Value Enhanced Nutrition Assessment (VENA) in WIC

***The First Step in Quality Nutrition Services***

**Implementation Guidance**

The implementation of VENA will be a gradual process determined by each
State agency's current nutrition assessment process and staffing, within
the timeframe noted below. The Food and Nutrition Service (FNS) Regional
offices are available to provide technical assistance to State agencies
throughout the VENA implementation process.

This guidance organizes the VENA implementation process into two phases.
The VENA implementation process for each State agency begins with an
evaluation and comparison (Phase I: VENA Self-Evaluation) of current
nutrition assessment policies and practices to the process and content
of a *value enhanced* WIC nutrition assessment as described in the VENA
Guidance. Phase II is the development of a VENA Implementation Plan.
This two-phase process should enable all State agencies to implement
VENA by Fiscal Year (FY) 2010.

The following is a detailed description of the two phases of VENA
Implementation and the required information to be submitted to FNS. In
addition, (optional) forms are included for submitting the VENA
Self-Evaluation results and the VENA Implementation Plan.

**[VENA IMPLEMENTATION]{.underline}**

**[Phase I: VENA Self-Evaluation]{.underline}**

**Purpose**

The purpose of the self-evaluation is to assist WIC State agencies in
establishing the baseline of *current* WIC nutrition assessment
practices (in the context of a *value enhanced* nutrition assessment).
The VENA initiative establishes standards for WIC nutrition assessment
with the intention of strengthening the nutrition assessment process.
The nutrition assessment serves as the basis from which other nutrition
services can be personalized to best meet the participant's needs.

**Outcome**

Completion of the self-evaluation by a State agency will produce a
summary of baseline WIC nutrition assessment practices, including
identification of strengths and areas for enhancements in the 5 priority
areas: WIC policies, WIC nutrition assessment practices and processes,
staff competencies/training, Management Information System (MIS), and
quality assurance and monitoring.

**Uses**

-   The Self-Evaluation will be used by the State agency to develop the
    VENA Implementation Plan.

> 1

-   The Self-Evaluation will be used by the FNS Regional Office to
    evaluate the appropriateness of the State agency VENA Implementation
    Plan.

**Due Date**

The due date for the submission of the VENA Self-Evaluation to the FNS
Regional office is **on or before December 15, 2006.**

**Local Agency Input for the Self-Evaluation**

It is crucial to the success of VENA for the State agency to solicit
local agency input in order to translate VENA principles into local
agency operations and staff practices. As such, FNS expects that State
agencies will obtain local agency input as part of the self-evaluation
process. Many State agencies have local agency task forces, committees
or other established mechanisms to facilitate local agency input. In
addition, there are other ways -- surveys, observational visits, etc. -
to facilitate this input. State agencies may choose the manner or means
by which to collect local agency input, as long as the local agency
perspective is included in the self-evaluation process.

**The Self-Evaluation Process**

VENA is envisioned to be a *continual process* in which the 5 priority
areas (see diagram below) build upon each other. Using this circular
concept, State agencies *[can choose to begin the VENA Self-Evaluation
at any point in the cycle]{.underline}* to best meet their needs.

A State agency may choose to begin their self-evaluation with a broad
look at operations, and subsequently narrow the focus down to specific
components of the assessment process and the competencies needed to
carry them out. Alternatively, they can start with specifics and
consider

2

how they contribute to overall operations. Whichever method is chosen,
the self-evaluation must cover the five priority areas.

With regard to the staff competencies/training priority area, a State
agency may want to wait until they attend their Regional VENA Competency
Training (rapport building, critical thinking and health outcome-based
WIC nutrition assessment) before completing this section of the
self-evaluation. The other focus areas of the self-evaluation may be
started prior to the regional trainings.

State agencies should refer to the following guidance and policy
memorandums to conduct the VENA Self-Evaluation:

-   FNS WIC Policy Memorandum #2006-5, Value Enhanced Nutrition
    Assessment - WIC Nutrition Assessment Policy;

-   The VENA Guidance;

-   WIC Program Regulations, Section 246.7;

-   *Nutrition Services Standards*, Standard 7 Nutrition Assessment,
    sections A, C and D and;

-   FNS WIC Policy Memorandum 98-9, Revision 8, WIC Nutrition Risk
    Criteria.

Two appendices in the VENA Guidance are particularly helpful in the
self-evaluation process. Appendix D, *Essential Staff Competency Tables
for WIC Nutrition Assessment,* identifies the six staff competency areas
necessary to conduct a *value enhanced* WIC nutrition assessment.
Appendix A, *Relevant WIC Nutrition Assessment Information Tables*,
identifies category specific information to be collected during a
comprehensive WIC nutrition assessment in order to:

-   Identify WIC nutrition risk criteria used by the State agency;

-   Meet existing Program requirements, such as immunization and lead
    screening status; and

-   Address issues that affect the overall health of the participant,
    such as access to health care, physical activity, and food security.

**Self-Evaluation Results**

State agencies may use the attached *Phase I: VENA Self-Evaluation
Form*, or another format, to submit a summary of their self-evaluation
results. The *Phase I: VENA Self-Evaluation Form* includes questions for
each of the five priority areas to help focus the review process. The
focused questions are not intended to be answered individually, but
should be used as a framework for completing the self-evaluation.
Whatever format a State agency chooses, the self-evaluation summary must
address the information requested for each of the five priority areas.
WIC State agencies are encouraged to contact their FNS Regional Office
if they have questions or would like technical assistance with
completing the self-evaluation.

This self-evaluation of the nutrition assessment process creates the
pre-VENA "picture". Once State agencies have created a detailed picture
of their current process and identified their strengths and areas for
enhancements, State agencies should begin to develop their
implementation plan.

3

**VENA IMPLEMENATION**

**PHASE I: VENA SELF-EVALUATION FORM\***

**Due On or Before December 15, 2006**

***This form was developed to assist State agencies in completing Phase
I: VENA Self-Evaluation. State agencies have the option to complete this
form or use another format that summarizes their finding from the
self-evaluation. Whatever format is used, the report must include the
information requested (see "Self Evaluation Results" column) for each
activity (see "Activity" column below) on this form.***

+---+---------------------------+---------------------+------------------+
|   | **Activity**              | **Self-Evaluation   | **Com            |
|   |                           | Results**           | ments/Additional |
|   |                           |                     | Information**    |
+---+---------------------------+---------------------+------------------+
| 1 | **Evaluate the current    | Please provide a    |                  |
|   | nutrition assessment      | brief summary **of  |                  |
|   | process in the 5 priority | existing resources  |                  |
|   | areas (items a-e)         | and processes**     |                  |
|   | identified below, in the  | from your State     |                  |
|   | context of a *value       | agency's review of  |                  |
|   | enhanced nutrition        | each priority area. |                  |
|   | assessment,* to establish |                     |                  |
|   | a *baseline* of WIC       |                     |                  |
|   | nutrition assessment      |                     |                  |
|   | practices. The questions  |                     |                  |
|   | posed below are provided  |                     |                  |
|   | to give focus to the      |                     |                  |
|   | review process and are to |                     |                  |
|   | be used as a framework    |                     |                  |
|   | for completing the        |                     |                  |
|   | self-evaluation. It is    |                     |                  |
|   | not intended that each    |                     |                  |
|   | question be answered      |                     |                  |
|   | individually.**           |                     |                  |
+---+---------------------------+---------------------+------------------+
| a | [WIC                      | In considering the  |                  |
|   | Policies]{.underline}     | WIC policy          |                  |
|   |                           | questions: Please   |                  |
|   | -   How do your existing  | note that policy    |                  |
|   |     State nutrition       | citations are not   |                  |
|   |     assessment policies   | the desired         |                  |
|   |     support and/or        | responses for the   |                  |
|   |     enhance VENA          | self-evaluation     |                  |
|   |     implementation?       | results.  Rather, a |                  |
|   |                           | brief narrative     |                  |
|   | -   How do your existing  | summary of current  |                  |
|   |     State nutrition       | policies that       |                  |
|   |     assessment policies   | support VENA and a  |                  |
|   |     inhibit VENA          | brief description   |                  |
|   |     implementation?       | of potential areas  |                  |
|   |                           | for policy          |                  |
|   | -   Are there State       | enhancements are    |                  |
|   |     policies (e.g.,       | expected for the    |                  |
|   |     certification,        | VENA                |                  |
|   |     breastfeeding         | Self-Evaluation     |                  |
|   |     promotion and         | results submission. |                  |
|   |     support) that impact  |                     |                  |
|   |     VENA implementation?  |                     |                  |
|   |                           |                     |                  |
|   | -   Have staff            |                     |                  |
|   |     competencies been     |                     |                  |
|   |     identified for        |                     |                  |
|   |     conducting specific   |                     |                  |
|   |     parts of the          |                     |                  |
|   |     nutrition assessment  |                     |                  |
|   |     process? (Refer to    |                     |                  |
|   |     Appendix D,           |                     |                  |
|   |     *Essential Staff      |                     |                  |
|   |     Competency Tables for |                     |                  |
|   |     WIC Nutrition         |                     |                  |
|   |     Assessment*, of the   |                     |                  |
|   |     VENA Guidance.)       |                     |                  |
|   |                           |                     |                  |
|   | -   What State policy     |                     |                  |
|   |     changes/revisions are |                     |                  |
|   |     needed to implement   |                     |                  |
|   |     WIC Policy Memorandum |                     |                  |
|   |     98-9, Revision 8?     |                     |                  |
+---+---------------------------+---------------------+------------------+

\* May be reported in another format. 4

**VENA IMPLEMENATION**

**PHASE I: VENA SELF-EVALUATION FORM\***

**Due On or Before December 15, 2006**

**(Continued)**

+---+----------------------------+-------------------+------------------+
|   | **Activity**               | **Self-Evaluation | **Com            |
|   |                            | Results**         | ments/Additional |
|   |                            |                   | Information**    |
+---+----------------------------+-------------------+------------------+
| b | [WIC Nutrition Assessment  |                   |                  |
|   | Processes and              |                   |                  |
|   | Practices]{.underline}     |                   |                  |
|   |                            |                   |                  |
|   | -   How is all relevant    |                   |                  |
|   |     nutrition risk         |                   |                  |
|   |     information collected  |                   |                  |
|   |     and how is priority    |                   |                  |
|   |     assigned? (Refer to    |                   |                  |
|   |     Appendix A, *Relevant  |                   |                  |
|   |     WIC Nutrition          |                   |                  |
|   |     Assessment Information |                   |                  |
|   |     Tables,* of the VENA   |                   |                  |
|   |     Guidance)              |                   |                  |
|   |                            |                   |                  |
|   | -   How are                |                   |                  |
|   |     interrelationships     |                   |                  |
|   |     between risks          |                   |                  |
|   |     considered?            |                   |                  |
|   |                            |                   |                  |
|   | -   How is dietary intake  |                   |                  |
|   |     assessed?              |                   |                  |
|   |                            |                   |                  |
|   | -   How does the           |                   |                  |
|   |     assessment process     |                   |                  |
|   |     provide a positive     |                   |                  |
|   |     experience for the     |                   |                  |
|   |     applicant?             |                   |                  |
|   |                            |                   |                  |
|   | -   How does the           |                   |                  |
|   |     documentation          |                   |                  |
|   |     facilitate follow-up   |                   |                  |
|   |     at subsequent          |                   |                  |
|   |     participant            |                   |                  |
|   |     appointments?          |                   |                  |
|   |                            |                   |                  |
|   | -   What is the process    |                   |                  |
|   |     for follow-up of goals |                   |                  |
|   |     established on a prior |                   |                  |
|   |     visit?                 |                   |                  |
|   |                            |                   |                  |
|   | -   What barriers          |                   |                  |
|   |     currently exist to     |                   |                  |
|   |     prevent local WIC      |                   |                  |
|   |     staff from doing       |                   |                  |
|   |     *value enhanced*       |                   |                  |
|   |     nutrition assessment?  |                   |                  |
|   |                            |                   |                  |
|   | -   How will these         |                   |                  |
|   |     barriers be addressed? |                   |                  |
|   |                            |                   |                  |
|   | -   How does clinic flow   |                   |                  |
|   |     affect the nutrition   |                   |                  |
|   |     assessment process?    |                   |                  |
+---+----------------------------+-------------------+------------------+

\* May be reported in another format.

5

**VENA IMPLEMENATION**

**PHASE I: VENA SELF-EVALUATION FORM\***

**Due On or Before December 15, 2006**

**(Continued)**

+---+----------------------------+-------------------+------------------+
|   | **Activity**               | **Self-Evaluation | **Com            |
|   |                            | Results**         | ments/Additional |
|   |                            |                   | Information**    |
+---+----------------------------+-------------------+------------------+
| c | [Staff                     |                   |                  |
|   | Competen                   |                   |                  |
|   | cies/Training]{.underline} |                   |                  |
|   |                            |                   |                  |
|   | -   What training is       |                   |                  |
|   |     provided to WIC staff  |                   |                  |
|   |     responsible for each   |                   |                  |
|   |     part of the nutrition  |                   |                  |
|   |     assessment process?    |                   |                  |
|   |                            |                   |                  |
|   | ```{=html}                 |                   |                  |
|   | <!-- -->                   |                   |                  |
|   | ```                        |                   |                  |
|   | -   How does the State     |                   |                  |
|   |     agency ensure that the |                   |                  |
|   |     training is            |                   |                  |
|   |     competency-based?      |                   |                  |
|   |                            |                   |                  |
|   | -   What nutrition         |                   |                  |
|   |     knowledge components   |                   |                  |
|   |     are included in the    |                   |                  |
|   |     training?              |                   |                  |
|   |                            |                   |                  |
|   | -   How does the State     |                   |                  |
|   |     agency ensure that the |                   |                  |
|   |     training prepares      |                   |                  |
|   |     staff to perform a     |                   |                  |
|   |     nutrition assessment?  |                   |                  |
|   |                            |                   |                  |
|   | -   How does the State     |                   |                  |
|   |     agency ensure that the |                   |                  |
|   |     training addresses     |                   |                  |
|   |     communication and      |                   |                  |
|   |     counseling skills?     |                   |                  |
|   |                            |                   |                  |
|   | -   How does the State     |                   |                  |
|   |     agency ensure that the |                   |                  |
|   |     training includes      |                   |                  |
|   |     critical thinking      |                   |                  |
|   |     skills (refer to the   |                   |                  |
|   |     VENA Guidance for more |                   |                  |
|   |     details)?              |                   |                  |
|   |                            |                   |                  |
|   | -   What competencies are  |                   |                  |
|   |     reassessed routinely?  |                   |                  |
|   |                            |                   |                  |
|   | -   Who is required to     |                   |                  |
|   |     receive training on    |                   |                  |
|   |     the nutrition          |                   |                  |
|   |     assessment process     |                   |                  |
|   |     (all Competent         |                   |                  |
|   |     Professional           |                   |                  |
|   |     authorities,           |                   |                  |
|   |     paraprofessionals) and |                   |                  |
|   |     at what intervals?     |                   |                  |
+---+----------------------------+-------------------+------------------+

\* May be reported in another format.

6

**VENA IMPLEMENATION**

**PHASE I: VENA SELF-EVALUATION FORM\***

**Due On or Before December 15, 2006**

**(Continued)**

+---+----------------------------+-------------------+------------------+
|   | **Activity**               | **Self-Evaluation | **Com            |
|   |                            | Results**         | ments/Additional |
|   |                            |                   | Information**    |
+---+----------------------------+-------------------+------------------+
| d | [Management Information    | It is important   |                  |
|   | System (MIS)]{.underline}  | to note that a    |                  |
|   |                            | sophisticated     |                  |
|   | -   How does the MIS       | data system is    |                  |
|   |     facilitate/inhibit the | not a necessity   |                  |
|   |     nutrition assessment   | for implementing  |                  |
|   |     process?               |                   |                  |
|   |                            | VENA. The State   |                  |
|   | -   What features/changes  | agency should     |                  |
|   |     to the MIS are         | consider the      |                  |
|   |     critical to the        | current system it |                  |
|   |     assessment process?    | has in place as   |                  |
|   |                            | the               |                  |
|   | -   What changes to the    | implementation    |                  |
|   |     MIS would enhance the  | plan is           |                  |
|   |     nutrition assessment   | developed, and    |                  |
|   |     process?               | bear in mind that |                  |
|   |                            | a data system's   |                  |
|   | -   What resources will be | main function is  |                  |
|   |     needed to make changes | to collect and    |                  |
|   |     to the MIS as a result | house information |                  |
|   |     of VENA?               | in an organized   |                  |
|   |                            | and efficient     |                  |
|   | -   How will staff be      | manner. Increased |                  |
|   |     trained on MIS         | automation is not |                  |
|   |     changes?               | the targeted      |                  |
|   |                            | end-point for     |                  |
|   |                            | successful        |                  |
|   |                            | implementation of |                  |
|   |                            | VENA. Rather, the |                  |
|   |                            | goal should be to |                  |
|   |                            | find the balance  |                  |
|   |                            | between a         |                  |
|   |                            | well-designed and |                  |
|   |                            | highly functional |                  |
|   |                            | MIS and a *value  |                  |
|   |                            | enhanced*         |                  |
|   |                            | nutrition         |                  |
|   |                            | assessment        |                  |
|   |                            | performed by      |                  |
|   |                            | well-trained      |                  |
|   |                            | staff. The MIS    |                  |
|   |                            | should serve as   |                  |
|   |                            | an adjunct that   |                  |
|   |                            | enhances the WIC  |                  |
|   |                            | nutrition         |                  |
|   |                            | assessment        |                  |
|   |                            | process.          |                  |
+---+----------------------------+-------------------+------------------+
| e | [Quality Assurance/        |                   |                  |
|   | Monitoring]{.underline}    |                   |                  |
|   |                            |                   |                  |
|   | -   How and how often are  |                   |                  |
|   |     all aspects of the     |                   |                  |
|   |     nutrition assessment   |                   |                  |
|   |     process monitored and  |                   |                  |
|   |     evaluated by the State |                   |                  |
|   |     and the local          |                   |                  |
|   |     agencies?              |                   |                  |
|   |                            |                   |                  |
|   | -   How does the State     |                   |                  |
|   |     agency monitor the     |                   |                  |
|   |     effectiveness of the   |                   |                  |
|   |     training provided?     |                   |                  |
+---+----------------------------+-------------------+------------------+

\* May be reported in another format.

7

> **VENA IMPLEMENATION**

**PHASE I: VENA SELF-EVALUATION FORM\***

**Due On or Before December 15, 2006**

**(Continued)**

+---+---------------+--------------------------------+-------------------+
|   | **Activity**  | **Self-Evaluation Results**    | **Co              |
|   |               |                                | mments/Additional |
|   |               |                                | Information**     |
+---+---------------+--------------------------------+-------------------+
| 2 | **Identify    | Please provide a **brief       |                   |
|   | enhancements  | summary** of identified        |                   |
|   | needed to     | enhancements needed in each    |                   |
|   | implement     | priority area. This summary    |                   |
|   | VENA.**       | should provide a preliminary   |                   |
|   |               | overview of your State         |                   |
|   |               | agency's intentions. Detailed  |                   |
|   |               | action steps and timelines     |                   |
|   |               | will be requested as part of   |                   |
|   |               | Phase II - VENA Implementation |                   |
|   |               | Plan in the Fiscal Year 2008   |                   |
|   |               | State Plan.                    |                   |
+---+---------------+--------------------------------+-------------------+
| a | -   WIC       |                                |                   |
|   |     Policies  |                                |                   |
+---+---------------+--------------------------------+-------------------+
| b | -   WIC       |                                |                   |
|   |     Nutrition |                                |                   |
|   |               |                                |                   |
|   |    Assessment |                                |                   |
|   |     Processes |                                |                   |
|   |     and       |                                |                   |
|   |     Practices |                                |                   |
+---+---------------+--------------------------------+-------------------+
| c | -   Staff     |                                |                   |
|   |     Competen  |                                |                   |
|   | cies/Training |                                |                   |
+---+---------------+--------------------------------+-------------------+
| d | -             |                                |                   |
|   |    Management |                                |                   |
|   |               |                                |                   |
|   |   Information |                                |                   |
|   |     Systems   |                                |                   |
|   |     (MIS)     |                                |                   |
+---+---------------+--------------------------------+-------------------+
| e | -   Quality   |                                |                   |
|   |               |                                |                   |
|   |    Assurance/ |                                |                   |
|   |               |                                |                   |
|   |    Monitoring |                                |                   |
+---+---------------+--------------------------------+-------------------+
| f | -   Other     |                                |                   |
+---+---------------+--------------------------------+-------------------+
| 3 | **Local       | Please summarize how local     |                   |
|   | Agency        | agency input was incorporated  |                   |
|   | input**       | into the VENA Self-Evaluation. |                   |
|   |               | Describe how local agency      |                   |
|   |               | input will be solicited for    |                   |
|   |               | the VENA Implementation Plan.  |                   |
+---+---------------+--------------------------------+-------------------+

\* May be reported in another format 8

**[Phase II: VENA Implementation Plan]{.underline}**

**Purpose**

The purpose of the VENA Implementation Plan is to assist WIC State
agencies in determining the necessary action steps and related
timeframes to ensure VENA implementation by October 1, 2009.

**Use**

The VENA Implementation Plan will be used by State agencies and Regional
Offices to evaluate progress towards achieving VENA during monitoring
evaluations, State Plan review, etc.

**Due Date**

The due date for the submission of the VENA Implementation Plan is **on
or before**

**August 15, 2007** (to be submitted with the FY 2008 State Plan).

**The VENA Implementation Plan**

The VENA Implementation Plan should include information about the State
agency's plans to:

-   Identify and prioritize work activities and expenditures related to
    VENA implementation.

```{=html}
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```
-   Develop or revise current policies and procedures to enhance the
    quality of WIC nutrition assessment (to include polices and
    procedures that will enhance the use of assessment information for
    personalizing nutrition interventions).

```{=html}
<!-- -->
```
-   Identify VENA training needs and develop training plans for all
    staff related to WIC nutrition assessment, to include but not
    limited to the 3 areas covered in the VENA Competency Training
    (critical thinking, rapport building and Health Outcome-Based WIC
    Nutrition Assessment).

```{=html}
<!-- -->
```
-   Develop a plan for shifting WIC nutrition assessment from a
    deficiency findings process to a more positive process that focuses
    on desired health outcomes. (May include development of new
    questionnaires or nutrition assessment methods e.g., use of the
    Health Outcome-Based WIC Nutrition Assessment model.)

```{=html}
<!-- -->
```
-   Identify changes to the Management Information System (MIS) that
    support the value enhanced WIC nutrition assessment process.

-   Incorporate VENA into the State and local agency management
    evaluation review process.

State agencies have the option to complete the attached *Phase II: VENA
Implementation Plan Form*, or submit in another format, their VENA
Implementation Plan. Whichever format the State agency chooses the VENA
Implementation Plan must have sufficient detail in each of the areas
identified above. The FNS Regional Office will request additional
information, if the plan submitted does not provide adequate information
for the implementation of VENA. WIC State agencies are encouraged to
contact their FNS Regional Office if they have questions or would like
technical assistance with completing the implementation plan. Approval
of the FY 2008 WIC State Plan will be dependent on the approval of the
VENA Implementation Plan. 9

**VENA IMPLEMENATION**

**PHASE II: VENA IMPLEMENATION PLAN FORM\***

**Due On or Before August 15, 2007**

***This form was developed to assist State agencies in completing Phase
II: VENA Implementation Plan. State agencies may use this form or
another format, such as the one used for State Plans, to develop their
VENA Implementation Plans. Whatever format is used, the VENA
Implementation Plan must have sufficient detail for each of the areas
indicated below and must be appended to the Fiscal Year 2008 State
Plan.***

  -------------- ----------------- -------------- ---------------- ------------ ---------------
                 **Activity**      **Action(s)    **Priority**     **Target     **Anticipated
                                   Needed**                        Dates**      Costs**

  **Policies and Develop or revise Please         Please           Please       Please identify
  Procedures**   current policies  **identify**   **prioritize**   identify     **anticipated
                 and procedures to actions needed actions needed   **target     costs** (if
                 enhance the       for each       for each         dates** for  any) for
                 quality of WIC    activity.      activity.        completion   actions needed
                 nutrition                                         of actions   for each
                 assessment (to                                    needed for   activity.
                 include policies                                  each         
                 and procedures                                    activity.    
                 that enhance the                                               
                 use of assessment                                              
                 information for                                                
                 personalizing                                                  
                 nutrition                                                      
                 interventions).                                                

  **Training**   Identify VENA                                                  
                 training needs                                                 
                 and develop                                                    
                 training plans                                                 
                 for all staff                                                  
                 related to WIC                                                 
                 nutrition                                                      
                 assessment, to                                                 
                 include but not                                                
                 limited to the 3                                               
                 areas covered in                                               
                 the Regional VENA                                              
                 Competency                                                     
                 Trainings                                                      
                 (critical                                                      
                 thinking; rapport                                              
                 building and;                                                  
                 Health                                                         
                 Outcome-Based WIC                                              
                 Nutrition                                                      
                 Assessment).                                                   
  -------------- ----------------- -------------- ---------------- ------------ ---------------

\*May be reported in another format.

10

**VENA IMPLEMENATION**

**PHASE II: VENA IMPLEMENATION PLAN FORM\***

**Due On or Before August 15, 2007**

**(Continued)**

+-----------+-----------+-----------+-----------+-----------+-----------+
|           | **A       | **        | **P       | **Target  | **An      |
|           | ctivity** | Action(s) | riority** | Dates**   | ticipated |
|           |           | Needed**  |           |           | Costs**   |
+-----------+-----------+-----------+-----------+-----------+-----------+
| *         | Develop   |           |           |           |           |
| *Positive | plan for  |           |           |           |           |
| A         | shifting  |           |           |           |           |
| ssessment | WIC       |           |           |           |           |
| App       | nutrition |           |           |           |           |
| roaches** | a         |           |           |           |           |
|           | ssessment |           |           |           |           |
|           | from a    |           |           |           |           |
|           | d         |           |           |           |           |
|           | eficiency |           |           |           |           |
|           | finding   |           |           |           |           |
|           | process   |           |           |           |           |
|           | to a more |           |           |           |           |
|           | positive  |           |           |           |           |
|           | process   |           |           |           |           |
|           | that      |           |           |           |           |
|           | focuses   |           |           |           |           |
|           | on        |           |           |           |           |
|           | desired   |           |           |           |           |
|           | health    |           |           |           |           |
|           | outcomes. |           |           |           |           |
|           | (May      |           |           |           |           |
|           | include   |           |           |           |           |
|           | de        |           |           |           |           |
|           | velopment |           |           |           |           |
|           | of new    |           |           |           |           |
|           | a         |           |           |           |           |
|           | ssessment |           |           |           |           |
|           | methods   |           |           |           |           |
|           | e.g., use |           |           |           |           |
|           | of the    |           |           |           |           |
|           | Health    |           |           |           |           |
|           | Outc      |           |           |           |           |
|           | ome-Based |           |           |           |           |
|           | WIC       |           |           |           |           |
|           | Nutrition |           |           |           |           |
|           | A         |           |           |           |           |
|           | ssessment |           |           |           |           |
|           | model.)   |           |           |           |           |
+-----------+-----------+-----------+-----------+-----------+-----------+
| **M       | Identify  |           |           |           |           |
| anagement | changes   |           |           |           |           |
| In        | to the    |           |           |           |           |
| formation | MIS that  |           |           |           |           |
| System    | support   |           |           |           |           |
| (MIS)     | the value |           |           |           |           |
| Support   | enhanced  |           |           |           |           |
| for       | WIC       |           |           |           |           |
| Ass       | nutrition |           |           |           |           |
| essment** | a         |           |           |           |           |
|           | ssessment |           |           |           |           |
|           |           |           |           |           |           |
|           | process.  |           |           |           |           |
+-----------+-----------+-----------+-----------+-----------+-----------+
| **Local   | In        |           |           |           |           |
| Agency    | corporate |           |           |           |           |
| Review    | VENA into |           |           |           |           |
| Process** | the State |           |           |           |           |
|           | and local |           |           |           |           |
|           | agency    |           |           |           |           |
|           | review    |           |           |           |           |
|           | process.  |           |           |           |           |
+-----------+-----------+-----------+-----------+-----------+-----------+

\*May be reported in another format.

11