Colorado WIC Program Policies and Procedures Section 2: Nutrition Services Revised: 10/01/2023

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Nutrition Education

Policy: Local agencies shall offer nutrition education at no cost to all WIC participants, parents, or caregivers according to federal regulations and state guidelines Agencies have the option to enter into an agreement with another agency to offer participant nutrition education.

Nutrition education may be provided through individual or group sessions. During each six-month certification period, at least two nutrition education contacts must be made available. When participants are certified for longer than six months, nutrition contacts shall be made available at a quarterly rate.

Nutrition education shall be participant-centered and include behavior change counseling. Goals must be set and followed-up on at subsequent appointments.

Note: A chart review does not count as a nutrition education contact for low or high risk participants.

Regulation: [246.11(b)]: 246.11(d)

Procedure/Additional Guidance: WIC provides nutrition education along with supplemental foods to guide participants toward a healthier lifestyle and to help them make changes to improve their dietary intake. Using a participant-centered approach helps to enhance the effectiveness of these activities.

Type of Nutrition Education Contacts In-Person Education: An in-person visit with the participant is provided either individually or in a group, and includes participant-centered nutrition education. A participant-centered nutrition education approach should address participant needs (NRFs), participant concerns, and/or relevant anticipatory guidance topics. Ideally, only 1-2 topics are addressed during a single visit. Topics not discussed during the appointment can be entered into the participant’s Plan to be addressed at a future visit.

Remote Education: Remote nutrition education options include:  Phone: As with in person education, provide participant-centered education. All required components of a WIC visit must be performed per policy, including nutrition education, goal setting, and documentation. During the end of the phone contact, food benefits will be issued remotely, and a subsequent visit scheduled.  Wichealth.org: An internet-based, online nutrition education website available in English and Spanish. Verification that the endorser completed a wichealth.org nutrition education lesson automatically uploads into the household’s Nutrition Education panel in Compass. Completion of a corresponding Care Plan is not required. The goal set at the prior in-person or phone appointment may be followed-up on at the nutrition education contact. Upon completion of an online lesson and during the month the participant’s food benefits expire; staff will verify the lesson completion, contact the participant, and issue food benefits remotely. Program and nutrition-related assistance and follow up must be available to address questions and to provide feedback to endorsers. Note: This education contact option is only for low-risk participants.  Interactive Video Call: Technology that allows video conference calls. As with in person education, provide participant-centered education. All required components of a WIC visit must be performed per policy, including nutrition education, goal setting, and documentation. During the end of the video call contact, food benefits will be issued remotely, and a subsequent visit scheduled. The local agency will provide for installation and maintenance of the equipment necessary for the video call contact. Interactive video calls should occur in an environment that promotes effective communication between the WIC staff and the participant and ensures that both are actively involved in the interaction. The confidentiality of participant information must be protected.

Providing Participant-Centered/Behavior Change Counseling

Colorado WIC Program Policies and Procedures Section 2: Nutrition Services Revised: 10/01/2023

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The education part of the visit should flow naturally from the assessment because it ties in with the participant‘s questions and concerns. However, sometimes no clear direction emerges and in this case, the WIC staff person works with the participant to develop an agenda for topics to discuss. Ways to do this are:  Ask the participant about any nutrition questions or concerns they would like to discuss. Nutrition information provided during the visit should match the participant’s needs and interests.  Suggest topics based on information gathered during the assessment.  Suggest topics that provide anticipatory guidance.

Tips for discussing nutrition information with participants:  Use a conversational format.  Find out what the participant already knows about a topic and fill in the gaps.  Affirm the things that are going well.  Be non-judgmental.  Personalize education so the participant understands how making changes can improve their health and well- being.

Readiness to Change Counseling While sharing nutrition information, WIC staff should assess the participant’s interest in applying the information to their life by making behavior changes. Sometimes participants are ready to change. Sometimes they are not. Or they might be anywhere between. It is important to get a sense for how ready to change a participant is in order to tailor counseling to meet them where they are. Applying readiness to change counseling is useful for providing ideas for ways to approach participants who are in different stages of readiness to change. The chart below describes readiness to change and the recommended counseling strategy associated with it. Readiness to Change Counseling

Level of Readiness to Change Counseling Strategy

Not Ready or thinking about changing Raise awareness. Be prepared not to push for change. This is likely to cause more resistance.

Uncertain about making a change Explore pros/cons of change, concerns/fears

Ready to change Have the participant talk about the reasons for, importance of, or their plans for change.

Goal Setting Goal setting is an important component of behavior change counseling because it encourages the participant to put into action something discussed during the appointment. The goals set with participants will differ depending on their readiness to change. For participants not ready to change, appropriate goals are ones that help to raise awareness or encourage the participant to think through the pros and cons of change. Examples of goals that are appropriate for no or low readiness to change are to simply read over educational material, to talk to a partner, or to think about what it would look like to make a specific change. These goals may not seem very ambitious; however, they are realistic and consistent with the participant’s motivation and readiness to change. As the participant becomes more committed to making a change, appropriate goals will be ones that are more action oriented. For example, the goal may be to have the participant take small steps toward making the behavior change.

When setting goals with participants it is important to remember these principles:  Goal setting should be done interactively with the participant. WIC staff’s role is to suggest ideas for goals that might be appropriate for the participant’s readiness to change. It is the participant’s role to make the decision about what they are able and willing to do.  Goals should be specific. A clearly stated goal is easier to follow.  Write down the goal (perhaps on a handout) as a reminder after they leave the appointment.

Documentation - Document the goal in the Participant Care Plan. The goal should be described clearly, so that WIC staff can easily follow up on the goal with the participant at the next appointment.

Follow up - Since behavior change is a process, it is important to follow up at the next visit by asking the participant about their progress in achieving their goal. Offer praise for any efforts they have made and provide support as appropriate. It may be necessary to adjust the goal to make it more doable.

Colorado WIC Program Policies and Procedures Section 2: Nutrition Services Revised: 10/01/2023

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Following up on goals helps to increase the participant’s accountability, provides opportunities for support and problem solving, and demonstrates to the participant that WIC cares about helping them make changes. Document follow up discussion(s) about goals in either the Subjective or Assessment section of the Participant Care Plan.

Nutrition Educational Materials: WIC’s nutrition educational materials help reinforce educational messages. Certain materials are available to order in print and all materials are available electronically to share via email or text.

Missed Nutrition Education Appointments and Non-Denial of WIC Benefits Although local agencies are required to make reasonable efforts to provide nutrition education to each participant, individuals cannot be denied supplemental foods for failure to attend an educational activity or for lack of willingness, readiness, or ability to participate in the activity.

When a participant does not attend or participate in a scheduled nutrition education contact, document why this occurred in the Participant Care Plan.

When a participant misses a scheduled appointment, offer the nutrition education contact the next time you make contact with the participant.