 WIC Nutrition Services Plan

Cover Sheet

Agency:

Counties Included:

Names and Titles of all the Contributors:

Lead Person on NSP:

13

Clinic Staff Summary Sheet

If there are different staff members at each clinic, complete a separate page for each clinic in your Agency. Mark with an (X) if the employee is the Breastfeeding Coordinator, Breastfeeding Peer Counselor, BFPC Supervisor, Civil Rights Coordinator, Nutrition Services Coordinator, Local Vendor Coordinator, or WIC Coordinator. Check that each employee’s information in the KWIC Staff Directory is correct and current (name, title, email, and the qualifications are selected as desired). Instructions on how to do this: In KWIC, under the Clinic Admin tab, choose Staff Directory. Search by last name and then you can update the information. To ensure you receive mass emails from the state, click on qualifications. You can move over any that you think would be relevant. (Such as P and I Memo)

Clinic Name:Employee Name Specify

RN, RD,Clerk

BFCoor

BFPC BFPC Supervisor

Civil RightsCoor

NSCoor

VendorCoor

WICCoor

14

Clinic Operations

Agency and clinic name (if appropriate):

Address; including city where clinic is located (If there is more than one, list each clinic separately):

If your agency conducts mobile clinics, list the county and city of each mobile location here:

Days and hours each WIC clinic or mobile operates:

If your clinic doesn’t have a full time Registered Dietitian, list the usual days and times an RD is contracted to see clients at your clinic and how much, if any, the RD works from home:

15

Evaluation of Previous Year’s Strategic Action Plans

1. Review the previous year’s Strategic Action Plans and complete the applicable forms for each Plan:

Breastfeeding Promotion Strategic Action PlanOur objective was: Include objective here

Was the objective achieved? Yes ___ No ___

If the objective was achieved, please describe your results (% or number achieved, change achieved, etc.):Add narrative here

List each of the action steps written for your objective and indicate if it was complete, successful, and/or if you will continue to implement it.

Was your Strategic Action Plan, including your objective and action steps, realistic for your agency, in terms of resources, needs and time frame?

Yes ____ No ___If no, please explain here.Add narrative here

Did you encounter any problems or obstacles? Yes ____ No ___If yes, please describe here.Add narrative here

Was a short-term or periodic evaluation completed?Yes ____ No ____

Action Steps Completed fully/partially?

Successful? Continue?

1.2.3.4.5.

16

If yes, did your evaluation change your action plan in the past year? How will it influence your plans for next year?Add narrative here

If no, why not?Add narrative here

Clinic Improvement Strategic Action PlanOur objective was: Include objective here

Was the objective(s) achieved? Yes ___ No ___

If the objective was achieved, please describe your results (% or number achieved, change achieved, etc.):Add narrative here

List each of the action steps written for your objective and indicate if it was complete, successful, and/or if you will continue to implement it.

Was your Strategic Action Plan, including your objective and action steps, realistic for your agency, in terms of resources, needs and stated time frame?

Yes ____ No ___If no, please explain here.Add narrative here

Did you encounter any problems or obstacles? Yes ____☐ No ___If yes, please describe here.Add narrative here

Action Steps Completed fully/partially?

Successful? Continue?

1.2.3.4.5.

17

Was a short-term or periodic evaluation completed?Yes ____ No ____If yes, did your evaluation change your action plan in the past year? How will it influence your plans for next year?Add narrative here

If no, why not?Add narrative here

SharingIf you accomplished a particular project this year related to any area of WIC, the SA would love to hear about it. For example, you might have made clinic changes, collaborated with another agency or sponsored a nutrition education event. Please share your story.Add narrative here

Can we share this information in a future newsletter?

Yes ____ No ___

18

Breastfeeding Promotion Needs Assessment

Statewide Goal: To increase the initiation, duration and exclusivity of breastfeeding among WIC participants.

The table below lists initiation and breastfeeding exclusivity to six months rates. Use information from Appendix 1 to fill in your county’s information.

Need to updateBreastfeeding Rates

Data Source Statewide WIC

________ County Kansas United States

2016 National ImmunizationSurvey (CDC) for BreastfeedingInitiation Rates

88.0% 83.8%

2018 Breastfeeding InitiationBirth Certificate Data 88.5%

2019 Breastfeeding Initiationfrom KWIC 77.2%

2019 Exclusive Breastfeeding to 6 months from KWIC 13.7%

The writing of the Breastfeeding Promotion Strategic Action Plan requires each Local Agency complete an assessment, develop one or more objectives to enhance their services, and write action steps to meet those objectives.

Begin your assessment by reviewing the list on the following pages. Place a checkmark in the appropriate column that indicates what progress your LA has made in regards to each Focus Area Indicator. Total the checkmarks (each counts as one) for each column. Note the Focus Areas that have the highest scores in the “needs work” column. Select one of the Indicators in that Focus Area to develop your Breastfeeding Plan objective(s). You may choose to create your own Action Plan objectives that are more applicable to your agency that you would like to accomplish.

Write an objective for your chosen Indicator and write the action steps to achieve that objective. For example, if the Focus Area, Access to Professional Support, had the highest total in the “needs work” column, you could choose the Indicator, Community has a breastfeeding support group, decide that your objective will be to start a breastfeeding support group, then the action steps will be the multiple steps you will take to start this group.

19

1. Breastfeeding Education, Promotion and SupportStandard: The state and local agency defines and establishes the breastfeeding education plan, policies, procedures and competency-based staff training to ensure the provision of high quality and comprehensive breastfeeding education, promotion and support.

(Mark each of the indicators below at the point where you currently are on meeting that indicator. Then total the 3 columns at the bottom – with each checkmark = 1.)

1.1 Indicators for Focus Area: Maternity Care Practices Yes!(Proud of it)

Almost(Could improve)

Nope(Needs work)

1.1a Our local hospital has earned the “Baby-Friendly®” designation.

1.1b Our local hospital is a “High 5” facility.

1.1c Our Health Department and/or WIC clinic displays “Breastfeeding Welcome Here” decal and has signed the pledge.1.1d Our Health Department and/or WIC clinic is Breastfeeding Friendly. (see sample 1.1d in Appendix 2,this is a Minnesota program that KS clinics can complete the steps, but a LA wouldn’t apply for a designation from MN)1.1e Lactation room is available for staff and clients.

1.1f Coffective materials are used regularly in WIC and various other community settings that serve pregnant and postpartum families.

Maternity Care Practices Total:

1.2 Indicators for Focus Area: Professional Education

1.2a Staff attend trainings about breastfeeding promotion and support.

1.2b Breastfeeding promotion and support training is provided to health professionals in our community.1.2c Community health professionals use evidence based breastfeeding promotion and support education materials.1.2d WIC staff includes an International Board Certified Lactation Consultant (IBCLC).

Professional Education Total:

20

1.3 Indicators for Focus Area: Access to Professional Support Yes!(Proud of it)


Nope(Needs work)

1.3a WIC staff calls moms right after they deliver to see how breastfeeding is going.

1.3b WIC staff are members of the local breastfeeding coalition.

1.3c WIC and local Medicaid representatives collaborate on referrals.

1.3d Community has a breastfeeding support group.

1.3e Hospital has a breastfeeding follow-up clinic. (example: discharged patients can drop in or schedule a time to talk about BF issues with a lactation expert)1.3f Resource list for breastfeeding support is provided to clients.

1.3g WIC program offers a warm line for clients to call with breastfeeding concerns.1.3h Local pediatrician or family practice physician offices participate in the Kansas Chapter American Academy of Pediatrics (KAAP) “Breastfeeding Friendly Practice” designation

Access to Professional Support Total:

1.4 Indicators for Focus Area: Peer Support Programs

1.4a Our community has a peer support program such as La Leche League or Breastfeeding Peer Counselor.1.4b WIC clinic has a breastfeeding peer counselor program that meets all of the Model Components.

Peer Support Programs Total:

21

https://wicworks.fns.usda.gov/resources/wic-breastfeeding-model-components-peer-counseling

2021 Breastfeeding Promotion Strategic Action Plan

Statewide Goal: To increase the initiation and duration of breastfeeding among WIC participants.

Local Agency/Clinic Name: ______________________________________________________

*If your Plan results in increased WIC costs, a Budget Revision may need to be submitted.

Objectives

Include the problem to be addressed, target audience, time frame, and the amount of change expected.

Action Steps

Minimum of 3 action steps included.

At least one must address a significantly new or improved strategy toward your objective.

Please identify new steps with “*” or bold font.

Each action step should be written with sufficient detail and depth to support your objective.

Person Responsible

ImplementationDate or DateRange

Short Term or Periodic Evaluation (at a minimum, quarterly):

Description: Person Responsible

Date or Date Range

Final Evaluation: Description: Person Responsible

Date or Date Range

.

22

Clinic Improvement Needs Assessment

The writing of the Clinic Improvement Strategic Action Plan requires each Local Agency complete an assessment, develop one or more objectives to enhance their services, and write action steps to meet those objectives.

Begin your assessment by reviewing the list on the following pages. Place a checkmark in the appropriate column that indicates what progress your LA has made in regards to each Focus Area Indicator. Total the checkmarks (each counts as one) for each column. Note the Focus Areas that have the highest scores in the “needs work” column. Select one of the Indicators in that Focus Area to develop your Clinic Improvement objective(s). Or create a new Indicator for that Focus Area that is more applicable to your agency that you would like to accomplish.

Write an objective for that Indicator and write the action steps to achieve that objective. For example, if the Focus Area, KWIC Documentation, had the highest total in the “needs work” column, you could choose the Indicator, Regular Record Reviews Will be Conducted. You might decide that your objective will be to make a plan for having WIC staff conduct regular record reviews, then the action steps will be the multiple steps you will take to plan and implement the procedure for these record reviews.

23

2. Staff Training

Standard: The local agency ensures that staff providing nutrition services adhere to the training schedule to complete a WIC State-approved training program.

(Mark each of the indicators below at the point where you currently are on meeting that indicator. Then total the 3 columns at the bottom – with each checkmark = 1)

2.1 Indicators for Focus Area: Training for WIC Employees Yes!(Proud of it)


Nope(Needs work)

2.1a WIC staff are trained in Motivational Interviewing (MI) and use MI principles while talking with clients.

2.1b In addition to the training required for WIC, new employees also shadow more experienced WIC staff.

2.1c Our agency coordinates with other WIC agencies to allow employees to visit and learn from each other.

2.1d Our agency encourages WIC employees to obtain additional training, beyond the annually required 2 trainings plus civil rights training.

2.1e Staff training is considered and planned costs are included when preparing the annual budget.

2.1f Staff who attend conferences share the information they learned with other staff at in-services or staff meetings.

Training for WIC Employees Total:

2.2 Indicators for Focus Area: Local Agency Documentation of Staff Training

2.2a A training file exists and includes up-to-date training documentation for each staff member.

2.2b Regular staff meetings are held to discuss WIC issues and these are documented by placing copies of the minutes in staff training files.

Training Documentation Total:

24

3. Nutrition Education and Counseling:

Standard: The State and local agency establishes policies to ensure development, implementation, evaluation and dissemination of quality nutrition education materials that deliver accurate, relevant and consistent messages to participants, to achieve optimal health outcomes in relation to their nutritional status and/or their nutrition-related concerns and goals.


3.1 Indicators for Focus Area: Nutrition Education Contacts Yes! (Proud of it)


Nope(Needs work)

3.1a 100% of clients are scheduled to receive the minimum number of nutrition education contacts. See Policy NED 02.00.003.1b Staff complete Flow Sheets at every Certification/Recertification up to and including the next Recertification month.3.1c Flow Sheets completed by staff are accurate and include the appropriate number and type of nutrition education contacts.

Nutrition Education Contact Total:

3.2 Indicators for Focus Area: Client Centered Education3.2a Staff ask clients about any questions/concerns they have and address their questions/concerns.3.2b If a staff member cannot address a client question/concern; staff refer the client to the correct staff member or external professional/program that can address the question/concern.3.2c WIC Staff provide exemplary customer service.

Client Centered Education Total:

3.3 Indicators for Focus Area: Education Based on Thorough Assessment3.3a Staff conduct a thorough nutrition assessment, including review of diet questionnaire, health and medical history, anthropometrics and discussion with client using open-ended questions for clarifying information.3.3b Based on the assessment and client questions/concerns, applicable nutrition education is provided and available nutrition education materials are used when appropriate.3.3c Documentation of information discussed and education provided is documented in KWIC using Nutrition Education Topics, Handouts and KWIC Notes.

Education Based on Assessment Total:3.4 Indicators for Focus Area: Education is Adapted as Needed Yes!

(Proud of it)Almost

(Could improve)Nope

(Needs work)

3.4a Staff assess client’s/caregiver’s literacy and primary language needs

25

http://www.kansaswic.org/manual/eWIC_NED_02_00_00_Nutrition_Education_Contact.pdf

and services are adapted as needed.3.4b There is a plan for how interpreter services will be provided, other than using a family member or friend of the client.3.4c All WIC staff know the LA plan for interpreter services and know how to arrange and use these services.

Adapted Education Total:3.5 Indicators for Focus Area: Education Includes a Life Course Perspective3.5a Staff use materials and messages appropriate to the client’s category.3.5b Staff provide anticipatory information for the client’s potential next life stage and have implemented PM NED 02.05.00 Exit Counseling: Reinforce Healthy Living.3.5c Staff provide information to caregivers on children’s developmental stages and make referrals as appropriate.

Life Course Perspective Total:3.6 Indicators for Focus Area: Alcohol, Tobacco and Other Harmful Substance Abuse (ATOD) Information3.6a ATOD information, including verbal messages, is provided to all clients/caregivers at every certification/recertification appointment and documented in KWIC.

ATOD Information Total:

3.7 Indicators for Focus Area: Client Goals3.7a All clients have documented goals (preferably nutrition/health-related) and practical step-by-step plans to help achieve these goals.3.7b Goals and plans are not written by the CPA for the client. The CPA uses the client’s words and interests, as appropriate, and works with the client for clarification and ideas for the client to choose from.3.7c Staff use the “staff reinforcers” section of the goal tab internally to help staff prompt discussion on the client’s goal at the next visit.

Client Goals Total:

3.8 Indicators for Focus Area: RD/LD Provides High Risk Client Nutrition Education3.8a Adequate RD/LD hours are available for the number of high risk clients in the caseload.3.8b All high risk clients are scheduled to receive their secondary nutrition education from an RD, before and after MC.

RD/LD Provides High Risk Education Total:

3.9 Indicators for Focus Area: Quality Assurance3.9a Some method is used to evaluate the quality of the nutrition education provided to clients.

Quality Assurance Total:

26

http://www.kansaswic.org/manual/NED_02_05_00_Exit_Counseling.pdf


4. Program Coordination and Client Referrals

Standard: The state and local agency coordinate program operations with services of other public and private programs at the local, state, and national level that will benefit participants.


4.1 Indicators for Focus Area: Community Partners Yes!(Proud of it)


Nope(Needs work)

4.1a We collaborate and communicate regularly with our mandatory referral agencies -Medicaid/Kancare representative, regional or local DCF staff.

4.1b Our clinic has an ongoing relationship with area medical providers to provide them with WIC information.

4.1c Our program coordinates with a dental hygienist that comes to our clinic to screen and educate clients on dental health.

4.1d One or more of our WIC staff represent our program at meetings of community health coalition, interagency coordinating council, city/county health planning group, etc.

4.1e We have active working relationships with three or more of the following: Head Start, Child nutrition programs, Extension, SNAP-ED, local hospitals, shelters and food banks, teen parent programs, migrant support agencies.

Community Partner Totals:

27

5. Outreach

Standard: The goal of outreach is to spread information about the WIC program and its many benefits to the public, especially to groups that likely would be eligible for WIC benefits, i.e. pediatrician’s offices, foster parents, teen parent groups, etc.


5.1 Indicators for Focus Area: Outreach Yes!(Proud of it)


Nope(Needs work)

5.1a We plan outreach activities every year, which includes strategies to reach high-risk groups such as teen mothers, migrants, students, etc.

5.1b We place information about our WIC program in public places such as the library, community recreation centers, immigrant centers, grocery stores, county fair, etc.

5.1c We have reached out to specific programs and asked them to share our information in a newsletter, flyers. These might include: Head Start, elementary schools, child care centers and child care organizations, hospitals, OB and pediatrician offices, etc.

5.1d We hold an outreach event each year such as a family fun day, open house, community baby shower, etc.

5.1e Our program accommodates working families so that they can apply for WIC by having extended hours, appointments over the lunch hour, etc.

Outreach Total:

28

6. Nutrition Services Documentation

Standard: The local agency develops documentation procedures that facilitate clear communication between staff as well as a seamless continuum of care for clients.


6.1 Indicators for Focus Area: Information is Documented in KWIC Yes!(Proud of it)


Nope(Needs work)

6.1a Whenever “other” is used in KWIC, staff document details in a KWIC note.

6.1b KWIC notes are written clearly and include adequate information so that anyone can read and understand them.

6.1c KWIC documentation is evaluated by conducting regular record reviews.

6.1d Staff record No Show appointment outcomes in KWIC at the end of every clinic day.

KWIC Documentation Total:

6.2 Indicators for Focus Area: KWIC Reports

6.2a Staff members are familiar with six or more KWIC reports. (See KWIC Report Instructions on the KS WIC website.

6.2b Staff use various KWIC reports to improve WIC services.

KWIC Reports Total:

29

http://www.kansaswic.org/local_agencies/KWIC_Report_Instructions.htm

2021 Clinic Improvement Strategic Action Plan

Local Agency/Clinic Name: ______________________________________________________

A different Standard must be chosen than was selected for the previous year’s NSP (unless prior approval is obtained from your state nutritionist). If your Plan results in increased WIC costs, a Budget Revision may need to be submitted.

Standard: ____________________________________________________________________

ObjectivesInclude the problem to be addressed, target audience, time frame, and the amount of change expected.

Action StepsMinimum of 3 action steps included.At least one must address a significantly new or improved strategy toward your objective. Please identify new steps with “*” or bold font. (For 2021, can repeat 2020 plan without new steps-see page 8 of this document to see conditions.)Each action step should be written with sufficient detail and depth to support your objective.

Person Responsible

ImplementationDate or DateRange

Short Term or Periodic Evaluation: Description: Person Responsible

Date or Date Range

Final Evaluation: Description: Person Responsible

Date or Date Range

30

2021 Nutrition Education Offerings (The SA will send out a lesson on Basic Cooking in late 2020)

☐ This table is not applicable, our clinic offers only individual nutrition education (NEI). ☐ Our clinic offers only NEI to certain low risk clients, specify below.

List client categories: _____________________________________________________________________________________________ Describe specific client situations, for example, BF dyads, all low risk family members when one is scheduled for an NEI: _______________________________________________________________________________________________________________

☐ Our clinic uses WIChealth.org.Month(s) Class Title Type of Class

(group, self-study notebook, Interactive center, etc.)

PG PP BF I<6m

I>6m

C Brief description of class content(include how this class applies toeach client category)

Optional –SA provided lesson SSB and the Importance of Water

Interactive center/self-study notebook

X X X no no X Educates about the use of SSB and their effect on health and the importance of water.

Please assess your offerings to ensure that during all time frames there is a low risk education option for each client category.

32

Appendix 1 – Statewide and Countywide Breastfeeding Data Birth Certificate-CY 2018 CY 2019 KWIC data

COUNTY Percent initiated BF

Number live births

Percent initiated BF

Exclusive BF % to 6 months

Number infants

Kansas 88.5% 36,268 77.2% 13.7% 14173

ALLEN 84.3% 159 63.6% 7.8% 77

ANDERSON 83.7% 105 75.9% 27.6% 29

ATCHISON 79.3% 185 48.7% 6.4% 78

BARBER 87.3% 55 81.8% 27.3% 22

BARTON 87.7% 321 85.4% 17.2% 151

BOURBON 90.6% 202 80.0% 17.3% 75

BROWN 82.3% 130 67.6% 12.7% 71

BUTLER 87.2% 700 76.5% 17.0% 200

CHASE 89.5% 24 76.9% 7.7% 13

CHAUTAUQUA 86.7% 35 84.2% 15.8% 19

CHEROKEE 74.5% 232 70.9% 11.8% 127

CHEYENNE 96.7% 21 88.9% 22.2% 9

CLARK 86.4% 24 100.0% 50.0% 4

CLAY 91.2% 90 82.4% 20.6% 34

CLOUD 86.2% 104 79.7% 23.7% 59

COFFEY 87.2% 73 75.0% 0.0% 8

COMANCHE 88.9% 14 100.0% 0.0% 4

COWLEY 79.8% 383 71.1% 9.9% 242

CRAWFORD 78.0% 451 66.8% 13.9% 316

33

Birth Certificate-CY 2018 CY 2019 KWIC data


Number live births



Number infants

DECATUR 87.9% 30 90.0% 10.0% 10

DICKINSON 84.6% 183 84.6% 24.6% 65

DONIPHAN 76.8% 90 61.5% 7.7% 26

DOUGLAS 88.9% 1,114 78.6% 17.4% 374

EDWARDS 73.9% 31 80.0% 20.0% 10

ELK 91.7% 24 87.5% 0.0% 8

ELLIS 89.3% 314 85.1% 25.4% 67

ELLSWORTH 86.2% 53 88.5% 11.5% 26

FINNEY 85.4% 621 78.2% 9.3% 431

FORD 84.7% 576 71.9% 6.4% 405

FRANKLIN 82.0% 302 80.5% 16.4% 128

GEARY 87.6% 936 71.2% 14.2% 281

GOVE 100% 38 84.6% 38.5% 13

GRAHAM 85.7% 24 95.0% 20.0% 20

GRANT 85.0% 126 76.3% 8.5% 59

GRAY 92.0% 78 92.9% 21.4% 28

GREELEY 96.0% 14 100.0% 12.5% 8

GREENWOOD 87.7% 54 75.0% 8.3% 12

HAMILTON 80.6% 31 No WIC Clinic

HARPER 85.9% 69 77.8% 11.1% 45

HARVEY 90.0% 386 84.1% 15.9% 170

34



Number live births



Number infants

HASKELL 97.8% 67 85.7% 28.6% 21

HODGEMAN 94.1% 14 80.0% 0.0% 5

JACKSON 81.1% 169 69.4% 6.5% 62

JEFFERSON 86.5% 188 78.3% 21.7% 46

JEWELL 96.8% 24 75.0% 12.5% 8

JOHNSON 93.8% 7,133 84.9% 15.3% 1199

KEARNY 90.8% 65 WIC Clinic Opened 2020

KINGMAN 88.9% 68 75.9% 10.3% 29

KIOWA 100% 42 75.0% 30.0% 20

LABETTE 76.2% 268 63.4% 10.8% 93

LANE 100% 19 100.0% 37.5% 8

LEAVENWORTH 88.5% 1,005 72.0% 17.6% 289

LINCOLN 100% 30 90.9% 9.1% 11

LINN 89.9% 102 76.8% 16.1% 56

LOGAN 89.7% 47 81.8% 9.1% 11

LYON 87.8% 406 83.4% 21.2% 193

MARION 90.4% 302 87.5% 15.6% 32

MARSHALL 93.8% 112 77.5% 12.5% 40

MCPHERSON 82.6% 117 82.5% 27.5% 80

MEADE 88.6% 56 82.4% 17.6% 17

MIAMI 88.9% 371 72.1% 17.1% 111

35



Number live births



Number infants

MITCHELL 82.4% 75 73.7% 10.5% 19

MONTGOMERY 76.9% 363 57.3% 5.8% 171

MORRIS 87.5% 64 70.0% 20.0% 20

MORTON 80.0% 27 No WIC Clinic

NEMAHA 89.4% 148 78.6% 7.1% 28

NEOSHO 78.1% 163 76.0% 13.2% 121

NESS 86.7% 35 69.2% 15.4% 13

NORTON 92.0% 56 93.1% 24.1% 29

OSAGE 84.2% 166 71.4% 10.7% 56

OSBORNE 91.1% 42 89.5% 15.8% 19

OTTAWA 90.9% 63 92.9% 28.6% 14

PAWNEE 88.9% 52 80.0% 25.0% 40

PHILLIPS 98.0% 62 78.9% 31.6% 19

POTTAWATOMIE

91.5% 383 83.8% 32.4% 37

PRATT 88.5% 116 83.3% 18.3% 60

RAWLINS 90.9% 37 100.0% 14.3% 7

RENO 88.3% 642 75.9% 16.9% 307

REPUBLIC 90.0% 44 86.7% 33.3% 15

RICE 79.6% 114 76.7% 37.2% 43

RILEY 90.0% 895 86.1% 27.4% 563

ROOKS 86.5% 67 79.2% 12.5% 24

36



Number live births



Number infants

RUSH 83.9% 23 87.5% 25.0% 8

RUSSELL 89.0% 84 69.7% 6.1% 33

SALINE 85.9% 639 78.5% 18.1% 293

SCOTT 89.5% 67 87.5% 9.4% 32

SEDGWICK 90.1% 6,732 76.5% 11.3% 2938

SEWARD 81.4% 381 83.8% 9.7% 277

SHAWNEE 81.5% 2,122 77.0% 11.5% 1083

SHERIDAN 89.7% 24 66.7% 33.3% 3

SHERMAN 87.7% 65 87.9% 15.2% 33

SMITH 90.7% 30 81.8% 0.0% 11

STAFFORD 85.2% 44 81.0% 19.0% 21

STANTON 89.3% 21 53.3% 6.7% 15

STEVENS 81.2% 72 86.7% 6.7% 45

SUMNER 84.7% 258 70.1% 14.3% 77

THOMAS 95.8% 99 79.2% 29.2% 24

TREGO 96.3% 31 100.0% 0.0% 5

WABAUNSEE 89.6% 72 75.0% 0.0% 8

WALLACE 83.3% 34 100.0% 33.3% 3

WASHINGTON 88.2% 77 88.9% 22.2% 9

WICHITA 90.0% 22 92.3% 15.4% 13

37



Number live births



Number infants

WILSON 78.8% 102 55.1% 8.2% 49

WOODSON 82.4% 24 57.1% 0.0% 7

WYANDOTTE 85.4% 2,620 74.8% 9.4% 1528

38

Appendix 2 - Sample Objectives & Action Steps – Breastfeeding Strategic Action Plan

1.1 Maternity Care Practices# 1.1a Sample: Baby-Friendly®Objective:Assist our local hospital in reaching one or more of the 10 steps toward achieving the “Baby-Friendly®” designation by ___ ___, 2021.

Prior to choosing this objective, a WIC staff member must meet with the appropriate person at the hospital to assess whether there would be interest in this project. If the hospital/community member is not interested, a different objective must be used.

Action Steps:1. WIC Coordinator will identify a WIC staff member to serve as the liaison between WIC and the

hospital to help lead action steps.2. WIC liaison will read about “Baby-Friendly®” and prepare an in-service for all WIC staff about it.

(Note: A Baby Friendly hospital completes a multi-year national program that includes a site visit.)

3. WIC liaison will schedule a WIC staff in-service on “Baby-Friendly®”. 4. WIC staff will learn about “Baby-Friendly®” at staff in-service. 5. WIC liaison will schedule a meeting with key hospital staff to introduce the Baby-Friendly

designation and prioritize actions towards reaching at least one of the steps. 6. WIC liaison will plan meetings with hospital staff at least quarterly to assess progress and

identify next steps.7. WIC liaison will schedule a year-end meeting in September 2021 to celebrate successes and

begin to map out next year’s goals.

# 1.1b Sample: High 5 Objective:Assist our local hospital in meeting requirements for High 5 status by ___ ___, 2021.


Action Steps:1. WIC Coordinator will identify a WIC staff member to serve as the liaison between WIC and the

hospital to help lead action steps.

39

2. WIC liaison will read about High 5 and prepare an in-service for all WIC staff about it. (Note: High 5 is a Kansas designation.)

3. WIC liaison will schedule a WIC staff in-service on High 5.4. WIC staff will learn about High 5 at staff in-service.5. WIC liaison will schedule a meeting with key hospital staff to introduce High 5 and prioritize

actions towards reaching all 5 requirements and plan timeline for submitting application.6. WIC liaison will plan meetings with hospital staff at least quarterly to assess progress and

identify next steps.7. WIC liaison will schedule a year-end meeting in September 2021 to celebrate successes and

submit application.8. Distribute and discuss the Coffective We’re Prepared Checklist with pregnant clients.

# 1.1c Sample: Breastfeeding Welcome Here Objective:By ________, 2021, _______(number) local businesses and/or public establishments will have obtained the “Breastfeeding Welcome Here” decal and signed the pledge .

Action Steps:1. Meet with upper level management at the health department about the Breastfeeding

Welcome Here decal and pledge to receive approval.2. Order “Breastfeeding Welcome Here” decal from the Kansas Breastfeeding Coalition. 3. Have administrators sign the pledge.4. Share the Breastfeeding Welcome Here Toolkit with local businesses and/or public

establishments.

# 1.1d Sample: Breastfeeding Friendly Health Department Objective: Accomplish three or more of the 10 Breastfeeding Friendly Health Department steps by ___ ___, 2021.

Action Steps:1. Establish a designated individual/group to manage BFHD.2. Have a written breastfeeding policy that addresses all BFHD 10 steps. 3. Collaborate with a community partner to provide access to breastfeeding classes.4. Encourage racially and ethnically diverse resources within the community.5. Through community partnership, encourage a local public place to provide a breastfeeding

friendly environment for families.6. Facilitate access to information and training for childcare centers and providers on how to

support a breastfeeding mother.

40

http://www.high5kansas.org/

# 1.1e Sample: Lactation Room Objective: Establish a designated lactation room for staff and clients according to the Nursing Room Guidelines by ___ ___, 2021.

Action Steps:1. Select a space in the clinic that is shielded from view, free from intrusion through signage and is

not a restroom. 2. Ensure that the space selected meets, at minimum, the requirements for the Basic Model of the

Nursing Room Guidelines.3. Meet the requirements for the Even Better or State of the Art Model of the Nursing Room

Guidelines.4. Promote the opening of the room to staff, WIC clients and the community.

# 1.1f Sample: Coffective Objective: Increase the number of contacts WIC clients have with the Coffective messaging, both in clinic and in the community by ___ ___, 2021.

Prior to choosing this objective, a WIC staff member must meet with the appropriate person to assess whether there would be interest in this project. If there is no interest, a different objective must be used.

Action Steps:1. Set up a meeting with doctors and their staff in your community who deliver babies to review

the Coffective mission and available materials. Describe how WIC uses the materials to prepare families for delivery. Discuss how the content is in alignment with the High 5 for Mom and Baby and Baby Friendly Hospital Initiative steps. Give copies of the We’re Prepared Checklist and Motivation Document and emphasize that consistent messaging is the key to improving breastfeeding support for families.

2. Talk with home visitor programs (Healthy Start, Parents as Teachers, Head Start/Early Head Start, etc.) about the Coffective mission and available materials. Give copies of the We’re Prepared Checklist and Motivation Document and emphasize that consistent messaging is the key to improving breastfeeding support for families.

3. Attend a local or regional breastfeeding coalition meeting. Review the Coffective mission and available materials. Give copies of the We’re Prepared Checklist and Motivation Document and emphasize that consistent messaging among coalition members is the key to improving breastfeeding support for families.

41

1.2 Professional Education# 1.2a Sample: Staff TrainingObjective: Increase breastfeeding promotion and support WIC staff training by ___ ___, 2021.

Action Steps:1. Attend the Kansas La Leche League annual meeting.2. Attend a Certified Lactation Education class.3. Attend a Certified Lactation Counselor 5-day Course.4. Attend Kansas Breastfeeding Coalition Breastfeeding Education Courses. 5. Attend Kansas Breastfeeding Coalition Annual Conference.6. Attend CDC-USBC Bi-Monthly Coalitions Webinars. 7. Share and discuss what was learned with all staff.

# 1.2b Sample: Training Community Health ProfessionalsObjective: Increase breastfeeding educational training opportunities for community health professionals in your community by ___ ___, 2021.

Prior to choosing this objective, a WIC staff member must meet with the appropriate person to assess whether there would be interest in this project. If the hospital/community is not interested, a different objective must be used.

Action Steps: 1. Host a Certified Lactation Counselor 5-day Course. (Add appropriate steps.)2. Host Kansas Breastfeeding Coalition Breastfeeding Education Courses. (Add appropriate steps.)3. Host an educational opportunity for hospital personnel and physicians with the assistance of

Gwen Whittit, High 5 for Mom and Baby Coordinator. (Add appropriate steps.)4. Share Childcare Provider Education with childcare providers in the community. (Add appropriate

steps.)

# 1.2c Sample: Materials for Community Health ProfessionalsObjective: Increase the use of evidence-based breastfeeding promotion and support education materials by community health professionals by ___ ___, 2021.

42


Action Steps:1. Provide clinical protocols developed by the Academy of Breastfeeding Medicine, specifically #19:

BF Promotion in the Prenatal Setting, to community health professionals.2. Provide handout “BF Questions for MD’s to ask their pregnant patients,” to applicable doctors.3. Share Coffective materials: Counseling sheets (laminated), Motivation Document (tearsheet),

We’re Prepared Checklist (tearsheet), Waiting room slideshow (contact State Breastfeeding Coordinator), Posters and/or App, with community health professionals.

# 1.2d Sample: International Board Certified Lactation Consultant Objective: Increase WIC client access to IBCLC services by ___ ___, 2021.

Action Steps: 1. Identify the agency Designated Breastfeeding Expert (DBE) and strengthen the referral process

within WIC.2. Identify nearby IBCLCs and establish or strengthen the referral process outside of WIC.3. Assist a WIC staff member in becoming an IBCLC.

1.3 Access to Professional Support# 1.3a Sample: WIC Contacts After DeliveryObjective: Increase proportion of PG clients that are contacted soon after delivery to discuss breastfeeding by ___ ___, 2021.

Action Steps:1. Implement a call program/policy including timeline and protocol for phone calls.2. Identify process for learning that PG clients have delivered, as soon as possible after delivery,

including partnering with other programs who may assist with providing delivery information.3. Assign staff members to make the contact(s).4. Develop specific open-ended questions to ask clients related to breastfeeding and the

breastfeeding relationship.5. Plan support and referrals for overall well-being of the breastfeeding dyad.

43

# 1.3b Sample: Local Breastfeeding CoalitionObjective:Increase WIC staff participation in local breastfeeding coalition activities by ___ ___, 2021.

Action Steps: 1. Start (or re-establish) a Local Breastfeeding Coalition (Add appropriate steps.)2. Attend Local or Regional Breastfeeding Coalition meetings. 3. Advertise Local or Regional Breastfeeding Coalition meeting information in the community.4. Actively participate in the planning and completion of Breastfeeding Coalition projects.5. Assist the Breastfeeding Coalition with achieving financial sustainability.

# 1.3c Sample: Collaborative WIC-Medicaid ReferralsObjective:Increase collaboration between WIC and local Medicaid representatives by ___ ___, 2021.


Action Steps:1. Meet with local Medicaid representatives if a relationship is not already established.2. Implement joint referrals.3. Implement a policy for assisting WIC clients in applying for Medicaid.4. Ensure that the local Medicaid representatives are referring Medicaid-participating women,

infants and children to the WIC program.5. Develop and distribute flyers and other outreach materials.

# 1.3d Sample: Breastfeeding Support Group Objective: Increase WIC client access to breastfeeding support groups by ___ ___, 2021.

Action Steps:1. Complete KS-TRAIN Course WIC: Breastfeeding Support Group (ID # 1047630).2. Establish a community breastfeeding support group.3. Advertise the community breastfeeding support group to WIC clients and the community, if

applicable.

44

# 1.3e Sample: Hospital Breastfeeding Clinic Objective:Increase WIC client access to hospital breastfeeding clinic services by ___ ___, 2021.


Action Steps:1. Meet with local hospital staff if a relationship is not already established.2. Meet with a community that has successfully established a breastfeeding follow-up clinic with a

strong relationship with the local health department.3. Assist the hospital in establishing a breastfeeding follow-up clinic.4. Refer clients to the breastfeeding follow-up clinic.5. Advertise the breastfeeding follow-up clinic to WIC clients and the community.

# 1.3f Sample: Breastfeeding Support Resource List Objective:Increase the proportion of WIC clients that receive a breastfeeding support resource list by ___ ___, 2021.

Action Steps:1. Work with hospital and community groups to develop or update a breastfeeding support

resource list.2. Implement a policy for when to distribute the breastfeeding support resource list to WIC clients.3. Assign staff member(s) to distribute the breastfeeding support resource list. 4. Determine which clients (e.g. PG, PP, BF) will receive the breastfeeding resource list.5. After 5 months, check back with the other community groups to see if their use of the Resource

list is working.

# 1.3g Sample: WIC Breastfeeding Warm LineObjective:Increase WIC client access to breastfeeding support outside of normal business hours by ___ ___, 2021.

45

Action Steps:1. Establish a dedicated phone number or extension for WIC clients to call and leave a message

24/7. 2. Implement an internal policy that the phone call will be returned within 1-2 business days. 3. Assign staff member(s) to return warm line messages and/or answer the phone during normal

business hours. 4. Advertise the breastfeeding warm line in the clinic and community. 5. Establish and implement a procedure for referring clients to the Breastfeeding Peer Counselor or

Designated Breastfeeding Expert depending on severity of breastfeeding problems.

# 1.3h Sample: Breastfeeding Friendly Physician OfficeObjective:Improve breastfeeding promotion and support in local outpatient clinics that serve WIC families by ___ ___, 2021.


Action Steps1. Visit local physicians’ offices, tell them about the program and encourage them to apply.2. Assist physicians’ offices with completing one or multiple of the 19 recommendations described

in the AAP Clinic Report, The Breastfeeding-Friendly Pediatric Office Practice.3. Encourage local physicians’ office staff to participate in the local or regional breastfeeding

coalition.4. Contact the Kansas AAP Chapter Breastfeeding Coordinator for more information on how to

help local outpatient clinics become more breastfeeding-friendly.5. Reach out to existing Breastfeeding Friendly Practices in Kansas for information and tips for

success.6. Create and distribute a promotional flyer to share with local physicians’ offices. 7. Share free one-hour breastfeeding webinars with local physicians.

46

1.4 Peer Support Groups# 1.4a Sample: Peer SupportObjective:Increase WIC client access to peer breastfeeding support by ___ ___, 2021.


Action Steps:1. Assist an interested mother in becoming a trained La Leche League Leader.2. Establish a meeting La Leche League meeting time and place in your community.3. Refer clients to the local La Leche League by sharing contact information for the LLL Leader or

providing information about meeting dates, times and locations.4. Advertise the LLL meetings in clinic and the community. 5. Contact Breastfeeding Peer Counselor Program Coordinator to discuss starting a BFPC program

in your clinic.6. Start a breastfeeding support group where clients can share with other WIC families.

# 1.4b Sample: Breastfeeding Peer Counselor ProgramObjective:Evaluate and increase the impact of the WIC Breastfeeding Peer Counselor Program by ___ ___, 2021.

Action Steps:1. Review each of the questions included on the Loving Support Award of Excellence Gold Award

Application. 2. Review each of the questions included on the Loving Support Award of Excellence Gold

Premiere and Gold Elite Award Application. 3. Review the WIC Breastfeeding Model Components for Peer Counseling.4. Select 3 components of the WIC BFPC program that can be improved. In other words, select at

least three questions that your agency cannot mark “yes” to and implement solutions.5. Conduct a needs assessment and determine the following: the needs of your target audience,

where gaps exist in breastfeeding services and resources within your local agency and the community that can be addressed through peer counseling; and where improvements in your program are needed.

47

https://wicworks.fns.usda.gov/resources/wic-breastfeeding-model-components-peer-counseling

Appendix 3- Sample Objectives & Action Steps – Clinic Improvement Strategic Action Plan using Staff Training Standard

2.1 Staff Training#2.1a Sample: Staff Will Learn About and Use Motivational InterviewingObjective: All WIC staff will be skilled in Motivational Interviewing for WIC by ___ ___, 2021.

Action Steps: 1. Implement a schedule for all staff to complete Motivational Interviewing (MI) for WIC, the 11-

modlue online course, over a designated period of time.2. Implement a schedule to observe staff practicing MI skills learned and provide feedback and

encouragement (tip: could be done throughout training period to focus on just 1 or 2 things at a time and build upon skills learned).

3. Discuss MI successes and challenges in staff meetings. 4. Plan how to bring new staff up to speed on MI and how to monitor WIC Staff so that MI

concepts will continue to be part of the WIC experience.5. Consider how to change any internal procedures or commonly used questions/practices based

on MI.

Appendix 3- Sample Objectives & Action Steps – Clinic Improvement Strategic Action Plan using Nutrition Education and Counseling Standard

3.1 Nutrition Education Contacts# 3.1a Sample: Required Nutrition Education Contacts Are ScheduledObjective:Appropriate nutrition education will be made available to all clients. By [date], [__%] or more of the minimum number and correct type of nutrition education appointments will be made for each client. The correct number and type of appointments is based on the client category and risk type.

Prior to choosing this objective, a WIC staff member must conduct a random client record review to assess the percent compliance with Policy NED 02.00.00. If 100% of the appropriate number and type of nutrition education appointments are being made per the record review, then a different objective must be used.

48

http://www.kansaswic.org/download/training/Motivational%20Interviewing_for_WIC_Staff.pdf

Action Steps:1. The WIC or Nutrition Services Coordinator will conduct a record review of [number] client KWIC

records to assess the percent of appropriate nutrition education appointments being made per Policy NED 02.00.00. Notes will be kept of the results of the record review. (This step should have been completed prior to choosing this objective.)

2. At a staff meeting, Policy NED 02.00.00 will be reviewed and discussed. Staff will put together a plan so that all staff know their role in ensuring that all of the required nutrition education appointments are made for each client. For example, who will complete Flow Sheets, who will make appointments, etc.

3. A staff person will be assigned to write up the notes at each staff meeting and copies will be placed in staff training folders.

4. At the next staff meeting, staff will discuss how the plan is working and decide if any changes need to be made.

5. At the end of [# months], the WIC or Nutrition Services Coordinator will do another random client record review of [number] records to assess compliance with policy in number and type of client nutrition education appointments made.

6. The Coordinator will share the results of the record review and compare the before and after record review results to assess whether there was an improvement.

7. Based on the results, staff may or may not need to change their plan.

# 3.1b Sample: Flow Sheets Objective:By [date], Flow Sheets will be completed fully and accurately, with the correct number and type of nutrition education contacts, in [__%] or more of client KWIC records.

Prior to choosing this objective, a WIC staff member must conduct a random client record review to assess the percent of fully and accurately completed client Flow Sheets. If 100% of the Flow Sheets are complete and correct per the record review, then a different objective must be used.

Action Steps: 1. The WIC or Nutrition Services Coordinator will conduct a record review of [number] client KWIC

records to assess the percent of records with fully and accurately completed flow sheets. The correct number and type of nutrition education contacts must be documented. Notes will be kept of the results of the record review. (This step should be completed prior to choosing this objective.)

2. At a staff meeting or prior to the staff meeting, WIC staff will review the KWIC Flow Sheet Training on the training page of the WIC website.

3. At the staff meeting staff will discuss the Flow Sheet training and how they can make sure all client flow sheets are completed fully and accurately at each appointment. Staff will discuss the

49



different types of nutrition education appointments for both low and high risk clients. A plan will be made so that all staff know their role in making sure Flow Sheets are completed fully and accurately.



6. At the end of [number] months, the WIC or Nutrition Services Coordinator will do another random client record review of [number] records to assess if [__%] or more of the client flow sheets have been completed fully and accurately.

7. At the next staff meeting, the Coordinator will share the results of the record review and compare the before and after record review results to assess whether there was an improvement.


3.2 Client Centered Education# 3.2a Sample: Staff Address Client’s Questions/Concerns Objective:At every nutrition education contact, staff provide effective education by asking clients about their questions/concerns and then taking time to address these.

Action Steps:1. The WIC Coordinator finds a source of information on client-centered education. This might be

a speaker, an online module, a book or an article. (Tip: Could have staff review VENA modules on KS-TRAIN #1067702 and #1067705; or see information on the Training Webpage of the Kansas WIC Website, under Additional Training Resources > Nutrition Counseling.)

2. At a staff meeting, the WIC Coordinator has someone speak or has all staff review the information found on client-centered education.


4. For the next several months, staff will be asked to make a specific effort to ask clients about their concerns at every nutrition education contact.

5. At the next staff meeting the WIC Coordinator asks each staff member to share an example of how a co-worker asked a client about their concerns and then addressed those concerns to the extent possible.

50

http://www.kansaswic.org/local_agencies/training.html

# 3.2b Sample: Staff Know When Clients Need to Be Referred to Someone Else and Identify Who Would be Appropriate Objective:Staff will be given guidance on when to refer a client’s questions/concerns to someone else and information on who to use or available sources/resources to use for referrals.

Action Steps:1. WIC Coordinator reviews new employee training to assess if information is given on when to

refer a client to someone else.2. A flow chart is created with examples of when to refer a client to someone else and who should

be used for different referrals.3. Staff become familiar with referral sources. 4. Staff document referrals in KWIC, if appropriate

# 3.2c Sample: WIC Staff Interaction with Clients Objective:By [date] all WIC Staff who interact with WIC clients will complete training on customer service.

Action Steps:1. WIC Coordinator researches options for staff customer service training that can meet

parameters of available times, cost and training content.2. If needed, WIC Coordinator presents information gathered to Administrator for approval of staff

customer service training.3. WIC Coordinator or other staff make arrangements for all staff to receive the customer service

training.4. All employees obtain some type of proof of attendance, which is placed in their training file.

3.3 Education Based on Thorough Assessment# 3.3a Sample: Assessment Objective:By [date] CPAs will create a tool that helps them include all components of the client nutrition assessment when selecting the appropriate nutrition education for each client.

Action Steps:1. One CPA WIC staff member is designated to lead the project.2. The leader will schedule meetings for all CPAs to discuss what might help them include all of the

client nutrition assessment components in order to target the client’s education.3. Based on discussion a tool of some sort is selected/created. 4. One or more CPAs create the tool, if not already created.

51

5. The newly developed tool is shared at a CPA meeting.6. CPAs test the tool and determine if any changes need to be made.7. Once a final tool is made all CPAs use it in their client appointments.

# 3.3b Sample: Nutrition Education MaterialsObjective:So that WIC staff are familiar with all nutrition education materials available for use with clients, a resource will be created by WIC staff no later than [date] to use to help select appropriate materials.

Action Steps:1. At a WIC staff meeting or a separate meeting all staff will participate in a brainstorming session

on what could help staff select appropriate nutrition education materials to use with WIC clients.

2. A small group/committee will be created to put together some ideas based on the brainstorming session. This group will then schedule another meeting.

3. At the scheduled meeting members of the small group will present their ideas on a resource that could be created to help WIC staff select appropriate education materials for clients.

4. Either the same small group or another group selected for the task will create the resource.5. All staff will test the resource and suggest changes.6. Any changes needed will be chosen by WIC staff.7. The “creation” group will make any suggested changes.8. Staff use the resource.

# 3.3c Sample: DocumentationObjective:To improve documentation of nutrition education in client’s KWIC records, a pre and post client KWIC record review will be conducted, with the results guiding improvement efforts.

Action Steps:1. No later than [date], the WIC Coordinator or Nutrition Services Coordinator shall randomly

select [number] client records and review documentation of low and high risk nutrition education given to clients.

2. At a staff meeting, the results of this record review will be shared with WIC staff.3. Staff shall discuss/brainstorm ideas of ways to improve documentation. Staff will select some of

the suggestions and implement them.4. Notes of the meeting will be kept and a copy placed in each staff member’s training file.5. After a period of at least [__ months}, the WIC Coordinator or Nutrition Services Coordinator will

conduct a post record review of documentation of nutrition education.

52

6. Results will be shared and discussed at a staff meeting, including any further suggestions to improve documentation. Copies of notes of the meeting will be placed in each staff member’s training file.

3.4 Education is Adapted as Needed#3.4a Sample: LanguageObjective:In order to provide appropriate information, that clients can understand, staff will ask [__%] of clients/cg about their primary language and document it in KWIC. No later than [date] a procedure will be written for the determination of need and provision of interpreter services.

Action Steps:1. It will be determined which staff have the role of asking all new client/cg what language they are

most comfortable with and staff will document it in the primary language field in KWIC.2. For all clients/cg that indicate their primary language is not English, designated staff will ask

whether they would like interpreter services and if yes, staff will document this in KWIC.3. Before staff provide any verbal or written instructions/education, staff will check KWIC to

determine the client/cg preferred language and whether interpreter services will be needed.4. It will be determined which staff will check __________ days ahead of appointments to see

which clients will need interpreter services and will make arrangements for those services. 5. No later than [date], a written policy/procedure will be created with instructions for the steps

listed above.6. By [date], all WIC staff will review this policy and follow it.

#3.4b Sample: Interpreter Services Are Available Objective:In order to provide appropriate information, that clients can understand, the clinic will have arrangements in advance for potential interpreter services needed.

Action Steps:1. The WIC Coordinator or designee will review the KWIC Report, Interpreter Services, to

determine the languages that current clients/cg speak. (This report will only be accurate if staff always ask clients about their primary language and document it in KWIC.)

2. The WIC Coordinator or designee will ask all WIC staff about which potential languages the clinic might have a need for interpreter services.

3. The WIC Coordinator will research available options for interpreter services for each potential language needed.

53

4. The WIC Coordinator and Administrator, if appropriate, will decide, based on cost and other factors, which interpreter services the agency will use.

5. Potential interpreter costs will be included in the WIC budget.6. All WIC staff will be instructed on how to provide or arrange to be provided any interpreter

services. 7. Instructions will be made into a written procedure.

3.5 Life Course Perspective # 3.5a Sample: Education Targeted to Client CategoryObjective:Client/caregiver education is applicable by using materials appropriate to the client’s category. In order to provide individualized education, staff use materials appropriate to the client’s category.

Action Steps:1. A staff member is designated to make a list of the educational materials available to use with

each client category. These include: infants under 6 months, infants over 6 months, children 1 – 5 yrs of age, pregnant women, breastfeeding women, postpartum women.

2. At a staff meeting, this list is reviewed and any gaps are identified.3. Designated staff will research available materials the agency could use to fill any gaps.4. The list of potential materials are reviewed by staff and it is determined which or any to obtain

for the clinic to use.5. Once any new materials are obtained or source located (print from a website), the original list of

materials is updated.6. It is determined how often this process will be repeated (once a year, every other year, etc.)

# 3.5b Sample: Staff Will Provide Exit Counseling to Appropriate ClientsObjective:By 7/31/21, all women (PG, BF, PP) and caregivers of children turning five years old will be provided with information about lifelong health at their last WIC appointment.

Action Steps:1. Review policy NED 02.05.00 Exit Counseling: Reinforce Healthy Living2. At a staff meeting WIC staff will discuss providing lifelong health information to all women and

caregivers of children turning 5 at their last WIC appointment. One WIC staff member is designated to lead the project.

3. The leader will coordinate with other staff to create an implementation plan and timeline.

54


4. Based on discussion it will be decided how the lifelong health information will be provided, who will provide it, who documents completion, etc.

5. Staff will follow the plan and timeline. The leader schedules any meetings needed to discuss implementation/trouble shoot.

# 3.5c Sample: Developmental Stages Objective:To assist caregivers in evaluating their child’s progress, designated staff share developmental stages information with caregivers. If it appears a child may not be at the expected developmental stage for their age, staff discuss and share referral sources with caregiver.

Action Plan:1. If a current staff member is knowledgeable, they will give an in-service to staff, as needed, on

children’s developmental stages.2. If needed, it will be arranged for an outside expert on developmental stages to hold an in-

service for staff.3. A designated staff member will identify resources for staff to use with caregivers on

developmental stages. 4. A designated staff member will identify referral sources that staff can give caregivers if their

child might need intervention for age appropriate development.5. KAN Be Healthy bookmarks will be ordered from the state WIC office, by using the WIC

Publications Order form. 6. Staff will share information about KAN BE Healthy with caregivers and if needed, assist the

caregiver to make a KAN Be Healthy appointment. 7. All resources and referrals given to caregiver will be documented in KWIC.

3.6 Alcohol, Tobacco and Other Harmful Substance Abuse (ATOD) Information# 3.6a Sample: ATOD information providedObjective:To assist clients/caregivers in understanding the dangers of ATOD, staff share ATOD information with all clients/caregivers at every certification/recertification appointment. A clinic procedure will be written on how staff should do this.

Action Plan:1. To establish a baseline, the WIC Coordinator conducts a random client record review of at least

[number] records to assess the percent compliance with Policy CRT 08.03.00, providing ATOD information. WIC Coordinator may want to observe staff as well.

55

http://www.kansaswic.org/manual/CRT_08_03_00_Drug_and_Substance_Abuse_Referrals.pdf

http://www.kansaswic.org/manual/forms/WIC_Publications_Order_Form.pdf

http://www.kansaswic.org/manual/forms/WIC_Publications_Order_Form.pdf

2. At a staff meeting the results of the record review will be shared and staff will discuss how to best meet the requirements of sharing ATOD information. Handing out a pamphlet is not adequate. There must be a verbal message appropriate for the adult client/caregiver.

3. Once staff decide the procedure they will use so that all clients and caregivers are given information on ATOD, it is written as a procedure. Part of the procedure must include how the information will be documented in KWIC.

4. Over a [__ month] period, staff will follow this procedure.5. Another random record review will be conducted on at least [number] client KWIC records to

see if there is any improvement. Observations may be helpful as well.6. Based on the results, the procedure may be revised.

3.7 Client Goals# 3.7a Sample: Clients Have Goals and PlansObjective:The quality and usefulness of client goals and plans will be improved through learning, discussion and practice by staff.

Action Plan:1. To establish a baseline, the WIC Coordinator conducts a random client record review of at least

[number] records to assess the client goals and plans in client’s KWIC records. WIC Coordinator may want to observe staff as well.

2. At a staff meeting the results of the record review will be shared and staff will discuss how to best help clients set a goal and create a practical step-by-step plan to meet their goal. Having a standard goal, such as “have a healthy baby” is not acceptable.

3. All staff will practice on each other the best approach to help a client set their goal and plan. Every staff member will take a turn being the “client” and being the “staff member.”

4. Staff use one or more of the techniques they discussed to help clients with goals and plans.5. At the next staff meeting, staff will discuss if any of their techniques helped. If so, staff will again

take turns in trying the technique on each other as “client” and then “staff” and switch.6. At the next staff meeting, staff will again discuss what worked well in helping clients with the

goal and plan.7. Another random record review will be conducted on at least [number] client KWIC records to

see if there is any improvement in the goal setting and plan writing. Observations may be helpful as well.

8. The record review will be discussed and any new ideas shared.

56

# 3.7b Sample: Review Client GoalsObjective:It will become routine that at every appointment clients/caregivers will either be setting a goal or sharing their progress on their goal.

Action Steps:Once clients have created a goal and plan at their Cert/Recert, staff will incorporate asking about client’s progress on their goals into subsequent appointments.

1. Staff will update the client’s goal and plan as needed in their KWIC record.2. Staff put notes in the staff reinforcers section of the goal tab to help in discussing progress with

the client on reaching their goal.

3.8 RD/LD Provides High Risk Nutrition Education# 3.8a Sample: Available RD HoursObjective:It will be evaluated whether our clinic has enough RD/LD work hours for the number of high risk clients in our caseload.

Action Steps:1. The WIC Coordinator or designee will check the following KWIC reports: High Risk Summary

Report, KWIC Staff Guided Ad Hoc Report. 2. Based on the reports, the number of high risk clients and the estimated number of hours

needed for providing high risk nutrition education by the RD/LD will be calculated.3. The Appointment Book will be checked for a [number] month time block to see the number of

RD/LD appointment slots available vs. the number of high risk clients needing appointments.4. The high risk client list will be used to check [number] or more high risk client records to see if

the correct type of appointment – RD is made for each high risk client for their secondary nutrition education.

5. The WIC Coordinator will create a report based on this information and share it with their administrator and/or state WIC RD.

6. After discussion, it will be determined whether additional RD/LD hours are needed to meet requirements for provision of nutrition education for all high risk clients.

7. If more hours are needed, the WIC Coordinator will determine if current staff hours can be increased or if further FTE/contract hours will be needed.

8. Based on the WIC budget it will be decided if the increase in hours can be made.

57

# 3.8b Sample: RD/LD Provides High Risk Nutrition EducationObjective: To see if RD/LD high risk nutrition education appointments are being made correctly and whether the outcome is handled correctly.

Action Steps:1. The WIC or Nutrition Services Coordinator will conduct a record review of [number] high risk

client KWIC records to assess whether the required RD/LD appointments for secondary nutrition education are being made. Notes will be kept of the results of the record review.

2. Results of the record review will be shared at a staff meeting. 3. Staff will put together a plan so that all staff know their role in ensuring that all of the required

nutrition education appointments are made for each client. For example, who will complete Flow Sheets, who will make appointments, who will record outcomes for No show, etc.



6. At the end of [number] months, the WIC or Nutrition Services Coordinator will do another random client record review of [number] high risk client records to assess if improvement has been made and high risk clients are now scheduled with the RD/LD for their secondary nutrition education.

7. The Coordinator will share the results of the record review and compare the before and after record review results to assess whether there was an improvement.


58

kansas department of health and environment: nutrition and ... · web viewthe cpa uses the...

Documents