Happy Valentines

“WIC TALKS”

“ Let us not

grow weary in well doing, for in due season we shall reap if do not lose heart“

-Galatians

Inside This Issue:

February 2015 Issue

Mailing Address

State WIC Office:

600 E Capitol Ave

Pierre, SD. 57107

WIC

Updates

2

Food Pack-

age Updates

3

Breastfeed-

ing

4

New Staff &

Training

5

State Staff 5

Q&A

6-11

Recently, there has been a trend of putting young, overweight children on diets meant for adults. Diets are not meant for children. The Academy of Nutrition and Dietetics recommends that children who are classified as overweight or obese maintain their current weight and only attempt to lose weight through calorie restriction if other risk factors for disease are present.

It is imperative that all children eat nutrient-dense foods each day. Overweight or obese chil-dren could benefit from these helpful tips to reach or maintain a healthy body weight.

Tip #1: Rethink The Drink Sugary drinks like lemonade, sports drinks, and soda might taste good, but they can add extra unwanted empty calories to anyone’s diet. By just removing the sweet stuff and switching to water, it’s incredible just how many extra calories can be avoid-ed.

Tip #2: Exercise The best way to help a child reach a healthy body weight is through physi-cal activity. Kids are lucky — they grow up, literally. Stabilizing weight gain while burning ex-cess body fat is the goal while they grow. A healthy dose of exercise for 60 minutes on most days will help them build strong bones and muscles, while burning that excess fat. The more fun the workout, the greater the chances are that a healthy, lifelong habit of exercise will de-velop.

Tip #3: Plate First Did you know that plating food in the kitchen and serving that pre-portioned plate at the table is called "American-style?" Pre-plating a child's meal reduces the urge for second helpings and the extra calories that come along with it. Try pre-plating your family's meals in the kitchen, and bring only those plates to the table.

Tip #4: Reduce Temptation The children rarely do the food shopping. When adults commit to purchase appropriate snacks and skip highly-processed, calorically-dense, nutrient-deficient foods, the likelihood of a child eating a sleeve of cookies or a bag of chips is re-duced. Most kids will go for the "easy grab," so leave out a bowl of fruit and keep one-portion bags of popcorn or pretzels in the pantry.

Tip #5: Plan Together Research has shown that kids tend to eat what they helped prepare. Find out what they like to eat and discuss recipes that are low in fat, sugar, and refined grains while staying high in fiber and nutrients. Measuring ingredients also offers an opportunity to teach portion sizes!

When you teach children how to eat well, then they learn how to eat as a way of life instead of as a quick fix to a weight problem. Diets and cleanses are not the answer.

By Beth Rosen, MS, RD

Tips to Help an Overweight Child

WIC UPDATES Page 2

Policy & Procedure: WIC Memorandum Released WIC#15-023 Translation for Breastfeeding Poster WIC#15-024 Marketing Materials WIC#15-025 Periflex Junior WCI#15-026 New Substance Abuse WIC Manual

Retailer Updates: Change of Ownership/New Stores Fresh Start Hometown Grocery, Edgemont Stores Closing: None We have been receiving a lot of calls from stores regarding unsigned checks. Please remind Clients to make sure they sign all checks.

2015 BI MONTHLY CALL DATES Tuesday, March 31

st, 2015: 9:30 – 11:00 am CST—CPA - Formula Updates Part 3 & Obesity

Talking Points

Tuesday, April 28th, 2015: 9:30 – 11:00 am CST—CPA - Food Package Updates 11:00 – 11:30 Local Agency Breastfeeding Coordinators

Quality Assurance/Program Integrity: Participant Survey Alisia completed survey and sent out for completion in March and April.

ME Tentative Schedule for 2015 March – Gettysburg, Viborg, Freeman – Environmental only – Mobridge April – Parkston, Armour, Rapid City May – Miller, Chamberlain June – Winner July – Canton August – Flandreau, Watertown, Bowdle September – Leola, Aberdeen – Ipswich- Environmental only October – Sturgis, Spearfish, Deadwood, Gettysburg Environmental Only: Bison, Timberlake and Wanblee

Page 3 “WIC TALKS”

Food Package Updates Food Package Updates

Effective July 1, 2015 ALL potatoes (fresh and frozen) will become

an allowable food items for WIC . See below timeline for roll out:

4/1/2015 Educational materials will be developed for participants providing

tips on using/cooking potatoes in a healthy way,

4/1/2015 An insert to go into the food guide describing allowable versions of fresh and frozen

potatoes will be available for participants.

4/1/2015 Will receive updated Authorized Foods Policy.

All changes to the food guide insert, policy, and educational materials will be ready for clinic use by

4/1/2015 to allow for trimonthly issuance. No changes will need to be made to SDWIC-IT as potatoes

will be purchased with the Cash Value Voucher. Please contact Shelby Sloan if you have any questions.

Page 4 February 2014

Breastfeeding Peer Counselor Update

Welcome Evie Dewitt the new Breastfeeding Peer Counselor in Mitchell. Evie loves working

with new moms and has been a Certified Birth Doula for 5 years. She has 3 children who are

all breastfed babies! Welcome, Evie!

Peer Counselor Survey Results A Breastfeeding Peer Counselor Survey was conducted in late 2014 into early 2015. Each peer

counselor site attempted to survey 60% of their participants about their experience with the

Breastfeeding Peer Counselor Program. All surveys received noted a positive experience work-

ing with our peer counselors. Comments given included: She was very open and spoke clearly in a way that I didn’t feel awkward about breastfeed-

ing in any way. I love my peer counselor. She is awesome and willing to talk about anything. I love how help-

ful and open she is. She texts me to check up on me and I love that!

She is very helpful. I enjoy talking to her when needed. It was nice to have someone to call when I needed help of just had a question. My counselor

was always so pleasant and helpful.

I believe I’m well aware of the benefits for both I and my child if I choose to breastfeed.

Thanks to WIC Office you are great help and support!

Great work, breastfeeding peer counselors and peer counselor sites!

World Breastfeeding Week 2015 Worldwide Theme Announced

Breastfeeding and Work—Let’s Make it Work!

Page 5 February 2014

2014 NEW STAFF ORIENATION TENTATIVE TRAINING SCHEDULE IN PIERRE

March - New Employee SDWIC-IT Training is scheduled for March 23-27 at R Center. Contact Dawn Boyle if you have any questions.

Sent out Annual Training Needs Assessment Survey for completion in March

PLEASE WELCOME NEW STAFF

WIC State Staff Jackie Binder: Nutrition/Training Coordinator. 605-668-5955

Dawn Boyle: Management Information Specialist. 605-773-4129

Rhonda Buntrock: WIC Program Director. 605-773-4786

Halli Holden: Vendor Manager. 605-773-6206

Renee Osterkamp: Retail Coordinator. 605-773-4782

Emily Paulsen: Program Operations Specialist. 605-773-4988

Shelby Sloan: Breastfeeding Coordinator. 605-394-2540

Alisia Whitaker: Quality Assurance Specialist. 605-773-4792 Dawn Boyle has accepted a promotion and will be leaving WIC April 8th. We wish her all the best in your new position. Thank you for all the work and your expertise over the past 10 years. You Will be missed.

Name Position Clinic

Start Date

Karen Larsen RN BRX Brookings 3/13/2015

Justine Reiter Clerk BUX

Chamberlain 3/11/2015

Question Answer

Recommendation to WIC Program: I am recommending that the WIC Program update policies & procedures, make major changes to WIC-IT, provide information about NEMPs, and make changes to food packages, etc. no more than twice in a year's time. We have experienced information overload for the last two years with too much information coming at us too fast. We can't process it or remember it when we need to use it. In some cases, just when we do get a handle on a change, the policy gets changed back to the way it was before which is to-tally confusing and frustrating. In my opinion, numbered memos, e-mails, and telephone conference calls are not very effective teaching/training tools. The trainings should be in-person, face-to-face trainings by WIC program staff and they should come to each region to train. Each region has either monthly or every-other-month staff meetings and the WIC Program staff could take advantage of these meetings to train. The WIC Program staff should bring computers and/or power-point equip-ment to show us exactly what to do step-by-step for any changed WIC-IT operation and also let us have some hands-on experience before we try to do it for real. Of course, the every-other-year June training where all the staff come to Pierre would be a perfect opportunity to train all staff, not just the clerical staff. The trainings shouldn't be held during the busy flu shot season and no changes should be implemented until every region has been trained AND the bugs have been worked out of the system with Sigma 3. The face-to-face trainings also give us a better opportunity to ask questions.

Thank you for your comments and sug-gestions. WIC will take your recom-mendations to the Regional Managers mtg. and ask for input. Currently Policy and procedure chang-es happen as we receive federal guide-lines with deadlines for implementa-tion. To wait and only do these once or twice a year would mean we are not in compliance with federal regulations. In an attempt to do better more con-sistent training we have recently added the monthly training calls and are at-tempting to bring policy and procedure before they are implemented. We have attempted to do just as you have indicated and have found it to be impossible to get the entire state availa-ble for onsite meetings and the cost to provide this type of training would not be able to be supported through the current NSA budget for WIC. We will continue to try and be cognizant of staff time and all of the different prior-ities that staff have as we move forward in the future.

Can a mandatory question regarding client safety be added back to our WIC certifications? We used to ask if they client felt safe or had any concerns about their safety or the safety of their children. We recently had a WIC client who was a victim of domestic abuse and was beaten, stabbed, and then killed by the father of her children. I know WIC could not have prevented this, but if we at least ask this question, it may open doors for some clients and encourage them to reach out for help. It is currently only asked at a PG woman Risk As-sessment. I think it should be asked at all certifications for women and children.

This is a great idea. We will bring it to our SDWIC-IT Assessment Questions VENA Committee for discussion

Could the document - South Dakota Department of Health: WIC Pro-gram Point of Contact from August 2012 be updated and re-sent to staff since there are many new people in state positions since first sent out?

Point of Contact sent out March 2015.

Now that a note needs to be added in order to issue benefits. Could a counseling summary note be auto generated when a client is checked as attending group class, listing the class attended so that checks could once again be printed in a mass printing vs the clerical and/or the nutrition staff needing to make individual notes in the client chart and printing separately.

Yes we are looking into this and will provide updates as soon as possible.

WIC Program Monthly Report Recommendation Responses December 2014 Reports

WIC-IT may not always allow us to put in a IBP category and give a fully formula fed package (this is usually a problem around 6 months old). We check the Mom’s category, but it matches. Sometimes after 6 months, WIC-IT will not allow us to print the No ben fits check for the Moms, which I believe is affecting stats for check issuance.

If possible please send screen shots when this doesn’t work, when it hap-pens “sometimes” it may be the or-der in which the staff are changing the categories, it is very specif-ic. See Maintaining Breastfeeding Scenarios for infants under 6 months and for infants over 6 months.

Anne Kriese is wondering if when there are changes with SD WIC IT, that field staff who work in it on a daily basis can try it out before it is “pushed” to everyone to see if it works how we need it to and also have instructions on how it is to be used. Examples would be the referral page – that doesn’t work yet, and it would also been nice to have di cussed the check box. Breast feeding – still have to page through this with all clients.

This is a great idea. The WIC State office will discuss the with the Re-gional Managers to determine if staff have time to test SDWIC IT enhancements before implementa-tion.

They are frequently in contact with the state staff regarding things that are not working correctly. They consider the resource referral page to still be a mess and not at all as usable as it should be. Karla has just been using their new updated resource/referral list to hand to clients since they are not able to print anything from the resource/referral page on SDWI-IT. They are still not able to use the follow up screen at all. This has been sent in to the state office, but Karla has not heard any-thing. It would be nice if they would put out a note saying they are at least working on it. If no one else is having problems but just their office, then they would like to know that as well.

State office provided follow up on the Referral Screen during February 24th call. Enhancements will be im-plemented March 13th. Clinic’s are able to update and maintain all referrals. Please see the Admin Module Help Manual for specific instructions.

With the changes to the screens in SDWIC-IT, Karla thinks it would be nice if staff could “try them out” prior to going in for a cert and something new pops up on the screen. She knows this is talked about during the WIC calls but talking about them and actually using them are not the same. The new breastfeeding screen is now available but it would be nice to have someone explain how or what types of things they are look-ing for on this screen.

This is a great idea. The WIC State office will discuss the with the Re-gional Managers to determine if staff have time to test SDWIC IT enhancements before implementa-tion.

We are wondering when our participant surveys will be coming out. They were sent out.

Many clients are reporting back that they prefer the pictures in the WIC Food Guide. It helps when shopping for various items as many stores do not have items labeled “WIC” or have items mislabeled as WIC ap-proved when they are not.

A cereal insert showing pictures of approved national brand cereals was sent in Late February. We will be adding these images back into the 2016 Approved Food Guide

Is there a way to autofill the mom’s height and weight on the child’s or infant’s medical screens if the mom is on WIC, too?

State office will look into this.

In WIC-IT, when a child turns five, can they be taken off the family list? I came across a girl today who is already six and still under the family name. That gets confusing.

This is not possible, however we are looking to see if they can become part of the HX in the family list

To reduce confusion and provide a reference it would be helpful if the policy and procedure manual was updated at the same time of imple-mentation.

Agree.

October Page 8

In WIC IT, you have to enter a CS note in order to print vouchers. If you enter a BF note, this does not count and you have to also enter a CS note. Can this be changed so that vouchers can be printed with either a CS or BF note entry? Many of these new program changes are very time consuming and frustrating in the field offices.

This is currently being worked on. We are not yet sure what the final outcome will be, but will update staff when we know.

We have a large amount of client’s that do not bring proper poof in for them-selves or their child at time of certification. Clerical sends a card home with what they need to bring to their appointment when scheduling and also reminds them when doing reminder calls. We have certifying the clients with a “Short Cert” and then printing one month of benefits and scheduling them for next check pickup 20 days out to allow for potential reschedule/missed appointments. We still have a large amount not bringing in their information within the 30 days due to forgetting or missing appointments and then we have to recertify them. This consumes more space on our calendar than we would like to see. We thought perhaps we could not print their checks at time of certification and schedule them for later that day or the next to bring in their information and be printed checks but are unsure if this complies with policy as we don’t want to “Withhold benefits” from them? Any other ideas would be helpful!

We can’t withhold benefits by not printing the participant checks. If they are missing proof of income, identification, or residency. Per fed-eral regulations the participant has 30 days to provide this information to the clinic. It is very proactive to reschedule them to come in 20 days later, just in case they forget to bring this information again, they have 10 days still before they are terminated. This is part of the participant’s re-sponsibility if they want to be in the program. If they are homeless or migrant worker this is handled a little different. Please call state office if you need further guidance. Please use the report: Expiring Short Certs found under participation to call in-stead of adding to the schedule.

Would WIC consider doing a new RECIPE Book that could be handed out to clients? I realize that we have the Fact sheets that have a recipe, but it would be nice to have a small pamphlet type recipe book that uses a lot of our WIC products. I feel that our clients have less exposure to cooking using a stove top or oven. The recipes could be easy, basic recipes to recipes that take more preparation and thought. I am dealing with a pregnant lady at this time that I feel could use some general knowledge of cooking and basic recipes would be the easiest for her to get started. I did find something to give her to start with.

This is a great idea. A recipe book has already been developed in WIC using WIC staff & WIC participant recipes. We have been asking for OA Funds for a WIC Recipe Book for the past 5 years. The project estimated cost will be around $10,000. If and when OA Funds are approved for this project WIC will proceed forward.

When you have an IBP and BP mother and they switch from mostly breastfeed-ing to what we use to call maintaining breastfeeding and infant is greater than 6 months, it often will not allow us to keep the infant category as an IBP. If we go and change mother to IBE/IBP/NPP no benefits per policy, it does not at times bring up the IFF food package even if the mom is tied to baby. It makes you change the infant to IFF in the Cert Action screen. ( I would assume this affects stats?) If mother isn’t changed correctly to this food package for “maintaining”, it also allows mom to get food until baby is 1 year even

There are 2 very different ways to updating the “maintaining” breast-feeding mother/infant. They are based on the age of the infant and both scenarios are laid out step by step in the Clinic User Help Manu-al. Search Maintaining Breastfeed-ing Scenarios.

Concern that the computer changes the certification start date for a client if their category changes from IBP to IFF for example. This can be very confusing when scheduling appointments. This also changes risk codes to category change and takes off risks in the nutrition summary (yes this is in the History, but again causes confusion).

This is one of the changes that will be in effect with the March 13th re-lease to production. The active record box—will upon saving go to the original cert start date.

When an infant is changed from Breastfeeding to non-breastfeeding, the com-puter will change the cert dates. It also automatically populates-all the previous notes from the day the cert was completed with today’s date (date category changed) so we may be writing our note that day and then have 4-5 notes to sift through to determine which note is actually ours to add to. This also makes it hard to determine what type of appointments have been done, if we are missing nutrition counseling since all the previous notes have that day’s date .

This is one of the changes that will be in effect with the March 13th re-lease to production.

October Page 8

The NPP package for BF Moms is going through the infant’s first birthday. We have to manually change this to end the day before the infant’s 6th month and then add another package for the no benefits package. All staff will not know to do this

Changing the Food Package is part of the instructions given in the Clinic Help Manual under Maintaining Breastfeeding Scenarios.

The problem of requiring everyone to put in a charting note before enabling the print button---how about a pop-up box that continues to pop-up with the name of the people requiring charting are completed

This is a great idea. State office will discuss during WIC Team.

I strongly dislike the mandatory note that has to be entered before issuing checks. It is not considerate of the client to be typing your note about their visit in front of them. The 15 minutes I get with the client for nutrition should be spent conversing with them, educating, changing food packages if need be, and plan-ning goals. Not clicking away at the computer which I feel like I do majority of the time. Also, if I am just seeing one client out of the family for an appointment, I don’t want to have to go to everyone in the family and make a note just to print their checks. It takes even more time when the computers are slow that day. More time doing this is less time working with the client to meet their needs.

State office is looking for a solution that will satisfy state auditors and WIC Staff. Will provide updates as soon as possible.

I’ve been emailing Dawn with concerns about the NE plan when you print it. She states she has been forwarding them on to 3 sigma when she couldn’t an-swer the questions. It keeps making the goal entered for one child the goal for everyone in the family. I had an IFF say their goal was to limit milk to 2 cups when it was supposed to be just for the older child.

The NE Plan was correct to print the

following: Goals specific to correct

client and all future appointments

that have been scheduled. If you

have issues please let Dawn know.

I’ve had some calls from nurses out of our region wanting approval for formula, generally Gentelase and AR, and were saying they thought they could approve them now. I don’t think the whole state was aware of the changes that have been in the memos.

We apologize for any confusion re-garding these formulas. We have provide updates on the last 2 Monthly Calls. And plan to review updates on March 31st.

I recently finished a mid-certification on a 4 year old that weighed 114#. I was unable to put this into her labs. The pop-up box I received stated that it was unable to save any number over 100#.

This will be reviewed with 3 –Sigma to determine if cut offs weights need to be adjusted to accommodate. I would assume that is should have given a message that this weight was outside the graph.

I emailed Dawn about sending out one text message for a family with multiple appointments instead of a different text for each individual appointment because it is still causing a lot of confusion with the clients on what time to come in even though we explain to them that they will receive multiple messages.

There are a few enhancements for the scheduler and appointment re-minders. If making “family” appt. there should only be one text.

Still think a statewide HIPPA system connected to SD-WIC-IT would be awe-some!

WIC is not s State Program is a Federal program with different regu-lations.

I would appreciate communication from BIT if they know a server is down or there are specific problems being worked on. It would save a lot of time to have this information.

This would be great, however WIC does not monitor BIT operations. Please discuss this with your Re-gional Manager.

October Page 8

A 9 month old baby that has normal hemoglobin, taking Enfamil Infant formula, and adequate growth would benefit going to tri-monthly issuance instead of bi-monthly. This would save the Mom for coming in to pick up checks for one month and then coming the next month for recert. With tri-monthly issuance, the next appointment would be the recertification at 1 year.

Infants that are low risk and are 6 months or older can be issued more than one month. Please review the following Policy: Food Benefit Issu-ance 8.01

When a client was over income and complained to State Office, there was no support for the clerical and the others who helped figure the income when we were following policy. This is very confusing and makes it look like we don’t know what we are doing.

The policy is being updated to better clarify income configuration. We apologize for not clearly identifying why we felt the income was incor-rect. Please contact us for further clarification.

We would also like to see the Feeding Our Future handout revised to include portions appropriate for the age. Example, a one year old and 4 year old would-n’t have the same food portion. The nutrition care manual has been helpful with this though so not sure if you would prefer us to just use that instead.

State Office & NEMP Committee will

review.

We would like to see an increase in the CVV and take juice off. Also, an option for yogurt would be nice. Addition of more options for those that have Celiac Disease would be great as well.

We will add this to the responses for the IOM institute of Medicine in rela-tion to WIC Food Package review.

Staff are very concerned with only being able to issue only 1 can of formula to breastfeeding Moms in the first month of life. We would like to see the state staff fighting the feds more on this. We understand this is a federal guideline, but there are valid concerns if we don’t issue over 1 can. The biggest one is with foreign clients is diluting the formula down to stretch it to meet their needs and therefore, risk of malnourishment or water intoxication. It also seems to be a barrier to breastfeeding.

Thank you for your continued com-ments on this issue. We will include this in our comments to the Institute of Medicine in relation to the WIC Food Package review.

I have had a lot of concerns about this new food rule and have emailed Shelby twice about it with questions on how to handle the situations where a mother is only breastfeeding once or twice a day and mainly using formula. When they are in your office and you tell them the food package for BP moms and BP infants, they will say 1 can is not enough, I want the non-breastfeeding package.” Even when educating the mother about ways to increase milk supply, issuing a pump, etc., some moms don’t want to breastfeed more than they are. I have a hard time with this because I don’t want to give a mom any extra formula than absolutely necessary because I want them all to breastfeed as much as possible but at the same time I don’t want moms to try and stretch their formula or water it down to make it last longer. I also know a mom will tell us she’s not breastfeeding even though she may be a little so she can get more formula, which doesn’t help our stats either, or help us support her in breastfeeding even a little. Below is the most recent email I sent to Shelby and her response. Basically she said that if a mom request the NPP package even though she is breastfeeding a little, we can give it, but should use discretion as to how much formula to give, not necessarily all 9 cans and can then go back and change her to BP/IBP after 1 month. This definitely messes with our stats, which is why I think this new food rule is not very good, but our situations aren’t always black and white. Again, our priority is education on how to help increase breastfeeding and not to encourage any extra formula, but we also don’t want to create situations where clients aren’t telling us they aren’t breastfeeding just to get extra formula and we are missing opportunities to support even some breastfeeding. I get this a lot with our African clients and they flat out say 1 can is not enough, even with education on how to increase breastfeeding and offering a pump, they say “I need more formula”. Many of these clients are refuges or have very little and I worry that they will not feed their baby enough or will water down the formula because they can’t afford to get more on their own. So this is where I have a hard time. I also make sure to document the exact situation as to why I am giving the NPP/IFF package if they are breastfeeding some.

WIC State Office will put this as an example in the food package review comments

October Page 8

Need a pop up that will alert the HP the client has a breast pump and the due date needs to be updated.

There is a report for in the clinic module that would be helpful to all HP’s by clin-ic that tells what clients have a pump and the due date of the pump. See Screen Shot below

October Page 8