Colorado WIC Program Policies and Procedures Section 8: Certification, Eligibility and Coordination Revised: 01/01/2025

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Anthropometric and Blood Screening

Policy: Appropriate procedures and equipment will be used to obtain participant weight, length/ height, and hemoglobin measurements when taken in WIC clinics. Every effort should be made to obtain measurements and hemoglobins/ hematocrits as required by policy. Measurements and hemoglobins may be gathered in the WIC clinic or from alternative trusted reliable sources (e.g. health care provider, community health center or program, health department, Head Start, etc.) or delayed. Heights and weight measurements may be delayed 60 days and hemoglobin 90 days. Only one repeat attempt is necessary for gathering heights, weights, and hemoglobins. Participants will not be terminated for failure to provide heights, weights, or hemoglobins.

Regulation: 7 CFR 246.7(e)(1)(i)(A) and (B), 7 CFR 246.7(e)(1)(ii)(B), 7 CFR 246.7(e)(1)(ii)(A), 7 CFR 246.7(e)(2)(i)(A) Memo 92-10 Bloodwork Protocols, 2001-2 Bloodwork

Procedures/Additional Guidance: The ongoing collection of accurate medical/nutritional data for participants allows WIC to provide nutrition education, appropriate referrals to other health services, determine nutrition risk factors and assign the appropriate food packages.

Options for Gathering Heights/Weights and Hemoglobins Heights/lengths, weights and hemoglobins may be gathered in a number of ways. Some options include: • Obtain in the WIC clinic heights, weights and hemoglobins measurements on a different day than the WIC appointment (cert/recert) by using the “Anthro/Hgb Only” appointment type or allowing walk-ins. • Obtain heights/weights in the WIC clinic at the same time as the WIC appointment (cert/recert). • Participant verbally reports the anthros/hemoglobin taken at a trusted reliable source (e.g. health care provider, etc) o Note: A measurement taken at home is not allowed.

WIC staff must enter the date when the measurement was taken in the Anthropometric panel (for heights/weights) or Blood panel (for hemoglobins) in Compass.

Refer to the Anthropometric and Blood Screen Schedules below for information on when measurements must be obtained.

Gathering Heights/Weights and Hemoglobins From A Trusted Reliable Source (e.g. healthcare providers, community health center or program, health department, Head Start, etc.) Medical data may be obtained from outside the WIC Program such as through a health care provider, public health nurse, or other public health program. Local WIC clinics are encouraged to obtain information from other sources to prevent repeated measurements, especially repeat hemoglobin measurements.

Anthropometric Measurements: Height and weight measurements from other sources may be used to determine WIC eligibility if the measurement is no more than 60 days old (from the date of actual WIC certification). Weight measurements for women should also reflect the physiological state for which she is being certified. For example, a postpartum woman’s weight should be from the time that she is postpartum and not from when she was pregnant. • In order to differentiate between anthros taken in the WIC clinic vs. those reported from a trusted reliable source, staff need to check the “Inaccurate Reason” check box, and choose “Reliable Source/Health Provider” from the drop down. Although the measurements may be accurate from a trusted reliable source, documenting the measurements in this way allows WIC staff to see which measurements were taken at the WIC clinic vs. the measurements taken at another location.

Hemoglobin Measurements: There is no time limit on how old a hemoglobin value can be when certifying a WIC participant as long as the measurement meets the following criteria:

Colorado WIC Program Policies and Procedures Section 8: Certification, Eligibility and Coordination Revised: 01/01/2025

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• For a woman: The hemoglobin value must correspond with the participant’s category for which she is being certified/recertified. For example, for a pregnant woman, the hemoglobin must have been performed at some time during the current pregnancy for which she is being certified. For a breastfeeding or postpartum woman, the hemoglobin must have been performed after the end of the woman’s most recent pregnancy. • For an infant or child: The hemoglobin must have been performed between 9-12 months of age, again between 15-18 months of age, and at least yearly after 18 months of age if the previous hemoglobin value was normal. If the previous hemoglobin value is abnormal, the hemoglobin should be repeated every 6 months until a normal value is obtained and then yearly thereafter.

If the anthropometric or hemoglobin measurement was taken on a day other than the day certification occurs, the WIC staff must enter the date when the measurement was taken in the Anthropometric panel in Compass.

Repeat Hemoglobin Measurements Taken At The WIC Clinic: WIC funds may be used for only one repeat hemoglobin measurement within a certification period.

When A Participant Reports Anthros or Hemoglobins ThatSeem Inaccurate: Use your best judgement. If a participant verbally reports weights/heights or hemoglobins from a trusted reliable source that appear inaccurate, enter the information in to the Anthropometric panel or Blood panel of Compass and make note of this issue in the Care Plan.

Delaying Anthropometrics and Hemoglobins Anthropometrics Delayed (60 days): Measurements may be delayed for up to 60 days. Since the height and weight field is required in Compass, you will need to do the following based on whether or not the participant has had a previous WIC anthropometric record: • Participant has had a previous WIC anthropometric record: Go back to the previous measurement record and note the measurement date, height and weight. In the Anthropometric panel of Compass, enter the previous Measurement Date, weight and height and choose “Delayed up to 60 days” from the Inaccurate Reason drop down. • Participant does not have a WIC anthropometric record: In the Anthropometric panel of Compass, enter the Measurement Date of today (the system defaults to this) and take a verbal on the participant’s weight and height. Then choose “Delayed up to 60 days” from the Inaccurate Reason drop down.

Hemoglobin Delayed (90 days): The hemoglobin screening may be delayed for up to 90 days. In the Blood panel of Compass, click “No” in the Blood Work Taken field, and choose “Delayed up to 90 days” from the No Test Performed Reason drop down.

Hemoglobin Exemptions Exemption - The only reasons which exempt an applicant/participant from hemoglobin testing are:

Religious: If an applicant/participant’s religious beliefs won’t allow him or her to have blood drawn, staff must choose “Religious” from the No Test Performed Reason drop down in the Blood panel in Compass.

Medical Reasons: If an applicant/participant has a medical condition (e.g. hemophilia, fragile bones (osteogenesis imperfecta, or serious skin condition) in which the hemoglobin screening procedure could cause harm to the applicant/participant, documentation from the health care provider of the medical condition must be submitted to WIC and scanned into Compass. If the noted condition is considered treatable, such as a serious skin condition, a new statement from the health care provider would be required for each recert. If the condition is considered “life long” such as hemophilia, a new statement from the health care provider is not necessary for the next recert.

Colorado WIC Program Policies and Procedures Section 8: Certification, Eligibility and Coordination Revised: 01/01/2025

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An unknown hemoglobin/hematocrit CANNOT be used as a qualifying risk factor for WIC participation. Participants refusing a hemoglobin/hematocrit screening for religious or medical reasons must qualify for WIC using another nutritional/medical risk factor.

Hemoglobin Non-compliant/Refusal If the staff is unable to obtain a hemoglobin in the clinic due to the participant being non-compliant (e.g. child may harm staff or themselves during hemoglobin procedure), staff may delay the hemoglobin for 90 days, document the situation and attempt at a later date. In Compass, click “No” for Blood Work Taken and “Noncompliant/Refused” in the No Blood Work Reason drop down. If the participant is non-compliant at a later date again, document the second attempt in the participant’s record.

If a participant refuses to have a hemoglobin screening performed and the reasons are not for religious or medical, review the importance of the screening and explore with the participant the possibility of obtaining the information at a later date at the WIC clinic or from their health care provider.

When staff are unable to obtain the hemoglobin due to noncompliance or refusal, in the Blood panel of Compass, mark “No” in the No Text Performed Reason and mark “Noncompliant/Refused”.

One Repeat Attempt is Required for Anthropometrics and Hemoglobins When the initial attempt to gather the height, weight, or hemoglobin is unsuccessful for whatever reason, only one repeat attempt is required. If the one repeat attempt is unsuccessful, the missed appointment is sufficient documentation to show the one repeat attempt. If there is no appointment or the client attends the appointment but doesn't provide the missing measurement, then the one repeat attempt must be documented in the Care Plan.

Anthropometric and Blood Screen Schedules Pregnant Women At each certification visit:  Hemoglobin or Hematocrit  Weight  Height.  Nutrition Interview. It is best practice to gather a weight measurement during each trimester for pregnant women at the follow-up prenatals visits, although it is not required. -For women who are seeing a healthcare provider for their pregnancy, gather the weight from the woman that was taken at her most recent doctor’s appointment or you can offer an in-person appointment to obtain her weight in the clinic. -When a pregnant woman has no health care provider, you can schedule an in-person WIC appointment to obtain the weight. If there is hardship coming into the clinic (travel, disability, or a health condition) and the client is unable to come into the clinic, benefits should not be withheld. This weight is not a requirement, but a best practice.

Postpartum Non-Breastfeeding Women At each certification visit:  Weight.  Height (for recertifications, a height needs to be taken for women less than 18 years of age only).  Hemoglobin or Hematocrit.  Nutrition Interview.

Breastfeeding Women At initial certification visit after delivery:  Breastfeeding Support.  Weight.  Height (for recertifications, a height needs to be taken for women less than 18 years of age only).  Hemoglobin or Hematocrit.

Colorado WIC Program Policies and Procedures Section 8: Certification, Eligibility and Coordination Revised: 01/01/2025

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 Nutrition Interview.

Infants and Children:  Weights and heights are to be taken at the cert/recert appointments. For infants, it is recommended that weights and heights are obtained at the mid-cert and and follow-upappointments, though it is not required.

 A hemoglobin must be performed between 9-12 months of age, again between 15-18 months of age, and at least yearly after the 15-18 month hemoglobin if the value was normal. If the hemoglobin value was abnormal, the hemoglobin should be repeated every 6 months until a normal value is obtained and then yearly thereafter. After the 15-18 months hemoglobin, clinic staff may wish to do the next hemoglobin at the recert appointment (6 months later) regardless of whether the hemoglobin was normal or abnormal in order to sync the hemoglobin schedule with the recert schedule.

 Immunization Screening: Staff members are required to ask endorsers to bring immunization records to all certification, recertification, and mid-cert visits for participants less than 25 months of age. If the record is available in the Colorado Immunization Information System (CIIS), agencies with access may use the CIIS electronic record instead of obtaining the immunization information from the caregiver. These records must be assessed for DTaP shots. If the information is not available in CIIS and the endorser does not bring their immunization records to the visit, the records cannot be assessed and staff should select "no" to the Compass question (Nutrition Interview, Immunization section, question 2a) "Can we look over your child's shot record today?" In those situations, staff must ask if the infant or child is up-to-date on their immunizations and document the caregiver’s verbal report in the Nutrition Interview or Care Plan. Endorsers/participants cannot be required to bring the participant’s immunization record to WIC visits. Once a child has received their four DTaP immunizations, WIC staff no longer need to ask about the child's immunization status.

 Lead Screening: Local WIC Programs must ask if every child, starting at their one-year certification appointment or upon enrollment beginning at 12 months of age, has had a blood lead screening test. If the child has not been tested, they must be referred to their doctor or another program where the test can be obtained during each certification, recertification, and mid-certification. Document lead screening referrals in the Nutrition Education Panel by selecting "Referred for Lead Screening" under child standard counseling. Once a lead test is performed and documented in the Blood panel in Compass, staff no longer need to ask about lead testing or provide a referral during subsequent recertifications and mid-certifications. The Lead Level Measurement field in the Blood panel in Compass can be left blank.