Missouri WIC Program Implementation: May 5, 2014.

Missouri WIC Program

Implementation: May 5, 2014

Identify the four guiding principles of participant-centered communication

Recognize the revisions to the follow-up questions Understand the implementation of the extended certification

periods Identify the procedures required at the Mid-Certification

Assessment (MCA) appointment

Guiding principles

• Guidance • Ask during a face-to-face session

• Responses are used for documentation. • The responses are not meant to be read to the

participant • Counseling staff will evaluate the questions to

determine if it meets a risk factor criteria• Manually assign the risk factor

Prenatal Follow-up Questions #1 No change

What have you heard about breastfeeding?

#2 Revised Tell me about the changes in your eating

habits since becoming pregnant? (Select all that apply)

No changes Improvements Concerns Other/Comments

Prenatal Follow-up Questions#3 Revised (question/responses)

Tell me about the minerals or herbal supplements you take besides prenatal vitamins? (Select all that apply.)

None Calcium Folic Acid Iron Iodine Herbal Other/Comments

Reference 427.1 & 427.4

Prenatal Follow-up Questions#4 change in the responses

What concerns do you have about providing, preparing and/or storing food for your family? (Select all that apply.)

No concerns Insufficient food sources Food preparation (new ideas/doesn’t

know how to cook) Inadequate kitchen appliances Other/comments

Prenatal Follow-up Questions#5 New question

What health or medical issues do you currently have or have had?

Open text box

Allows staff to access for clinical/medical conditions

Risk Factors 341-362

Prenatal Follow-up Questions#6 Revised Question

How would you like to improve your eating and/or physical activity habits? Reminder: Establish a new goal and/or follow-up on a previous goal.

Open text box

You can document the goal here or indicate “see notes” if you want to place them in the general/SOAP notes

Prenatal Follow-up Questions #7 Revised

Optional Documentation: Full name and WIC title of person completing the nutrition

assessment - required

Breastfeeding Women Follow-up Questions #1 Revised (responses)

What concerns related to breastfeeding do you have? (Select all that apply.)

No Concerns Milk Production

lack of milk production, engorgement, etc. Anatomical Breast issues

recurrent plugged ducts, mastitis, flat/inverted nipples, tenderness, etc.

Other/Comments

#2 Revised Tell me about any changes in your eating

habits since delivery? (Select all that apply.) No changes Improvements Concerns Other/Comments

Breastfeeding Women Follow-up Questions #3 Responses revised

Tell me about the minerals or herbal supplements you take? (Select all that apply.)

None Prenatal/Multi vitamin Calcium Folic Acid Iron Iodine Herbal Other/Comments: Reference 427.1 & 427.4

Breastfeeding Follow-up Questions#5 New question

What health or medical issues do you currently have or have had?

Open text box



Breastfeeding Women Follow-up Questions#4 change in the responses

What concerns do you have about providing, preparing and/or storing food for your family? (Select all that apply.)

No concerns Insufficient food sources Food preparation (new

ideas/doesn’t know how to cook)

Inadequate kitchen appliances

Other/comments

Breastfeeding Women Follow-up Questions#6 Revised Question

How would you like to improve your eating and/or physical activity habits? Reminder: Establish a new goal and/or follow-up on a previous goal.

Open text box


Breastfeeding Women Follow-up Questions #7 Revised

Optional Documentation: Full name and WIC title of person completing the nutrition

assessment - required

Reference 425.4 & 428

Question #1 - Tell me about your child’s eating habits, appetite, and how the foods are prepared. (Select all that apply.)

Eats well Picky eater Eats age appropriate food and uses age

appropriate utensils Does not eat age appropriate food

and/or does not use age appropriate utensils

Other/comments

Question #2 How do you feel about your child’s

height and weight? Just fine Too little Too big Other/comments Reference RF 113, 114, 134, 135

#4 New question What health or medical issues do

you currently have or have had? Open text box



#3 change in the responses What concerns do you have

about providing, preparing and/or storing food for your family? (Select all that apply.)

No concerns Insufficient food sources Food preparation (need

ideas/doesn’t know how to cook)

Inadequate kitchen appliances

Other/comments

#5 Revised Question How would you like to improve your

child’s eating and/or physical activity habits? Reminder: Establish a new goal and/or follow-up on a previous goal.

Open text box


#6 Revised Optional Documentation: Full name and WIC title of person completing the

nutrition assessment - required

System displays the infant questions based on:

Feeding status – health info tab Age Certification vs. Mid-Certification

Question #1 - Tell me about breastfeeding your baby. no concerns feeding on demand less than 8 feedings in 24 hours if less than 2 months old less than 6 feedings in 24 hours if between 2 months and 6 months

old proper storage of breastmilk breastfeeding concerns (sore nipples, etc) other/comments

Feeding Status: Fully breastfeeding and breastfeeding/formula

Question #2 - Tell me about formula feeding your baby. (Select all that apply.)

no concerns formula properly mixed and stored adequate amount of formula and feedings fed on demand other/comments

Feeding status: breastfeeding/formula only

Reference 411.4, 411.6, 411.9

Tell me more about your decision to supplement with formula. (Select all that apply.)

Health Care Provider Low supply (actual or perceived) Personal choice Other/comments:


Tell me about your baby’s wet and dirty diapers.

no concerns black and sticky brownish to greenish green and foamy/frothy yellowish and seedy firm hard and pebbly watery other/comments

Feeding status: Fully breastfeeding and breastfeeding/formula

Tell me about any supplements or vitamins you give your baby.

None Infant multivitamin Vitamin D Herbal supplements, remedies, teas Iron Fluoride Other/comments

Feeding status: All feeding optionsReference 411.10, 411.11Nutrition Training Manual – Infant Section



Feeding status: All feeding options

Reference 411.10, 411.11Nutrition Training Manual – Infant Section

Revised Question What feeding goals do you have for your

baby? Establish a new goal and/or follow-up on a previous goal.

Open text box


Revised Optional Documentation: Full name and WIC title of person completing the

nutrition assessment - Required

Breastfeeding only = 4 questions

Breastfeeding & formula = 6 questions

Formula only = 4 questions

Tell me about breastfeeding your baby. No concerns Feeding on demand Proper storage of breastmilk Breastfeeding concerns (sore nipples,

etc.) Other/Comments

Feeding status: Fully breastfeeding and breastfeeding/formula

Tell me about formula feeding your baby. no concerns formula properly mixed and stored adequate amount of formula and feedings fed on demand other/comments

Feeding status: breastfeeding/formula and formula only

Reference 411.4, 411.6, 411.9

Tell me more about your decision to supplement with formula.

Health Care Provider Low supply (actual or perceived) Personal choice Other/comments:


Tell me about the foods you are feeding your baby.

None No concerns Age appropriate foods Proper feeding methods Other/Comments


Reference 411.4, 428

Tell me about any supplements or vitamins you give your baby. None No concerns Infant multivitamin Vitamin D Herbal supplements, remedies, teas Iron Fluoride Other/comments


Tell me about playtime for your baby. None No concerns Age appropriate activities Other/Comments

Revised Question What feeding goals do you have for your

baby? Establish a new goal and/or follow-up on a previous goal.

Open text box


Revised Optional Documentation: Full name and WIC title of person completing the

nutrition assessment - required

Certification Periods•Infant: To the last day of the month the infant turns one year old•Breastfeeding Woman: To the last day of the month in which her infant turns one year old or until the woman stops breastfeeding•Child: Yearly ending with the last day of the month in which the child turns five years old

New certs for Infants Children Breastfeeding women

Infant is fully breastfeeding Infant partially breastfeeding

< max

• Complete Assessment• Anthropometric Measurements• Bloodwork

• based on bloodwork schedule• Nutrition Assessment – including oral assessment• Immunization Screening (if applicable)• Category/Age Appropriate Nutrition Education• Referrals

• Infant• Done at 9 through 11 months of age

• Children• Between 12 months of age and prior to

their second birthday, recommended at 15-18 months of age.

• Required for the 2-year old certification • Children 24 – 60 months of age must

be taken at least once every 12 months.

Refer to ER# 2.02800

Components:• Review last nutrition assessment & health

information tab

• Address new concerns raised by the participant

• Identify new medical diagnosis

• Identify changes in eating pattern/food intake/food package

• Identify changes in physical activity behaviors

• Agencies may choose an option

1. Initial and follow-up questions

2. Initial and mid-certification questions

3. Mid-certification questions only

Three different sets of questions Initial Questions Follow-up Questions MCA Questions


• based on bloodwork schedule• Nutrition Assessment – including oral assessment• Immunization Screening (if applicable)• Category/Age Appropriate Nutrition Education• Referral

Nutrition education must be offered at the equivalent of one contact for each three months (quarterly)2 face-to-face contacts 2 secondary contacts

Approved Nutrition Education Methods

ER#2.06400 Effective Nutrition Education: Standards, Participant-Centered Goals, Delivery Methods and Documentation


• based on bloodwork schedule• Nutrition Assessment – including oral assessment• Immunization Screening (if applicable)• Category/Age Appropriate Nutrition Education• Referral

• Must be at least six months old and before the last day of the infant’s 11th month

• 60 days prior to her MCA date • No later than the last day of the

certification period

• Up to 60 days prior to the MCA date

• Before the last day of the certification period

MOWINS Participant List Window

• When a pseudo cert is created the system is dropping off several risk factors

• Dietary Risk Factors • Risk Factor 121 Short Stature

• Risk Factor 142 Premature • When a pseudo cert is created

the system is dropping this risk factor

• Not assigning at certification

• Staff orientation regarding MCA • Are staff members able to

apply new skills learned in training to their daily routine?

• When to schedule the participants for their MCA

• Determine how many WIC employees a participant sees during a WIC appointment.

• Who will be involved in the MCA appointment as it relates to the Nutrition Assessment tab

• Agencies may choose an option• Initial and follow-up questions• Initial and mid-certification

questions• Mid-certification questions only

Missouri WIC Program Implementation: May 5, 2014.

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