Appropriate follow-up questions are not asked Questions are asked in a leading and/or judgmental manner Available and relevant assessment data is ignored or not noticed Nutrition Assessment is not individualized; unnecessary or repetitive questions are asked Adequate follow-up questions are not always asked Some available assessment data is not used Irrelevant data is sometimes used Leading or judgmental questions are asked on occasion Adequate and appropriate follow-up questions are asked Uses all available and relevant assessment data Question are asked in a non-judgmental, manner Score: _____ Comments: Identifies and documents nutrition risk factors All applicable risks are not generally assigned Non-applicable risks are assigned Documentation of the risk for risk assignment when applicable is not done Additional documented is not completed The Nutrition Risk Manual is not referred to when needed Inconsistently identifies all applicable risks Non-applicable risks are assigned on occasion. Inconsistently documents the reason for risk assignment when applicable Additional information is not consistently documented The Nutrition Risk Manual is not always referred to when necessary Uses information collected to identify and individualize nutrition risks All applicable risks are assigned Documents reason for risk assignment when applicable Documents importation information gleaned from assessment Refers to Nutrition Risk Manual when necessary Score: _____ Comments: Uses information obtained from nutrition assessment Information obtained is not used to tailor food packages, provide nutrition education and make appropriate referrals Information is used inconsistently to tailor food packages, provide nutrition education and make appropriate referrals Uses information obtained to tailor food packages, provide nutrition education and make appropriate referrals Score: _____ Comments: Referrals Lacks Competence 0 Needs Improvement 1 Demonstrates Competence 2 Identifies and refers clients Documents the status of a referral without asking clients Inconsistently refers clients to appropriate health and social programs Clients are referred to appropriate health and social programs (mandatory and additional referrals)
Written information on a referral program is not provided Additional referrals, outside of mandatory ones, are not made or documented Inconsistently provides written information on program referred to Clients are provided necessary written information to contact the referred program Referrals are documented appropriately in STARS Score: _____ Comments: Follow-up on referrals from previous visits Follow-up made at previous visits in not done Additional referrals are not identified or provided Status of referrals are not documented in STARS Inconsistently follows up on previous referrals Inconsistently documents the status of referrals The status of documented referrals are inquired about at follow-up appointments Additional referrals are made when appropriate The status of referrals are documented in STARS Score: _____ Comments: Program Education Competence 0 Needs Improvement 1 Demonstrates Competence 2 Demonstrates appropriate program education skills Rights and Responsibility Form is not read by the client or explained to the client Programs with whom WIC shares client information with are not shared with clients Substance abuse is not provided when appropriate ID folder is not explained to clients Rights and Responsibility Form is not consistently read by the client or explained to the client Programs with whom WIC shares client information with are not consistently shared with clients Substance abuse is not consistently provided to all clients when appropriate ID folder is not consistently explained to clients Uses knowledge of program rules to explain the Rights and Responsibilities Clients are made aware of programs share information with Provides accurate and appropriate education to clients on substance education at new certifications (includes certification of all pregnant women) Explains the Identification Folder to new clients Score: _____ Comments: Demonstrates appropriate food delivery education skills Food list is not provided and/or explained Check education is limited or does not typically occur Individual food packages are not explained Vendor list is not provided and/or explained Food list is provided, but not consistently explained in detail Parts of check education is explained, but some parts are missed Inconsistently explains the clients individual food package Explains in detail authorized foods and provides food list Explains in detail how to redeem checks to new clients
General Service Standards Lacks Competence 0 Needs Improvement 1 Demonstrates Competence 2 Documents additional information in STARS appropriately Mother to child are not linked or linked incorrectly Determines and documents race and ethnicity incorrectly or does not ask client registration is not offered or discussed voter registration and/or is not documented correctly Appointments are routinely scheduled incorrectly/inappropriately Inconsistently correctly mother to child Inconsistently determines and documents race and ethnicity correctly Inconsistently offers and discusses voter registration and documents correctly Occasionally schedules inappropriate appointments Correctly links mother to child Determines and documents race and ethnicity correctly Offers and discusses voter registration and documents correctly Schedules appropriate appointments Score: _____ Comments: Demonstrates skills in providing services Knowledge of STARS functionality and the ability to navigate and document efficiently in STARS is limited Services are provided in a discriminatory manner Information is collected interrupting or correcting the client Questions are asked in a non-judgmental and/or non-leading manner Follow-up or clarifying questions are not used to ensure understanding Clients are not notified of next appointment or of what to bring Confidentiality of client information is not kept Program integrity is not maintained (separation of duties, serving relatives) Demonstrates inconsistent knowledge of STARS functionality, the ability to navigate and document efficiently in STARS Occasionally interrupts or corrects the client when collecting information Leading or judgmental questions are asked on occasion Clarifying or follow-up questions are not consistently used Inconsistently notifies clients of next appointment what the client will need to bring Confidentiality of client is not kept on occasion Program integrity is not consistently practiced Demonstrates knowledge of STARS functionality and the ability to navigate and document efficiently in STARS Provides services in a non-discriminatory manner Collects information without interrupting or correcting the client Asks questions in a non-judgmental and manner Ensures understanding by clarifying or asking questions Notifies clients of next appointment and identifies items the client will need to bring Ensure confidentiality of client information Ensure program integrity (separation of duties, serving relatives) Score: _____ Comments: Demonstrates PCS skills Typically does not set the agenda Permission is rarely Uses mostly closed-ended questions Inconsistently sets the agenda Asks permission sometimes Uses some open-ended questions with the majority of being closed-ended Sets the agenda Asks permission Uses an effective balance of open-ended and closed-ended questions
Inconsistently documents handout, goal and ways to meet goal appropriately Documents topic, handout, goal and ways to meet goal appropriately Score: _____ Comments: Breastfeeding Competence 0 Needs Improvement 1 Demonstrates Competence 2 Demonstrates adequate breastfeeding knowledge Lack of knowledge on current breastfeeding recommendations, how to’s and guidelines is shown Lack of knowledge to assist a breastfeeding woman is shown On occasion breastfeeding information provided does not coincides with current breastfeeding recommendations and guidelines Inconsistently provides adequate and appropriate breastfeeding assistance Provides breastfeeding information that coincides with current breastfeeding recommendation and guidelines according to ITCA policy Provides adequate and appropriate breastfeeding assistance _____ Comments: Demonstrates appropriate skills in breastfeeding education and assessment Breastfeeding assessment are not completed Real and perceived barriers and possible contraindications to breastfeeding are not assessed The impact of early formula supplementation and mother/infant separation on milk supply and the mother’s breastfeeding intention is not evaluated Support and encouragement to promote breastfeeding initiation and to sustain continued breastfeeding is not provided Breastfeeding incentives are not distributed. Problems or concerns at critical points in the early postpartum period are missed during a breastfeeding assessment Inconsistently assesses real and perceived barriers and possible contraindications to breastfeeding Inconsistently evaluates the impact of formula supplementation and mother/infant separation on milk supply and the mother’s breastfeeding intention Inconsistently provides support and encouragement to promote breastfeeding initiation and to sustain continued breastfeeding Breastfeeding incentives are not routinely provided Uses breastfeeding assessment to identify and address breastfeeding problems or concerns at critical points in the early postpartum period Assesses real and perceived barriers and possible contraindications to breastfeeding Evaluates the impact of early formula supplementation and mother/infant separation on milk supply and the mother’s breastfeeding intention Provides support and encouragement including incentive to promote breastfeeding initiation and to sustain continued breastfeeding Score: _____ Comments: