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MISSOURI WIC PROGRAMIMPLEMENTATION OCTOBER 1, 2014
WIC FINAL FOOD RULE TRAINING: PHASE 1
OBJECTIVES
• Acknowledge the new food items on the WIC Approved Food List
• Identify the changes related to milk types• Identify factors which affect milk preference and
purchasing • Identify barriers to the use of lower fat milk • Identify the changes related to milk substitutes • An overview of WICHealth.org
MISSOURI ALREADY IMPLEMENTED
• Allows organic fruits and vegetables to be purchased with the CVV • October 1, 2009
• No longer allows cheese to be issued beyond the maximum monthly allowance • June 1, 2014
• CVV increased to $8.00 for children• June 1, 2014
POTATOES
• White potatoes • Not recommended by IOM• Not approved
• Sweet potatoes/Yams• Approved
CANNED FISH
• Canned Salmon• 5 oz.• Variety
• Pink salmon
• Any brand
• Sardines • 3.75 oz. • Varieties
• Water packed• Tomato sauce • Mustard sauce
• Any brand
Food Package VII-Fully Breastfeeding women-Partially Breastfeeding Multiples (mostly) -Pregnant women with multiples-Pregnant women who are still breastfeeding whose infants receive less than the max amount of formula allowed
LOW SODIUM PRODUCTS
• Low sodium foods• Cheese • Peanut butter
JUICE 46 OUNCES
• Women• 46 oz. can juice
• Not allowed as of October 1st • Allowed 11.5 or 12 oz. frozen
concentrate • The food list is being updated
PEANUT BUTTER
• Allowed• Smooth, creamy or regular• Store brand only• 16-18 oz. jar only
• Not allowed• Crunchy• Low-fat• Organic• Mixtures with jams, jellies, honey,
marshmallows or chocolate
GOAT MILK
• Size and Details • 12 oz.• Whole• Evaporated
• Variety • Meyenberg brand only
• Approved category• Children 12 – 23 months
GOAT MILK (CONT.)
• Size and Details • 12.6 oz.• Non-fat• Powder
• Variety • Meyenberg brand only
• Approved category• Children 24 - 59 months• Women
GOAT MILK 101
• Useful in some cases• Cow milk intolerance • Allergy to soy-based beverage
• Not appropriate in these situations• Cow’s milk protein allergy
• Increased allergic potential to goat milk
• Lactose intolerance • Lactose content is comparable to
cow’s milk
• As a replacement for infant formula
TOFU
• Size• 16 oz.
• Varieties• Azumaya
• Firm • Extra Firm
• NaSoya• Silken Organic
FOR ALL PROGRAM CATEGORIES
DAIRY ALLOWANCE
• Link to the video• www.fns.usda.gov/core-nutrition/milk
• Scroll to the bottom of the page
MILK VIDEO
DAIRY12 – 23 MONTHS OF AGE
• Standard issuance
(default) • Whole Milk
DAIRY12 – 23 MONTHS OF AGE (CONT.)
• Standard issuance (default)
• Whole Milk
• 2% Reduced fat milk• CPA determination • 2% milk cannot be
assigned simply because of a preference or parental request
WHEN CAN WE ASSIGN 2% TO CHILDREN 12 – 23 MONTHS OF AGE?
1. After the CPA makes the determination based upon: • Nutrition Assessment
• Health Assessment/Growth charts
• Risk factors
2. A request received from the health care provider
3. Document the justification in the record
4. Revise the default food prescription
WHEN CAN WE ASSIGN 2% TO CHILDREN 12 – 23 MONTHS OF AGE?
• CPA makes the determination based upon:
• Nutrition Assessment • These include
• Ensuring the child is drinking appropriate amounts of milk
• Weaning from the bottle around 12 months of age• Avoiding sweetened beverages• Avoiding sippy cups (and other covered containers
that a child can carry and drink from throughout the day)
• Ensuring snacks are structured and appropriate• Preparing and providing appropriate foods; limiting
fast food
WHEN CAN WE ASSIGN 2% TO CHILDREN 12 – 23 MONTHS OF AGE?
20
CPA makes the determination based upon:
Health Assessment Growth related issues may include:
The growth pattern shows a trend of high weight gain
The participant’s health care provider requests 2% because of a health concern
Other issues or risks identified by the CPA
WHEN CAN WE ASSIGN 2% TO CHILDREN 12-23 MONTHS OF AGE?
21
• CPA makes the determination based upon: • Risk Factors
• RF 114 Overweight • RF 115 High Weight-for-Length • When a CPA identifies a growth related issue or risk
during a complete health assessment.
USE YOUR CRITICAL THINKING SKILLS
22
Mom and Dad bring in their 18 month old to be enrolled. MOWINS assigns Risk Factor 115. The parents express concerns about their weight but aren’t really concerned about their little one, yet. They drink 2% but give their 18 month old whole milk.
Other dairy products?
How much milk?
Other health issues?Sweetened
beverages
Growth pattern?
Other foods or sources of fat?
• Document the justification in the record • Revise the default food prescription
DAIRYCHILDREN > 24 – 59 MONTHS OF AGE
• Standard issuance• Non-fat (skim) and low-fat (1%)
• 2% Reduced fat milk• CPA determination • 2% milk cannot be assigned simply
because of a preference or parental request
WHEN CAN WE ASSIGN 2% TO CHILDREN 24 – 59 MONTHS OF AGE?
1. CPA makes the determination based upon: • Nutrition Assessment
• Health Assessment/Growth charts
• Risk factors • Underweight 103• Failure to Thrive 134 • Inadequate Growth 135
2. A request received from the health care provider
3. Document the justification in the participant's record
4. Revise the default food prescription
WHEN CAN WE ASSIGN 2% TO CHILDREN 24 – 59 MONTHS OF AGE?
• CPA makes the determination based upon: • Nutrition Assessment
• These include
• Ensuring the child is drinking appropriate amounts of milk
• Ensuring snacks are structured and appropriate
• Preparing and providing appropriate foods
WHEN CAN WE ASSIGN 2% TO CHILDREN 24 – 59 MONTHS OF AGE?
27
CPA makes the determination based upon:
Health Assessment Growth related issues may include:
The growth pattern shows a trend of low weight gain
The participant’s health care provider requests 2% because of a health concern; or,
Other issues or risks identified by the CPA
WHEN CAN WE ASSIGN 2% TO CHILDREN 24 – 59 MONTHS OF AGE?
28
• CPA makes the determination based upon: • Risk Factors
• Underweight 103• Failure to Thrive 134 • Inadequate growth 135 • When a CPA identifies a growth related issue or risk
during a complete health assessment.
USE YOUR CRITICAL THINKING SKILLS
29
Dad brings in his 3 year old daughter for a certification. The child’s general health and BMI are normal for her age. The fat content changes in milk have been explained. Dad is adamant that his family only drinks 2%.
What kinds of things should be considered?
Psychological environment?
Lack of food?
Excessive caloric
expenditure?
Growth pattern?
• Document the justification in the record • Revise the default food prescription
DAIRY WOMEN
• Standard issuance• Non-fat (skim) and low-fat (1%)
• Reduced fat milk (2%)• CPA determination • 2% milk cannot be assigned
simply because of a preference
WHEN CAN WE ASSIGN 2% TO WOMEN?
1. CPA makes the determination based upon: • Nutrition Assessment
• Health Assessment/Prenatal Weight Gain Chart
• Risk factors • Underweight 101 • Low Maternal Weight Gain 131• Maternal Weight Loss during pregnancy 132
• A request received from the health care provider• Document the justification in the participant's record• Revise the default food prescription
WHEN CAN WE ASSIGN 2% TO WOMEN?
• CPA makes the determination based upon: • Nutrition Assessment
• These include
• Ensuring snacks are structured and appropriate
• Preparing and providing appropriate foods
• Insufficient food sources
WHEN CAN WE ASSIGN 2% TO WOMEN?
34
CPA makes the determination based upon: Health Assessment
These may include: The growth pattern shows a trend of low weight
gain (e.g. the PWGC shows a decrease in recommended weight gain channel);
Other issues or risks identified by the CPA Other issues or risk identified by the Healthcare
provider Issue must be documented Doesn’t require a WIC-27
WHEN CAN WE ASSIGN 2% TO WOMEN?
35
• CPA makes the determination based upon: • Risk Factors
• RF 101 Underweight • Prenatal, breastfeeding and non-breastfeeding
women• RF 131 Low Maternal Weight Gain (prenatal)• RF 132 maternal Weight Loss during pregnancy
USE YOUR CRITICAL THINKING SKILLS
36
What are some reasons women would need 2% milk?
What kinds of things should be considered?
Psychological environment?
Lack of food?
Excessive caloric
expenditure?PWGC?
• Document the justification in the record • Revise the default food prescription
WHAT IS IT CALLED?
WholeLow-fat
Reduced fat
Fat-freeNon-fatSkim
Barriers and strategies to transitioning to a lower fat milk?
BASED ON CATEGORIES
DAIRY SUBSTITUTIONS
LACTOSE-FREE MILK
• Lactose-free milk should be offered before non-dairy milk alternatives • tofu and soy milk
The value of vitamin D in milk assist with the development of bone mass.
TOFUWOMEN & CHILDREN
• Reason for issuance (e.g. milk allergy, lactose intolerance, vegan diet, etc.) • Four pound max can be issued
• Children (12 – 59 months of age)• CPA is authorized to determine the need
• Must document the reason for issuance • Women
• No CPA documentation needed
TOFU 101
• Overview• Rich in B vitamins • Low in sodium• Lacks vitamin D• Less calcium than milk• Lactose free• Casein free
• Useful in some cases• Lactose Intolerance• Cow’s milk allergies
Available in the warehouse
TOFU EXCHANGE
1pound tofu = 1quart of milk
SOY-BASED BEVERAGEWOMEN & CHILDREN
• Children (12 – 59 months of age)• CPA is authorized to determine the need
• Max allowed • Must document the reason for issuance (e.g. milk
allergy, lactose intolerance, vegan diet, etc.)
• Women• No CPA documentation needed
• Max allowed
SOY-BASED BEVERAGE 101
• Overview• Source of omega-3 fatty acids• Has the same amount of protein as cow's milk• Eating 25 grams a day of soy protein might help
lower blood cholesterol levels
• Useful in some casesMilk allergies
People who don’t consume dairy products
Children’s diets may be nutritionally inadequate when milk is replaced with other foods.
SOY-BASED BEVERAGE EXCHANGE
1 half-gallon of soy milk = 2 quarts of milk
CHEESE EXCHANGE
• One pound of cheese = 3 quarts of milk• Total amounts which can be issued
• One pound - Food Packages IV, V & VI• Two pounds - Food Package VII
THE “DANGLING QUART”
• Dangling quart substitutes could be:• 1-12 oz. can of evaporated milk• 1 quart of buttermilk• 1 quart of milk (whole, 2%, 1%, skim)
FOOD PACKAGE III
• ER# 2.07000• Children 24 – 59 months of age and women
• Types of milk may be issued:• Whole milk• Evaporated whole milk• Lactose free whole milk• Requires a WIC 27 • Formula or medical food must be issued along with
the whole milk request
FOOD PACKAGE III (CONT.)
• ER# 2.07000• Not authorized for:
• Infants whose only condition is formula intolerance or food allergy to lactose, sucrose, milk or soy protein
• A non-specific formula or food intolerance
• Women and children who have a food intolerance to lactose or milk protein
• Solely for the purpose of enhancing nutrient intake or managing body weight
GENERAL CHANGES
• Terminology change• From Medical foods to WIC eligible nutritionals
• Metabolic formulas • Changed from 3 months to providing up to 2 months
BREASTFEEDING AMOUNT
RESOURCE
• AAP policy statement http://pediatrics.aappublications.org/content/122/1/198.full
wichealth.org
Statewide Promotion 2014
• Stage-based, participant-centered, behavior change nutrition education for WIC participants
• 26 lessons available online• Available for English and Spanish speaking
participants• Currently used by WIC programs in 23 other states
• WIC staff promote wichealth.org to eligible participants.• Participant creates an account and completes a lesson.• Participant provides the Certificate of Completion to the
WIC agency.• Upon verification of completed lesson staff follow up with
participant.
• Number of Lessons Completed: 607 lessons
• Average Time Spent on Site: 12.13 minutes
• Average Number of Links Visited: 1.56 links
• Number of Participant Accounts Created:390 accounts
Most Popular Lessons: Make Meals and Snacks Simple 85% Secrets for Feeding Picky Eaters 57% Fun and Healthy Drinks for Kids 49% Trust your child to eat enough 49% Happy Healthy Active Children 40% Fruits and Veggies Grow Healthy Kids 39% Understanding your baby’s cues 37%
User Ages: 77% of parent/guardians were between the ages of 25 – 29 years.
Computer Locations: 45% home, 34% WIC Clinic,7% work, 3% parent’s home
Convenient for the participant, especially working parents
Freed up some staff time
Participants say they like it and the topics too.
Wide range of information that can be tailored to individual interests/needs/learning styles
Well received by participants who like choosing what time to have their lesson (working mom, class schedule, etc)
Created room in my schedule to accommodate those who needed to reschedule
Participants liked the lesson choices.
Nice to have a different way of learning for those that like to read or watch videos online and not always like to listen to something we say.
Explaining the program without making it sound too difficult
Figuring out how it was going to work for our agency
at first
Participants with no internet access Hoping participants won't forget to do their lesson
Figuring out how to present wichealth.org and make it sound as exciting as it actually is
Getting all the staff on board and excited to promote wichealth.org
Participants not emailing their Certificates of Completion after they finished a lesson
Internet access seems to be an issue with our participants, and some think it would be too difficult.
WIC Program Participants“I really enjoyed the way material was presented and I
look forward to utilizing these tips in day to day settings with my kids. Also love that there were several recipe suggestions.”
“Inspired me to create different ways to play with my daughter indoors, even in a small apartment.”
“I really like getting the recipes for smoothies. We’ve started making them at our house and the kids really enjoy them.
Yes!
Why? Convenient for participants especially working families
Provides another perspective on nutrition education
Schedule flexibility: covering staff vacations, more time for continuing education, more appointment times open for certifications/mid-certifications
Provides another option for completing that nutrition education visit
Full statewide implementation Timeline for Implementation
Training –September 2014. Dates to be finalized.
Nutrition policy being revised to accommodate WICHealth.org
Agency Logistics-Promotion to LWP staff and Participants. Implementation and Support of Nutrition Education
Rose [email protected]
573-522-2831