Presentation to: Presented by: Date: 2016 Monitoring Tool Training Nutrition Observation Tools...

Presentation to:

Presented by:

Date:

2016 Monitoring Tool TrainingNutrition Observation Tools

Georgia WIC ProvidersGA WIC Program Operations & NutritionSeptember 23, 2015


At the end of this training participants will be able to:• identify the changes and rationale for the

changes in the observation tools for the nutrition visit

• describe subjective and objective evaluation• describe the scoring based on the

observation requirements

Please have the three monitoring tools available

2016 Monitoring Tool TrainingNutrition Observation Tools - Rationale

Back to the Basics: VENA and PCE

VENA is Value Enhanced Nutrition Assessment

PCE is Patient Centered Education aka Motivational Interviewing

2016 Monitoring Tool TrainingNutrition Observation Tools – Rationale

WIC Staff will use their limited time to:• Collect relevant assessment information• Use critical thinking to link assessment to the participant’s needs and concerns• Personalize the intervention• Engage the participant in dialogue and goal setting• Nutrition, diet and activity is the common thread

2016 Monitoring Tool TrainingNutrition Observation Tools – Rationale

Georgia WIC Evaluation• Georgia WIC Reviews

– Subjective– Objective

• Georgia WIC Strong 4 Life Training: Improving the Effectiveness of Childhood Obesity Counseling and Goal Setting

• Quality Assurance and Continuous Quality Improvement

2016 Monitoring Tool TrainingNutrition Observation Tools – Summary of

Changes• More total points for the observations• Three observation tools

– Certification – High Risk – Low Risk (Individual or Class)

• Match to Strong4Life observations where possible

• Increase the objectivity

Please pull out copies of the Tools (3)


2016 Monitoring Tool TrainingNutrition Observation Tools - Certification

• The form has been changed to reflect the importance of open-ended questions, reflective listening, asking permission and goal setting process

• “If you didn’t document it you didn’t do it” – so you will see there is verification within the tool back to the documentation for Goals, Risks, & Nutrition Education

• Referrals and Exit Counseling


Establishing and Maintaining Rapport (10 Points)

• Most is similar to the previous tool• Changed the scoring to reflect the

importance of following-up and praise & encouragement (A. 1-5)

2016 Monitoring Tool TrainingNutrition Observation Tools - CertificationA. Establishing and Maintaining Rapport Score Points

1. Made eye contact (when culturally Appropriate). (1pt) 1 1

2. Displayed respect for other cultures and used translator appropriately. (2pt)

1 2

3. Used appropriate non-verbal communication. (2pt) 1 2

4. Ensured privacy (quiet enough to talk, adequate space, closed door, unobstructed view of participant) (1pt)

1 1

5. Expressed appreciation for participant’s time, discussed the follow-up plan; used praise and encouragement. (4pt)

.5 2


Accuracy of Assessment & Certification (15 Points)

• Changed the title from completing assessment forms to reflect the critical thinking required within the certification process; documentation will still be evaluated

• Changed the observation to reflect the way the Questionnaire should be used during the visit (B.1)

• Added the conceptual requirement for identifying, documenting and reviewing all Nutrition Risks (B.2)

• Anthropometric evaluations remains a key part of the Certification Visit (B.3)


B. Accuracy of Assessment & Certification Score

Points

1. Asked probing questions to clarify and understand information on the Nutrition Questionnaire. (5pt)

1 5

2. Correctly identified, documented, and reviewed all Nutrition Risks. (5pt)

.75 3.75

3. Correctly assessed, plotted and counseled related to anthropometric measurements. (5pt)

1 5


Counseling Skills/Topics Covered (30 Points)

• Provided a more objective way to evaluate open-ended questions as well as addressed the need to explore feelings (C.1)

• Deleted praise & encouragement from this section; it is already addressed in rapport building

• Deleted “client led” discussion and “if nothing offered” – as this is addressed or implied in the other pieces of this section


Counseling Skills/Topics Covered (30 Points) cont’

• Provided a more objective way to evaluate reflective listening as well as addressed that understanding and the client being heard is key (C.2)

• Added the need to follow-up on previous goals set (C.3)

• Added the priority counseling skill of asking permission (C.4)

• Mandatory referrals added* and maintained appropriate referrals (*removed from Accuracy of Certification Findings) (C.5)

• Mandatory exit topics remains (C.6)

2016 Monitoring Tool TrainingNutrition Observation Tools - CertificationC. Counseling Skills/Topics Covered Score Points

1. Asked open- ended questions to gain information and determine participant’s concerns and feelings related to the nutrition assessment. (5pt)

.8 4

2. Utilized reflective listening skills to clarify what was heard and assure understanding. (5pt)

.4 2

3. Evaluated progress/success towards previous goal(s) set. (5pt)

0 0

4. Asked permission prior to sharing their concerns with the participant. (5pt)

0 0

5. Mandatory (Medicaid, TANF, SNAP) and appropriate referrals (Children's First, Immunizations, Housing Authority, Food Bank, Dental, MD) are made. (5pt)

1 5

6. Mandatory exit topics covered. (5pt) 1 5


Score in Excel Table

Definition

1.0 Always – throughout the session as appropriate

0.8 Frequently – throughout the session but misses several opportunities

0.6 Sometimes – during the session but misses multiple opportunities

0.4 Rarely – once during the session

0.0 Never – MI skill not used


Goal Setting (25 Points)• Removed “summarized the discussion” as

that is covered in reflective listening and the process of verbalizing the goal

• Clarified the language for evaluating the goal setting process (D.1)

– Client language– Client focus – Strengths/barriers


Goal Setting (25 Points) cont’• Clarified that the goal documented must

match the goal that was processed in the session and be documented in SMART format (D.3)

– Specific– Measureable– Achievable/Attainable– Realistic– Time focused


D. Goal Setting Score

Points

1. Worked with participant to create achievable goal(s) using client’s ideas and language including identification of strengths or barriers to achieving the goal. (10pt)

0.4 4

2. Assured the participant verbalized the goal before leaving. (10pt)

1.0 10

3. Goals documented match the goal worked on during the assessment and are in SMART format. (5pt)

.8 4


Accuracy of Nutrition Education and Counseling (20 Points)

• Changed the title to reflect VENA/PCE• Deleted “Appropriate Referrals” as this is

now covered in the counseling skills section• Changed the wording about identification of

findings to reflect the need for appropriately sharing both information about risk factors and growth information (E.1-

2)


Accuracy of Nutrition Education and Counseling (20 Points) cont’

• Evaluating that the information provided is accurate and evidenced based; and that appropriate education is documented – documentation of education that is not provided would be an unsatisfactory score (E.3)

• Nutrition education materials must match to the session and at minimum be referenced as to how the participant can use the materials (E.4)


E. Accuracy of Nutrition Education and Counseling Score Points

1. Shared findings about weight gain, weight loss or growth rate appropriately and accurately using appropriate tools. (5pt)

1 5

2. Shared findings about nutrition risk factors appropriately and accurately using appropriate tools. (5pt)

1 5

3. Provided accurate nutrition education and appropriately documented education provided. (5pt)

1 5

4. If nutrition education materials were provided, they matched to the specific education of the session or were referenced during the session. (5pt)

1 5

Please pull out copy of the High Risk Education Session


2016 Monitoring Tool TrainingNutrition Observation Tools – HR Follow-up

Establishing and Maintaining Rapport (10 Points)

• No differences from certification (A. 1-5)


Accuracy of Assessment (15 Points) • Changed the title • Utilization of probing questions to clarify and

understand participant provided information in relation to the risk (s) covered at that visit (B.1)

• Identified, documented and reviewed appropriate risk (s) for the high risk visit (B.2)

• Anthropometric evaluations, when appropriate, must be assessed, plotted and counseled about accurately (B.3)

– GA WIC does not require anthropometric rechecks at High Risk Encounters;

– Recalled information may be used (document accordingly)


B. Accuracy of Assessment Score

Points

1. Asked probing questions to clarify and understand information. (5pt)

1 5

2. Correctly identified, documented, and reviewed all Nutrition Risks for discussion.(5pt)

1 5

3. Correctly assessed, plotted and counseled related to anthropometric measurements from recall or obtained measurements, if appropriate. (5 pt)

1 5


Counseling Skills/Topics Covered (30 Points)

• Most of this section is the same as for Certification visit (C.1-4)

• Deleted exit counseling (not required at the HR Visit)– 2 points added to “open-ended questions” (C.1)

– 2 points added to “reflective listening” (C.2)

– 1 point added to “ask permission” (C.4)

• No mandatory referrals are required at the HR visit – there may be appropriate referrals (C.5)

2016 Monitoring Tool TrainingNutrition Observation Tools – HR Follow-upC. Counseling Skills/Topics Covered Score Points

1. Asked open- ended questions to gain information and insight about participant’s concerns and feelings related to the nutrition assessment. (7pt)

.6 4.2

2. Utilized reflective listening skills to clarify what was heard and assure understanding. (7pt)

.6 4.2

3. Evaluated progress/success towards previous goal(s) set. (5pt)

0 0

4. Asked permission prior to sharing their concerns with the participant. (6pt)

.4 2.4

5. Appropriate referrals (Children's First, Immunizations, Housing Authority, Food Bank, Dental, MD) are made. (5pt)

1 5


Care Plan (Includes the SOAP/ADIME Note)(25 Points)

• Renamed – Goal setting is not required at the HR Visit but treatment planning (care plan) is required

• Nutrition Care Process (D.1-3)

– Intended that the Nutrition Care Process be followed – We have approval from the Academy to use GA WIC

Risk Criteria as our Nutrition Diagnosis (We will be developing a ladder to match to the IDNT)

– Documentation in SOAP or ADIME format


Care Plan (Includes the SOAP/ADIME Note)(25 Points) cont’

• Assessment/Diagnosis* (D.1) - Assess and diagnose based on the high risk and participant concerns– Diet– Food/Food Package– Formula– High Risk Criteria– Physical Activity

*Diagnosis means Nutrition Diagnosis = Georgia WIC Risk Criteria in this model


Care Plan (Includes the SOAP/ADIME Note)

(25 Points) cont’• Intervention (D.2)

– Nutrition Education– Nutrition Counseling– Food Package Changes

• Monitoring/Evaluation (D.3)

– Summarization– Follow-up plan

2016 Monitoring Tool TrainingNutrition Observation Tools – HR Follow-upD. Care Plan Score Points

1. Assessment/Diagnosis - participant's concerns, diet, food, formula, high risk criteria, and/or physical activity. (5pt)

1 5

2. Intervention - Nutrition Education and counseling related to assessment and high risk criteria, when appropriate changes to the WIC food package. (5pt)

1 5

Monitoring/Evaluation - Summary and follow-up plan discussed. (5pt)

.6 3


Accuracy of Nutrition Education and Counseling (20 Points)

• Same as certification observation for most part (E.1-2, 4)

• Any food package changes and/or formula exchanges is included in accuracy of nutrition education (E.3)

– Education provided– Education documented

2016 Monitoring Tool TrainingNutrition Observation Tools – HR Follow-upE. Accuracy of Nutrition Education and Counseling Score Points

1. Shared findings about weight gain, weight loss or growth rate appropriately and accurately using appropriate tools. (5pt)

1 5

2. Shared findings about nutrition risk factors appropriately and accurately using appropriate tools. (5pt)

1 5

3. Provided accurate nutrition education (including food package changes) and appropriately documented education provided. (5pt)

1 5

4. If nutrition education materials were provided, they matched to the specific education of the session or were referenced during the session. (5pt)

1 5

Please pull out copy of the Low Risk Education Session


2016 Monitoring Tool TrainingNutrition Observation Tools – LR Education

Low Risk Education Session(100 points)

1.) Either had an outline or used a topic suggested by participants (10 points)

Nutrition Assistants must have an outline; their outline can be in their file of approved topics (scope of practice)



2.) Made introduction of self and topic of discussion (5 points)

3.) Invited questions and encouraged discussion (10 points)

4.) Remained courteous, respectful and non-judgmental (5 points)



5.) Used open ended questions, reflective listening, praise & encouragement (20 points)

• For classes might be more reflective listening when being asked a question, or praise & encouragement when participants offer supportive content• For individual sessions would be more like what is seen during a certification visit• Points are reflective of the importance of these techniques for all providers of WIC Nutrition

Education


A. Low Risk Nutrition Education Session (first half) Score Points

1. Had outline of topic and related questions/used topic suggested by participants. NA must have outline. (10pt)

1 10

2. Made introduction of self and topic of discussion. (5pt) 1 5

3. Invited questions and encouraged participation. (10pt) .8 8

4. Remained courteous, respectful, and non-judgmental. (5pt)

1 5

5. Used open ended questions and reflective listening to facilitate participation including the use of praise and encouragement. (20pt)

.4 8



6.) Accuracy of information, appropriateness of materials and assurance limiting to provider scope of practice (10 points)7.) Displayed respect for other cultures (10 points)8.) Used summary and closing (10 points)



9.) Evaluation of learning (10 points)• For class, pre and post test – can be

verbal• For individual – participant recall of

a key content



10.) Documentation of Education (10 points)•Documentation of content that was

not actually covered will result in 0 points

2016 Monitoring Tool TrainingNutrition Observation Tools – LR EducationLow Risk Nutrition Education Session (second half)

Score Points

6. Provided accurate nutrition education information and appropriate materials. (10pt)

1 10

7. Displayed respect for other cultures (used translator appropriately, eye contact, time management, greetings). (10pt)

1 10

8. Used summary and closing. (10pt) .6 6

9. .Evaluation of learning utilized. (10pt) 1 10

10. Documented group education in the electronic medical record. (10pt)

1 10

Questions


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