# Presentation: 406395

## HEALTH OUTCOME BASED WIC NUTRITION ASSESSMENT

## Introduction

- The purpose of this module is to *explore a model for nutrition assessment* offered as an ***option*** for implementing VENA

## Introduction

- Supports VENA philosophy by
- 	1.  Using a positive, holistic approach
- 	2.  Communicating risks in a positive manner
- 	3.  Identifying barriers to change
- 	4.  Using non-judgmental assessment and counseling
- 	5.  Setting the stage for a more positive and relevant     WIC interaction
- Provides a way to *organize assessment* so that *focus is*** on ***WIC’s goal of promoting good health*
- Incorporates content and skills learned in previous two modules

- This module:

## Assumptions

- WIC counselors bring competencies of
- 	•  Principles of lifecycle nutrition
- 	•  Anthropometric and hematological data    collection techniques
- 	•  Nutrition assessment process (in general –    VENA-directed changes are still evolving)
- Counselors have varied knowledge base regarding    VENA and health outcome approach
- Environmental barriers (lack of privacy, time, etc.)    have been addressed in previous modules

## Instructional Objectives

- Health outcomes are participant centered
- 	H1  Instructional Objectives for       Health Outcomes Based       WIC Nutrition Assessment

## Nutrition Assessment Changes Directed by VENA

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

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

## Anticipated Results of VENA

- State agencies will:
- 	•  Enhance nutrition assessment process
- 	 • Empower staff to improve nutrition assessment     skills
- 	 • Enjoy more satisfied staff and participants
- Health Outcome Based WIC Nutrition Assessment is sample model or *option* for accomplishing these results

## Rethinking the WIC Nutrition Assessment

- View and discuss the video *Beyond Nutrition Counseling:** **Reframing the Battle Against Obesity*
- Produced by the FIT WIC Project, a collaboration between Children’s Hospital Medical Center in Cincinnati, Ohio and the Kentucky WIC Program with funding provided by USDA

## Video Summary

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

## Video Summary (cont’d)

- This new approach will
- 	•  Create the opportunity for dialogue
- 	•  Personalize relationship with clients
- 	•  Couch risks in a positive, move-forward        framework vs. dwelling on the current crisis
*Being able to feel good about what we do and empowering the WIC participant to change*

## WIC Nutrition Assessment Defined

- A **WIC nutrition assessment** is the process of obtaining and synthesizing relevant and accurate information in order to:
- •	Assess an applicant’s nutrition status and risk
- •	Design appropriate nutrition education and counseling with the participant
- •	Tailor food packages to address nutrition needs for the participant
- •	Make appropriate referrals for the participant

## WIC Nutrition Services Process

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

- WIC Nutrition Services Process

*Collect*** **the relevant information
*Clarify*** **and** ***synthesize* the information that has been collected
*Identify *the pertinent and appropriate risk(s) and other related issues
*Document *the assessment
*Follow up *on previous assessments, as appropriate

## WIC Nutrition Assessment Process – Tools and Resources 

- To determine where the content of these training modules and the VENA guidance document apply, let us look at the process in more detail
- Review Handout 2	H2  WIC Nutrition Assessment Process –          Tools and Resources

## Health Outcome Based Nutrition Assessment

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

## Health Outcome Based Nutrition Assessment  ̶  Sources

- The health outcome approach is adapted from
***	****Healthy People 2010: **S**ystematic **A**pproach to**  **I**mproving **H**ealth**	*
- 	     and
*	**Bright Futures: **G**uidelines for **H**ealth **S**upervision**  of **I**nfants, **C**hildren and **A**dolescents*
- 	Primary reference is Appendix C of VENA guidance document.

## Categories of WIC Participants

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

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

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

- Categories of WIC Participants Key Components

- Desired health outcome
- Set of health determinants
- Information to be collected for each health determinant
- WIC nutrition risk criteria for each health determinant
- Other information required for individualizing nutrition

## Desired Health Outcomes

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

## Desired Health Outcomes

- What is the desired health outcome for each participant category and *where do we find this information*?

- Appendix C!

## Pregnant Woman

Breastfeeding Woman

Non-Breastfeeding Postpartum Woman

- Breastfeeding Woman
- Non-Breastfeeding Postpartum Woman

- Delivers a healthy, full-term infant while maintaining optimal health status
- Achieves optimal health during the child bearing years and reduces the risk of chronic disease
- Achieves optimal health during the child bearing years and reduces the risk of chronic diseases

- Categories of WIC Participants  – Desired Health Outcomes

## Infant

Child 12-60 Months

- Child 12-60 Months

- Achieves optimal growth and development in a nurturing environment and develops a foundation for healthy eating practices
- Achieves optimal growth and development in a nurturing environment and begins to acquire dietary and lifestyle habits associated with a lifetime of good health

- Categories of WIC Participants  – Desired Health Outcomes

## WIC Health Determinants

- The *health determinants* are a set of factors influenced by individual behaviors, past and current health conditions, and the family and social environment that contribute to reaching the *desired health outcome* * *
- In Appendix C, *health determinants* are found in the shaded boxes

## Health Determinants for Pregnant Women

- Receives ongoing preventive health care including prenatal care
- Achieves a recommended maternal weight gain
- Remains free from nutrition-related or food-related illness, complications, or injury
- Avoids alcohol, tobacco and illegal drugs
- Consumes a variety of foods to meet energy and nutrient requirements
- Makes informed decision to breastfeed infant

## For Each Health Determinant

- Data collection information
- Risk factor identification number(s)(WIC nutrition risk criteria ̶ FNS Policy Memorandum 98-9)
- 	Example for the determinant *“Achieves a recommended maternal weight gain” – *collect pregravid weight status and maternal weight gain pattern (101, 111, 131, 132, 133)

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

- Oral health care
- Physical activity
- Food security
- Breastfeeding knowledge, support and potential contraindications
- Potential barriers to breastfeeding

- Other Information Required for Individualizing Nutrition Services

## Using health outcomes in WIC nutrition assessment is one systematic approach that can be adapted to state and local needs and may lead to positive health outcomes for both WIC staff and participants!VENA can be implemented without using the health outcome approach; however, the model is suggested for its organization and ease of use.

- Health Outcome Approach

## Staff Benefits from Health Outcome Nutrition Assessment

- Health outcome based nutrition assessment has the capability for
*Emphasizing*** **strengths and healthy practices of the participant and family
*Highlighting *accomplishments and/or developmental progress
*Reinforcing* the increasing competence of caregivers

## The positive context may help the participant, parent, or guardian in
Developing a greater understanding of the purpose of WIC nutrition assessment
Recognizing her/his role in achieving the desired health outcome
Empowering her/him to decide how (or whether) to alter current behaviors

*Developing* a greater understanding of the purpose of WIC nutrition assessment
*Recognizing* her/his role in achieving the desired health outcome
*Empowering* her/him to decide how (or whether) to alter current behaviors

- Participant Benefits from Health Outcome Nutrition Assessment

## Application of Health Outcome Based Nutrition Assessment

- Video Case Study
- Group Process: Sharing/Networking
- Individual Participant Activities

## Scenario #1 portrays Current system of using food frequency questionnaire to determine eligibility, “rote” questions, no stages of change assessment, etc.
View Scenario #1
Stop the video and discuss strategies, questions, additional data to gather for conducting the same assessment using the health outcome approach

- View Scenario #1
- Stop the video and discuss strategies, questions, additional data to gather for conducting the same assessment using the health outcome approach

- Video Case Study Scenario

## Video Case Study Directions

- Scenario #2 portrays health outcome nutrition assessment using rapport building, critical thinking, stages of change with health outcome terminology  ̶  especially desired health outcomes and some determinants
- View Scenario #2
- Stop the video and identify examples of critical thinking, rapport building techniques including identification of stages of change and health outcome terminology

## Health Outcome Approach Strategies ̶ Scenario 2

- Eye contact – focus on client
- Open ended questions
- Focus on health outcome goal – ”How has your pregnancybeen going?”
- Open body posture
- Affirmation
- Reflective listening
- Conveys respect
- Assesses stages of change
- Summarizes

## Use of assessment ruler
Active listening
Helps client enlist support
Nonjudgmental
Supportive
Helping to problem solve
Longer, but still time sensitive – shows effective use of allotted timeframe for interview
Changes are subtle, but allowed underlying issues of “fear of weight gain” to surface, client to drive the plan and verbalize health outcome goal

- Active listening
- Helps client enlist support
- Nonjudgmental
- Supportive
- Helping to problem solve
- Longer, but still time sensitive – shows effective use of allotted timeframe for interview
- Changes are subtle, but allowed underlying issues of “fear of weight gain” to surface, client to drive the plan and verbalize health outcome goal

- Health Outcome Approach Strategies ̶ Scenario 2