# Presentation: 536672

**Notes:**
The Value Enhanced Nutrition Assessment (VENA) is a major initiative developed jointly by the Food and Nutrition Service (FNS) and the National WIC Association (NWA) to improve nutrition services in the WIC program. 

As a result of the IOM report findings and recommendations, FNS identified the need to develop a comprehensive nutrition assessment policy and guidance. VENA establishes standards for the assessment process used to determine WIC eligibility and provide nutrition services to participants.

VENA will not only serve to enhance the nutrition services of the WIC Program, but to ensure the integrity of the integrity of WIC as a premier public health nutrition program. 

VENA is part of the continuing effort to improve nutrition services in the WIC Program – Revitalizing Quality Nutrition Services (RQNS).  Many of you in the audience are familiar with RQNS.  Other RQNS initiatives include:

 BF Support – As part of USDA’s Loving Support Makes Breastfeeding Work  campaign, two important projects are Loving Support through Breastfeeding Peer Counseling and Using Loving Support to Build Breastfeeding Friendly Communities.

The Institute of Medicine’s 2005 Report made recommendations for revising the supplemental foods offered through the WIC Program.  Our colleagues at the National Office have prepared a proposed rule and in the process of seeking clearance.  

Nutrition Services Standards are a wide range of performance practices used in the delivery of WIC Nutrition Services to promote quality nutrition services.

New Nutrition Education Policy and Guidance was released earlier this year, to help assure that WIC uses policy is under development.  

The WIC Works Resource System is a web site that has a wealth of information related to WIC nutrition services and also serves as on online training venue.

So, VENA is a part of a larger process with the overall goal of providing quality nutrition services to the people the WIC Program serves.

##   
State Agency Role in 
Managing Change for the Successful Implementation of VENA

Carol Peirce, MS, RD, LD/N
Nutrition Program Director
Palm Beach County Health Department
West Palm Beach, Florida

**State Agency Role in **
**Managing Change for the Successful Implementation of VENA**
**Carol Peirce, MS, RD, LD/N**
**Nutrition Program Director**
**Palm Beach County Health Department**
**West Palm Beach, Florida**

## Managing Change for the Successful Implementation of VENA

**Planning for change**
**Supporting the change environment**
**Assessing Local agency readiness for change**
**Managing the change process**

## Planning Change for the Success of VENA

**For VENA to be successfully implemented there needs to be several State agency “****Plans****” in place to ensure that the human side of directing change is sensitive and thorough.**
- Communications Plan
- Learning Plan
- Reward and Recognition Plan
- Alignment Plan
- Sustainability Plan

## “Plans” Needing To Be In Place 

**An effective ****Communication Plan**** – to help local agencies learn about, understand and accept the VENA philosophy and model.**
**A ****Learning Plan**** – which describes and drives the actions that staff at all levels will take to implement the change.**
**A ****Reward and Recognition Plan**** – which encourages Local Agency efforts to move through the change process and explain the consequences of choosing not to change.**

## An Alignment Plan – to assure that existing technology; policies and procedures are reviewed and reworked to support the VENA philosophy.

A Sustainability Plan – to prevent return to old ways and sustain implemented changes.

**A ****Sustainability Plan**** – to prevent return to old ways and sustain implemented changes.**

**“****Plans” Needing To Be In Place **

## Planning Change for the Success of VENA

**Remember that “Plans” are just that. **
**They are generally a management tool to help us focus on the 20% of factors that will produce 80% of the change results that we want to see. **

## Planning Change for the Success of VENA

**A benefit of planning change is the chance it gives staff to focus on what really matters to long term survival and success. We often think people know what to expect, therefore, we fail to articulate the “Plan” clearly enough for them to understand and follow.**

## Supporting the Change Environment

**All of us are at different places in our readiness to change habits and behaviors. The challenge is to create a process for change that will not strengthen resistance and demoralize staff.  Instead, create and support the change environment. **

## Supporting the Change Environment

**States should expect that some Local Agency staff will have a hard time understanding and adapting to the VENA model.**

## Supporting the Change Environment

**States should expect that Local Agencies will want to feel that all their concerns about VENA are addressed and that they are partners in the change process and not targets.**

## Supporting the Change Environment

**States should expect that some Local Agencies will resist the idea of VENA – and may find it difficult to implement for a number of reasons.**

## Resistance...Some Local Agency Staff:

**Don’t want to change the way they do things as this may diminish their influence and comfort level in the work place.**
**Don’t want to go through the effort to learn a new way of doing things in fear that their expertise will become less valuable. **
**Don’t trust the state agency’s ability and commitment to support the new way.**
**Question the credibility and worth of changing to the VENA model.**
**Perceive the work to implement VENA as overwhelming and demanding.**

## Managing Change for the Success of VENA

**The way that WIC and Nutrition Service are currently delivered may need to be reexamined to come in line with the VENA philosophy. This may mean revisiting nutrition service delivery policies, procedures and monitoring tools and deciding whether they will enhance or hamper the success of VENA.**

## Managing Change for the Success of VENA

**Trying to impose change by means of authority is rarely a sound idea. **
**Therefore, states should design a plan to roll out VENA that will help Local Agencies successfully navigate through the change process, according to where they are in their readiness to change.**

## Assessing Local Agency Readiness for Change

**Local Agencies may likely be at one or more of the following stages of readiness to change: **
**Pre-contemplation**
**Contemplation**
**Preparation**
**Action**
**Maintenance**
**Transition**

## Stages Of Readiness To Change

**Where there is no intention to change the way nutrition assessment and certification is conducted in the Agency (pre-contemplation stage) **
- States need to market VENA to gain staff acceptance and buy in and increase their knowledge and understanding of the benefits of VENA.

## Stages Of Readiness To Change

**Where there has been some discussion about changing the way nutrition assessment and certification is conducted in the Agency (contemplation stage).**** – **
- States need to assist these Local Agencies to identify and design strategies to implement VENA successfully. In addition Local Agencies will need state guidance in setting goals and identifying  barriers to VENA implementation

## Stages Of Readiness To Change

**Where the Local Agency has begun  to discussion design plans for changing the way nutrition assessment and certification is conducted using the VENA model (preparation stage).**** – **
- States need to support and assist these Local Agencies in adjusting and refining  their implementation plan.

## Stages Of Readiness To Change

**Where Local Agencies have taken some actionable steps to change the way nutrition assessment and certification is conducted, using the VENA model (action stage). – **
**States need to encourage them to move forward with their plans for implementation and be prepared to provide technical assistance.**

## Stages Of Readiness To Change

** ****Where Local Agencies are working at sustaining the changes made through evaluating and refining new processes and benchmarking best practices (maintenance stage). **
** **
- States need to encourage these actions, provide guidance through program monitoring and help to identify gaps in service.

## Stages Of Readiness To Change

**6. Where new procedures and practices are thoroughly incorporated into the nutrition service delivery process, identified gaps in service delivery which require state level (policy) fixes should be addressed quickly so that temptations to revert back to previous behaviors are totally removed ****(transition / new 6th stage).**

## Managing Change for the Success of VENA

**VENA will significantly change the way nutrition assessment, certification and counseling is done in most states.**
**Staff development needs will, therefore, take center stage ****in most cases****. **
**States should be prepared to support staff training efforts at all levels. **

## Managing the Change Process

**Acknowledging that transition from one model to another is only complete when sustained change has withstood the test of time. **
**States should be available to coach, guide and mentor Local Agency staff as they move through these stages of change.**

## Managing Change for the Success of VENA

**Some Agencies may spend longer time in certain stages of change because of internal resistance, competency issues or other external barriers. **
**In these situations state interventions may be needed to address sources of distress for Local Agencies. **
**States can directly market to Local Agency Leaders and community partners who are also struggling or enabling barriers to change.**

## Managing Change for the Success of VENA

**Leading a major change effort such as VENA in any organization is tough work and may begin by creating emotional “shock waves”. **
**This paradigm shift will require every employee to embrace this change for VENA to be successful.**

## Managing Change for the Success of VENA

**Once staff sees:**
**what’s in it for them,**
**that the change is supported up and down the chain of command****,**
**that the change process considers their learning styles, speed, training needs, stage of preparedness for change**
**and that resources will be made available to support implementation efforts, enthusiasm for VENA will grow.**

## Managing Change for the Success of VENA

**State Agencies can assist Local Agencies by gathering and sharing information on best practices. **
** **
**In addition, encourage Local Agencies to share best practices and strategies among themselves. (Buddy system)**

## Managing Change for the Success of VENA

**Plans for rolling out and marketing VENA should employ several venues to assure success.  **
**newsletters, focus groups, workshops, face to face meetings, conference calls, seminars, continuing education trainings etc., **
**Staff assessments should be done early to identify,  and develop individual training  plans and to keep staff fully engaged in the change process.**

## Managing Change for the Successful Implementation of VENA

**Summary**
- Planning for change
- Supporting the change environment
- Assessing Local agency readiness for change
- Managing the change process