CERTIFICATION WPPM #240-30 Subject: Mid-Certification Item: Mid-Certification Nutrition Assessment

Revised California WIC Policy and Procedure Manual Page 1 of 4 January 8, 2024 PURPOSE: To maintain the quality and accessibility of WIC nutrition services for participants certified for longer than six (6) months. POLICY: I. Local agencies (LA) must schedule a mid-certification assessment for breastfeeding, infant, and child participants who are certified for longer than 6 months. LAs must schedule the mid-certification during specific timeframes based on participant category, as described in Section I of the procedure(s). II. During the mid-certification, LAs must perform a nutrition assessment as described in the procedure(s) and provide appropriate nutrition education, breastfeeding promotion and support, and referrals. PROCEDURES: I. Timeframe for the Mid-Certification Nutrition Assessment A. LA staff must perform the mid-certification nutrition assessment within the following timeframes for participants who are certified for longer than 6 months: 1. Infants: five to seven months of age. 2. Children: fifth to seventh month of the certification period. For children who are turning five years old and who have a certification period that is longer than six months but shorter than one year, the LA must schedule the mid- certification approximately within the middle months of the certification period. 3. Breastfeeding participants: five to seven months postpartum. This requirement applies to participants who are doing any amount of breastfeeding. II. Components of the Mid-Certification Appointment A. Anthropometric Measurements 1. LA staff must make a concerted effort to obtain referral data or anthropometric measurements in advance of or at the time of mid- certification. 2. LA staff must document participant anthropometric measurements and assess growth and/or weight status. Refer to WPPM 210-10. a. If the participant is physically present at the appointment, properly weigh and measure the participant.

CERTIFICATION WPPM #240-30 Subject: Mid-Certification Item: Mid-Certification Nutrition Assessment

Revised California WIC Policy and Procedure Manual Page 2 of 4 January 8, 2024 b. If the family representative/caretaker provides measurements from a non- WIC source, the data must be: i. Provided from referral forms or other allowable sources. ii. Measured within 60 days of the date of the mid-certification appointment. c. If neither the participant nor an acceptable source of anthropometric measurements is available, LA staff must: i. Proceed with the mid-certification appointment without the anthropometric measurements. ii. Check the “Not Present” checkbox in the Anthropometrics grid of the Wt/Ht/Bloodwork screen in the WIC Web Information System Exchange (WIC WISE). iii. Provide a referral to the health care provider (HCP). iv. Ask the family representative/caretaker to bring the participant or provide current anthropometric measurements at the subsequent contact(s). B. Bloodwork (as necessary) 1. If bloodwork is due, staff must document the bloodwork/anemia screening results or the reason that bloodwork was not obtained in the Bloodwork grid of the Wt/Ht/Bloodwork screen in WIC WISE. Refer to WPPM 210-11. 2. Staff must review the bloodwork results to assess abnormalities and provide nutrition education as appropriate. C. Review and Update of Health and Dietary Assessment 1. A Competent Professional Authority (CPA) must perform a health and nutrition assessment to identify and assess major changes in the participant’s health/dietary status since the previous certification/recertification. 2. For infant mid-certifications, the CPA must ask and record responses to all questions on the Nutrition screen in WIC WISE. It is not necessary to re-ask the questions on the Health screen. 3. For mid-certifications for children and breastfeeding participants, the CPA is not required to re-ask the questions on the Health and Nutrition screens. Instead, the CPA is allowed to perform an assessment that consists of the following: a. Briefly reviewing the participant’s past health/dietary information recorded on the Health and Nutrition screens.

CERTIFICATION WPPM #240-30 Subject: Mid-Certification Item: Mid-Certification Nutrition Assessment

Revised California WIC Policy and Procedure Manual Page 3 of 4 January 8, 2024 b. Asking if there are any new concerns, new medical diagnoses, or changes in eating pattern or physical activity behaviors. c. Reviewing the previous Care Plan(s) and goal(s). d. If there are any updates, the CPA must make changes to the appropriate questions on the Health and Nutrition screens. D. Documentation of Nutritional Risk 1. Identification of a new nutritional risk is not required for the mid-certification. 2. If the CPA identifies any new risks during the assessment, the CPA must ensure proper documentation of the risks by verifying that an appropriate risk was generated based on the new or updated information entered on the Health and/or Nutrition screens, or by manually assigning the appropriate risk(s) on the Nutrition Risk screen in WIC WISE. E. Nutrition Education/Counseling 1. The CPA must provide age and developmentally appropriate nutrition education and guidance based on: a. Information collected during the nutrition assessment. b. The participant’s previous Care Plan(s) and goal(s). F. Cash Value Benefit (CVB) Nutrition Assessment and Education (Infants Only) 1. Perform the infant mid-certification nutrition assessment to determine infant readiness for fresh fruits and vegetables. Refer to WPPM 320-10. 2. Provide appropriate education to ensure that infants who will receive the fresh fruits and vegetables CVB will meet their nutritional needs in a safe and effective manner. G. Update of Care Plan 1. The CPA must: a. Update the status of the participant’s current goal. b. Document a new goal if appropriate (e.g., the participant has met the previous goal or the participant has not met the previous goal but wants to choose a different goal). c. Create a follow-up note in the existing Care Plan. Refer to WPPM 400-12 for Care Plan requirements.

CERTIFICATION WPPM #240-30 Subject: Mid-Certification Item: Mid-Certification Nutrition Assessment

Revised January 8, 2024 California WIC Policy and Procedure Manual Page 4 of 4 H. Referrals 1. As necessary, staff must provide follow-up on referrals made during the previous certification/recertification and offer new referrals if appropriate. Refer to WPPM 700-02. III. Missed Mid-Certification Appointments A. If the family representative/caretaker is not able to attend the mid-certification on the scheduled appointment date, LA staff must issue only one month of benefits at a time until the mid-certification is completed or the timeframe for completing the mid-certification has passed (See Section I for timeframe). B. If the timeframe for completing the mid-certification has passed, the LA should no longer attempt to reschedule or complete the mid-certification. Instead, the LA should move on to the next nutrition education contact in the participant’s Nutrition Education Plan. AUTHORITY: 7 CFR §246.7(e) USDA WIC Guidance 8/29/2011: Guidance for Providing Quality Nutrition Services During Extended Certification Periods. USDA WIC Policy Memorandum 2006-05: VENA – A WIC Nutrition Assessment Policy USDA WIC Policy Memorandum 2011-5. WIC Nutrition Risk Criteria. Value Enhanced Nutrition Assessment (VENA) CROSS REFERENCE: WPPM 210-10 Determining Nutritional Risk – Anthropometric WPPM 210-11 Determining Nutritional Risk – Biochemical WPPM 320-10 Food Package Tailoring WPPM 400-12 Care Plan WPPM 700-02 Referral Requirements WPPM 970-100 Minimum Immunization Screening and Referral Protocol WNA Training Manual