HEALTH OUTCOME BASED WIC NUTRITION ASSESSMENT

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HEALTH OUTCOME BASED WIC NUTRITION ASSESSMENT
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Introduction

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

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Introduction
This module

• 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 WICs goal of promoting good health
• Incorporates content and skills learned in
  previous two modules

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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

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Instructional Objectives
Health outcomes are participant centered H1
Instructional Objectives for Health
Outcomes Based WIC Nutrition Assessment
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Nutrition Assessment Changes Directed by VENA

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

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Summary of WIC Nutrition Assessment Pre- and
Post-VENA
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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

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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 Childrens Hospital Medical Center in
  Cincinnati, Ohio and the Kentucky WIC Program
  with funding provided by USDA

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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

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Video Summary (contd)

• 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

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WIC Nutrition Assessment Defined

• A WIC nutrition assessment is the process of
  obtaining and synthesizing relevant and accurate
  information in order to
• Assess an applicants 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

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WIC Nutrition Services Process
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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

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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

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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 infants
  or childs needs for health improvement can lead
  to more effective WIC interventions.
• It also provides an organized, systematic way to
  perform an assessment.

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Health Outcome Based Nutrition Assessment ?
Sources

• The health outcome approach is adapted from
• Healthy People 2010 Systematic Approach to
  Improving Health
• and
• Bright Futures Guidelines for Health
  Supervision of Infants, Children and
  Adolescents
• Primary reference is Appendix C of VENA guidance
  document.

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Categories of WIC Participants
Health Outcome Based WIC Nutrition Assessment
provides guidance for each of the five WIC
participant categories

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

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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

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Desired Health Outcomes
The Desired Health Outcome is the health goal for
each of the five WIC participant categories
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Desired Health Outcomes
What is the desired health outcome for each
participant category and where do we find this
information?
Appendix C!
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Categories of WIC Participants Desired Health
Outcomes

• Pregnant 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

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Categories of WIC Participants Desired Health
Outcomes

• Infant
• 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

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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

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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

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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)

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Sample of other information that could be
gathered for individualizing nutrition services
for a pregnant woman
Other Information Required for Individualizing
Nutrition Services

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

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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
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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

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Participant Benefits from Health Outcome
Nutrition Assessment

• 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

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Application of Health Outcome Based Nutrition
Assessment

• Video Case Study
• Group Process Sharing/Networking
• Individual Participant Activities

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Video Case Study Scenario

• 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

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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

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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

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Health Outcome Approach Strategies ? Scenario 2

• 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