660.1 Policy 660 Competent Professional Authority (CPA): Requirements June 28, 2019 POLICY Each local WIC program shall have a Competent Professional Authority (CPA) on staff to determine nutrition risk eligibility and prescribe appropriate food benefits for each participant. PURPOSE To assure the quality of nutrition services in the WIC program. RELEVANT REGULATIONS 7 CFR §246.2—Definition Competent Professional Authority 7 CFR §246.6(b)(2)—Perform certification procedures 7 CFR §246.7(d)—Determine nutritional risk 7 CFR §246.7(d)(4)—Fill caseload slots 7 CFR §246.7(g)(7)—Sign Certification Form 7 CFR §246.10(a)(2)(iii)—Prescribe supplemental food 7 CFR §246.11(e)(5)—Provide individual care plan USDA WIC Nutrition Services Standards—Standard 5 (C) OREGON WIC PPM REFERENCES ♦ 215—Local Program Monitoring and Review ♦ 435—Staffing Requirements ♦ 440—Staff Training Requirements ♦ 661—Competent Professional Authority: Appropriate Counseling for Risk Levels APPENDICES Page 660.7 Appendix A CPA Competency Model DEFINITIONS Competent Professional Authority (CPA): An individual on the staff of the local WIC program authorized to assess program eligibility, determine nutritional risk, provide nutrition education and counseling and prescribe supplemental foods. WIC Nutritionist: A nutrition professional working in WIC who meets one or more of the following qualifications: a Master’s Degree in nutrition; a Registered Dietitian (RD) with the Academy of Nutrition and Dietetics, or eligible for RD registration; an Oregon Licensed Dietitian (LD).

Competent Professional Authority (CPA): Requirements, Continued 660.2 Paraprofessional CPA: A person employed to assist or expand the efforts of professional CPAs. A health professional will supervise the paraprofessional’s direct contact with WIC participants and their conducting of education programs. Professional CPA: A person with a bachelor’s or master’s degree in a health profession, such as nutrition, nursing or health education. Includes physicians, physician assistants, registered nurses, dietitians, or public health educators. Competencies: Skills, actions, or behaviors related to a specific knowledge requirement that a person can be determined to possess based on a specified set of criteria. CPA Competencies: Broad, program-related statements describing tasks or skills to be mastered by a CPA; derived from performance roles and stated in behavioral terms so they can be observed and mastery can be determined. Training Supervisor: A person designated by the local program to ensure training of local staff is completed in accordance with state policy. Minimum qualifications: must be a health professional as defined in ¶2.0 of this policy. PROCEDURE

Only staff designated and trained as a Competent Professional Authority (CPA) may determine nutrition risk eligibility and prescribe or assign food packages. 1.1. Clerical staff, or any staff not trained as a CPA, may not prescribe/assign food packages for participants. All food packages must be approved/assigned by a CPA. 1.2. Staff who determine nutrition risk eligibility and/or assign food packages must meet the CPA requirements described in this policy, regardless of whether they are paid for with WIC funds or not. Qualifications: Professional CPA

Health professionals in any of the following categories may be authorized to serve as a professional CPA: 2.1. Registered dietitian/nutritionist or Oregon licensed dietitian 2.2. Bachelor’s or master’s degree in nutritional sciences 2.3. Bachelor’s or master’s degree in home economics with emphasis on nutrition 2.4. Bachelor’s or master’s degree in health education 2.5. International Board-Certified Lactation Consultant (IBCLC) 2.6. Physicians 2.7. Registered nurses 2.8. Physician’s assistants Qualifications: Paraprofessional CPA

Individuals may be authorized to serve as paraprofessional CPAs by meeting all of the following requirements: 3.1. Has a high school diploma or GED equivalent.

Competent Professional Authority (CPA): Requirements, Continued 660.3 3.1.1. It is recommended that local programs select individuals with appropriate educational background to meet the functional requirements, for example, language needs. 3.2. Has received training in specified competency areas by completing WIC training modules or online courses identified in 440—Staff Training Requirements. 3.2.1. Initial training should prepare paraprofessionals for duties of the position by teaching them the basic skills needed to function as a CPA. 3.2.2. Competencies attained during the initial training should be further developed through on-the-job training. Required Quarterly In-services 3.3. Completes quarterly in-services on topics related to the CPA competencies (see 440—Staff Training Requirements). 3.4. Is observed performing certifications at least annually and has periodic evaluations to assess performance. 3.5. Works under the direct supervision of a health professional who is also responsible for ongoing job training and evaluation. 3.5.1. Paraprofessional CPAs need to consult with the WIC nutritionist on more complex nutrition issues. 3.6. Has training in referring appropriately to the WIC nutritionist. 3.6.1. All paraprofessionals will receive training in the identification of high- risk participants and in how and when to refer high-risk participants. (See 661—Competent Professional Authority: Appropriate Counseling for Risk Levels) 3.6.2. Clear referral guidance will be provided to all paraprofessionals. Responsibilities

Responsibilities of the CPA include: 4.1. Perform the certification procedures, including required documentation in the data system; 4.2. Determine nutritional risk; 4.3. Prescribe food packages; 4.4. Provide appropriate nutrition-focused counseling and breastfeeding promotion and support; 4.5. Refer to health care and community services; 4.6. Refer high-risk participants to a WIC nutritionist for follow-up and individual care plans based on the need for such plan (see 661-Competent Professional Authority: Appropriate Counseling for Risk Levels).

CPA Competencies

Competent Professional Authority (CPA): Requirements, Continued 660.4

A complete list of CPA competencies are described in the CPA competency model (see Appendix A). The CPA competency model illustrates the complexity of the tasks expected of a CPA and can be used to guide staff development and training over time. It is not expected that CPAs will meet all the competencies identified in the model after completing the WIC training modules or online courses. The CPA competency model reinforces the need for ongoing support, training and continuing education for CPAs. 5.1. Minimum CPA competencies are met by completing the WIC training modules or online courses identified in 440—Staff Training Requirements. 5.2. Local programs may choose to encourage staff to develop additional competencies to improve the quality of the services they provide to participants. 5.3. Staff development and quarterly in-services may address any of the competencies listed in the CPA competency model. Required Training for CPAs

All persons designated as CPAs must demonstrate proficiency in the identified minimum CPA competencies by: 6.1. Completing the appropriate WIC training modules or online courses. See 440—Staff Training Requirements for specific training completion guidelines. 6.1.1. The following Oregon WIC training modules must be completed before an individual can begin certifying WIC participants of a particular category: • “Introduction to WIC” module • Appropriate sections of the “Nutrition Risk” module • The module or online course specific to the participant category to be certified 6.1.2. All training modules or online courses must be completed within six months of the time the individual begins certifying WIC participants. 6.1.3. Best practice would be for CPAs working full time to complete all the required training modules and online courses within 2 to 3 months of hire. Ongoing Competency Development 6.2. Once an individual has completed the appropriate WIC training modules or online courses, the local program training supervisor shall document continued competency development by observation, chart reviews, etc. At a minimum, this must be done yearly and can be a component of biennial program self- evaluation (see 215—Local Program Monitoring and Review). 6.3. WIC staff serving in the roles of WIC registered dietitian/nutritionist or training supervisor must complete the training to be a CPA.

Documentation

Competent Professional Authority (CPA): Requirements, Continued 660.5

The local program must maintain a current list of staff members authorized to act as CPAs by completing the “Staff Training” screen in TWIST for each CPA. 7.1. The local program must document that staff authorized to act as CPAs are appropriately trained and supervised. 7.2. Module or course completion forms must be kept on file at the local program.

POLICY HISTORY Date * Major Revision, Minor revision 7/30/2012 Revision 5/2/2018 Revision 6/28/2019 Major Revision

The date located at the top of the policy is the implementation date unless an “effective date” is noted on the policy. Policies will become compliance findings 6 months from the implementation date. Release notes can be found in the corresponding document on the Policy and Procedure Manual page. *Major Revisions: Significant content changes made to policy. Minor Revisions: Minor edits, grammatical updates, clarifications, and/or formatting changes have occurred. Date of Origin: Date policy was initially released If you need this in large print or an alternate format, please call 971-673-0040. This institution is an equal opportunity provider.

Competent Professional Authority (CPA): Requirements, Continued 660.6 APPENDIX A Competency Model for Oregon WIC Certifiers Competent Professional Authority (CPA) In this document, competencies are identified for WIC personnel identified as a CPA by their agency (see Policy 660) who complete certification tasks and procedures. The 11 core areas for WIC certifiers include: 1. Program Integrity; 2. WIC Program overview; 3. Principles of life-cycle nutrition; 4. Nutrition assessment process; 5. Anthropometric and hematologic data collection techniques; 6. Communication; 7. Multicultural awareness; 8. Critical thinking; 9. Technology Literacy; 10. Nutrition Education; and, 11. Community Resources and Referrals Each competency area is presented in a separate table. The components of the tables and their definitions are listed below: Core area A particular area of skill or body of knowledge. Knowledge required A specific topic or content area needed to achieve the competency and is the basis for training content. Competency Skills, actions, or behaviors related to a specific knowledge requirement. Training Methods How staff will become competent – identifies state provided materials, training or support. This does not address training and support provided by the local agency and/or the local agency training supervisor. Note: Individual local agencies determine prerequisite competencies they expect at hire. This competency model does not include those basic competencies, but rather includes only competencies that are related to the tasks specific to being a certifier/CPA. Note: Minimum CPA competencies are met by successful completion of the WIC training modules identified in Policy 440. Note: Competencies may pertain to more than one core area, but are listed only once in the competency model.

Competent Professional Authority (CPA): Requirements, Continued 660.7 1. Program Integrity Competency Area: Shows personal accountability. Knowledge Required Competency Training Methods Personal accountability 1. Balances multiple responsibilities between nutrition assessment, nutrition education, data entry, and voucher issuance (e.g. shopper education). 2. Practices positive work ethics to ensure program integrity (honesty, integrity, reliability, consistency, fairness) 3. Participates actively in staff development/training. 4. Uses technology and program equipment/materials in an appropriate and safe manner for work purposes only. 5. Performs duties within the context of written policies of the agency where employed, Oregon State policy and USDA regulations. Certifier’s Guide Intro to WIC Module

USDA and State agency policies about participant confidentiality

6. Obtains release of information (Participant Signature Form) according to State agency policy before sharing any participant data. 7. Protects participants’ confidentiality in all conversations. 8. Maintains confidentiality of all electronic participant records and information. Intro to WIC Module Certifiers Guide Civil rights 9. Complies with the provisions of Civil Rights laws, regulations and policies. Civil Rights In-service

Competent Professional Authority (CPA): Requirements, Continued 660.8 2. WIC Program Overview Competency Area: Understands and is able to explain the WIC Program. Knowledge Required Competency Training Methods WIC Program orientation 1. Correctly describes the WIC program to potential participants. 2. Directs participants through the clinic flow. 3. Correctly explains a WIC participant’s rights and responsibilities 4. Correctly identifies the 4 primary WIC services (Nutritious food, nutrition education, breastfeeding promotion and support, referrals into health and social services) 5. Correctly explains the value of WIC services to the participant and the impact WIC can have on the life course of their family. Intro to WIC Module WIC and public health 6. Describes how the WIC program fits within the public health field. Intro to WIC Module WIC eligibility criteria 7. Correctly screens participants for eligibility. Intro to WIC Module Food Benefit issuance and use 8. Correctly issues food benefits to participants. 9. Educates WIC shoppers on the correct use of WIC food benefits. Intro to WIC Module

Competent Professional Authority (CPA): Requirements, Continued 660.9 3. Principles of Life-Cycle Nutrition Competency Area: Understands normal nutrition issues for pregnancy, lactation, the postpartum period, infancy, and early childhood and their impact on the life course. Knowledge Required Competency Training Methods Nutrition requirements and dietary recommendations for women, infants, and children served by WIC

1. Understands basic nutrition concepts. 2. Identifies function and food sources of major nutrients. 3. Analyzes health and nutrition histories based on lifecycle stage. 4. Evaluates the impact of the parent/child relationship and feeding dynamics on nutritional status, growth and development. Basic Nutrition Online Course Baby Behaviors Online Course Child Nutrition Online Course Responsive Parenting Course Toddler Behaviors Federal nutrition policy guidance and its implications for women, infants and children served by WIC (e.g., Dietary Guidelines for Americans, MyPlate) 5. Interprets and compares dietary practices of WIC participants to federal policy guidance. 6. Differentiates between safe and inappropriate food and nutrition practices. Basic Nutrition Online Course

Relevant evidence-based recommendations from the American Academy of Pediatrics, the Academy of Nutrition and Dietetics, the American College of Obstetrics and Gynecology, the International Lactation Consultant Association, and the Institute of Medicine 7. Analyzes and compares dietary and feeding practices with evidence-based recommendations. 8. Analyzes and compares physical activity practices with published and evidence-based recommendations Nutrition Risk Module Food Package Module Responsive Parenting Course All lifecycle nutrition courses

Competent Professional Authority (CPA): Requirements, Continued 660.10 Knowledge Required Competency Training Methods Infant Nutrition Relevant evidence-based recommendations from the USDA and FNS, American Academy of Pediatrics, and the Academy of Nutrition and Dietetics 9. Identifies the impact of infant development on feeding. 10. Understands the nutritional needs of infants. 11. Makes correct recommendations regarding infant feeding. 12. Educates participants about nutrition-related problems experienced by infants. Breastfeeding Level 1 Online course Breastfeeding Level 2 Module or Breastfeeding Level 2 Training Infant Feeding and Nutrition Module Infant Formula Module Baby Behaviors Online Course Responsive Parenting Course Child Nutrition Relevant evidence-based recommendations from the American Academy of Pediatrics, and the Academy of Nutrition and Dietetics 13. Understands the development and nutritional needs of children 1-5 years of age. 14. Educates participants about nutrition related problems experienced by children 1-5 years of age. 15. Makes correct recommendations to participants on feeding practices for children 1-5 years of age. Child Nutrition Online Course Responsive Parenting Course Toddler Behaviors Relevant evidence-based recommendations from the American Academy of Pediatrics, and the Academy of Nutrition and Dietetics 16. Recognizes factors that may contribute to childhood obesity. 17. Provides appropriate counseling for parents, with the goal of promoting a healthy weight for their child. Child Nutrition Online Course Toddler Behaviors

Competent Professional Authority (CPA): Requirements, Continued 660.11 Knowledge Required Competency Training Methods Prenatal Nutrition Relevant evidence-based recommendations from the Academy of Nutrition and Dietetics, the American College of Obstetrics and Gynecology, and the International Lactation Consultant Association 18. Recognizes factors relating to weight gain in pregnancy. 19. Identifies the importance of proper nutrition for a healthy mother and baby. 20. Makes recommendations to participant on safe practices and behaviors that impact pregnancy. 21. Recognizes the importance of referral and follow-up of women with nutrition-related health problems. 22. Able to work with pregnant women from special population groups. Prenatal Nutrition Online Course

Breastfeeding Relevant evidence-based recommendations from the American Academy of Pediatrics, the Academy of Nutrition and Dietetics, the American College of Obstetrics and Gynecology, and the International Lactation Consultant Association 23. Promotes breastfeeding as the biological norm for feeding infants. 24. Recognizes potential concerns related to breastfeeding and refers participants appropriately. 25. Recognizes health and lifestyle contraindications to breastfeeding. 26. Assesses real and perceived barriers to breastfeeding and counsels to assist mothers to overcome these barriers. Intro to WIC Module

Breastfeeding Level 1 Online Course

Breastfeeding Level 2 module or Breastfeeding Level 2 Training

Competent Professional Authority (CPA): Requirements, Continued 660.12 Knowledge Required Competency Training Methods The basic physiology of lactation and evidence- based techniques for lactation management

27. Applies knowledge of anatomy and physiology in the assessment of normal breastfeeding and breastfeeding problems. 28. Demonstrates and assesses effective practices that support breastfeeding. 29. Completes breastfeeding assessments at critical points in pregnancy and the early postpartum period according to State agency policies. 30. Analyzes common breastfeeding problems and identifies solutions using evidence-based information. Breastfeeding Level 2 Module or Breastfeeding Level 2 Training

Baby Behaviors Online Course Breast pumps 31. Appropriately issues and explains the use of breast pumps. Breastfeeding Level 2 Module or BF Level 2 Training Breast Pump Handbook TWIST Training Manual

Postpartum Women Relevant evidence-based recommendations from the Academy of Nutrition and Dietetics, and the American College of Obstetrics and Gynecology 32. Understands the nutritional needs of postpartum women. 33. Makes correct recommendations to postpartum participants regarding interconception health. Postpartum Nutrition Online Course Family Food Environment Relevant evidence-based recommendations from US Department of Health and Human Services, American Academy of Pediatrics, and Healthy Eating Research 34. Recognizes the role of parenting style and responsive feeding in the development and well-being of infants and children. 35. Makes correct recommendations to parents and caregivers regarding parent-child feeding relationships and behaviors. Responsive Parenting module Toddler Behaviors

Competent Professional Authority (CPA): Requirements, Continued 660.13 4. Nutrition Assessment Process Competency Area: Understands the WIC nutrition assessment process including risk assignment and documentation. Knowledge Required Competency Training Methods Purpose of nutrition assessment in the WIC Program and how to collect accurate and relevant information 1. Uses nutrition assessment information to determine eligibility, select appropriate food packages, provide appropriate nutrition education, and make appropriate referrals. 2. Provides individualized nutrition assessment for WIC participants. 3. Uses assessment techniques that consider the varied needs of age- specific populations. 4. Obtains relevant assessment data from current and previous WIC visits, including anthropometric, hematologic, clinical, dietary, family and social environment information. 5. Uses standardized data collection tools or procedures according to State agency policies. Nutrition Risk Module WIC Participant Centered Education Online Course Certifier’s Guide

TWIST Training Manual WIC nutrition risk criteria 6. Assigns nutrition risks correctly using appropriate cut-off values and definitions. 7. Provides appropriate follow up for assigned risk (i.e. high-risk referrals with the RD or second NE). Nutrition Risk Module Certifier’s Guide

Importance of documenting nutrition assessment results

8. Correctly documents nutrition risks according to State agency policies. 9. Maintains appropriate documentation of contacts with participants according to State agency policies. 10. Uses accepted documentation format for nutrition care plans according to State agency policies. Certifier’s Guide TWIST Training Manual

Competent Professional Authority (CPA): Requirements, Continued 660.14 5. Anthropometric and Hematologic Data Collection Techniques Competency Area: Understands the importance of using appropriate measurement techniques to collect anthropometric and hematologic data. Knowledge Required Competency Training Methods Relevance of anthropometric data to health and nutrition status

1. Demonstrates appropriate anthropometric measurement techniques specific to infants, children ages 2-5, and adults. 2. Accurately reads and records, and measures. 3. Correctly interprets growth data and prenatal weight gain. Anthropometric Online Course Nutrition Risk Module Relationship of hematologic parameters to health and nutrition status

4. Demonstrates appropriate techniques for performing a hemoglobin or hematocrit assessment. 5. Evaluates hemoglobin or hematocrit results correctly (e.g., adjusts for smoking and elevation, etc.). Hematology Online Course Nutrition Risk Module

Competent Professional Authority (CPA): Requirements, Continued 660.15 6. Communication

Competency Area: Knows how to develop rapport and foster open communication with participants and caretakers. Knowledge Required Competency Training Methods Principles of effective communication

1. Uses appropriate techniques to establish a relationship and begin a conversation. 2. Practices active listening and observation skills. 3. Collects information without interrupting or correcting the applicant. 4. Checks for understanding by paraphrasing or reflecting what was heard. 5. Compares participants’ verbal responses to non-verbal behaviors to assess participants’ attitude, feelings, and readiness for change. 6. Uses an effective balance of open-ended and closed-ended questions. 7. Affirms participants’ feelings, beliefs and efforts. 8. Expresses empathy for the participants’ situation. 9. Completes nutrition assessment tasks before providing nutrition counseling. 10. Selects forms and materials for participants to complete that are appropriate for the target population (i.e. language, reading level, length, format) according to State agency policy. PCS Setting the Stage Online Course WIC Participant Centered Education Online Course Breastfeeding Level 2 Module or Breastfeeding Level 2 Training

Competent Professional Authority (CPA): Requirements, Continued 660.16 Knowledge Required Competency Training Methods Principles of customer service 11. Provides excellent customer service in person and on the phone to WIC participants, vendors, medical providers, community partners, and referral organizations. PCS Setting the Stage Online Course Principles of health literacy 12. Utilizes principles of health literacy in spoken or written communication with participants. 13. Uses health literacy techniques to ensure participant understanding, such as avoiding WIC and medical jargon, or using the teachback method. Intro to WIC module Standards of practice for supporting resilience and providing trauma informed care 14. Recognizes the prevalence and impact of trauma on participants and staff. 15. Provide services that promote the physical and emotional safety of participants. 16. Provide services which facilitate healing, avoid re-traumatization, and promote choice and empowerment. 17. Provides services that focus on strength and resilience. ACE’s and Trauma Informed Practice online course

Competent Professional Authority (CPA): Requirements, Continued 660.17 7. Multicultural and Socio-economic Awareness

Competency Area: Understands how sociocultural issues (race, ethnicity, religion, group affiliation, historical trauma or lived experience, gender, educational level, built environment, behavioral health, socioeconomic status, and world view) affect nutrition and health practices and nutrition-related health problems. Knowledge Required Competency Training Methods Cultural groups in the target population including their families and communities, values and beliefs, characteristics, and resources

1. Respects different belief systems about issues such as blood work, immunizations, dietary supplements, alternative medicine, and traditional healers. 2. Evaluates socio-cultural practices for their potential to influence the participants’ health or nutritional status. Intro to WIC WIC Participant Centered Education Online Course Food Package Module Cultural eating patterns and family traditions such as core foods, traditional celebrations, and fasting

3. Includes a culture’s core foods and recognizes their nutrient contributions in any assessment of eating patterns. 4. Evaluates food selection and preparation within a cultural context. Food Package Module Differences in communication styles between groups and how these differences may impact the certification process 5. Uses socio-culturally appropriate communication styles to collect nutrition assessment information and provide participant centered counseling. 6. Uses interpretation and/or translation services appropriately to communicate with participants with limited English proficiency. 7. Uses culturally appropriate strategies to assess breastfeeding and child feeding practices and beliefs. WIC Participant Centered Education Online Course Breastfeeding Level 2 Module or Breastfeeding Level 2 Training Certifier’s Guide Theory of social determinants of health 8. Recognizes impact of the social determinants of health on participant’s family environment. Intro to WIC module Certifier’s Guide

Competent Professional Authority (CPA): Requirements, Continued 660.18 Knowledge Required Competency Training Methods 9. Tailors services provided to participants based on their family environment. 10. Appropriately screens and refers for food insecurity.

Competent Professional Authority (CPA): Requirements, Continued 660.19 8. Critical Thinking

Competency Area: Knows how to synthesize and analyze data to draw appropriate conclusions. Knowledge Required Competency Training Methods Principles of critical thinking 1. Collects all information before drawing conclusions and deciding upon the best next steps (course of action). 2. Asks additional questions to clarify information or gather more details. 3. Recognizes superfluous or tangential information and disregards it. 4. Considers the applicant’s point of view regarding their needs, concerns, and nutrition and health priorities. 5. Recognizes factors that contribute to the identified nutrition problem(s). 6. Identifies relationships between behaviors/practices and nutritional risk. 7. Checks the accuracy of inconsistent or unusual measurements. 8. Identifies factors that influence the accuracy of anthropometric or hematologic measurements (e.g. uncooperative child or faulty equipment) and documents them. Takes appropriate actions (e.g., rechecks measurements, documents factors that interfere with measurements). 9. Draws conclusions about nutritional status supported by objective data, observations, experience, and reasoning. 10. Prioritizes nutrition concerns to be addressed. 11. Assigns the food package most appropriate to the participants’ category, risk, and personal preferences. Certifier’s Guide WIC Participant Centered Education Online Course Hematology online course Anthropometric online course Scope of practice 12. Works within the scope of practice for their position and accesses appropriate resources. CPA Guide (TBD) Breastfeeding Level 2 Module or Breastfeeding Level 2 Training

Competent Professional Authority (CPA): Requirements, Continued 660.20 9. Technology Literacy

Competency Area: Uses technology to record participant data, schedule appointments and produce vouchers. Knowledge Required Competency Training Methods Computer use 1. Demonstrates basic computer skills. Local Agency Training Supervisor Data system 2. Records correct participant information in the data system. 3. Uses the data system to document nutrition assessment data including anthropometric measurements, hemoglobin or hematocrit levels, health history and diet assessment information. 4. Uses the data system to record participant contacts, care plans, and nutrition education provided. 5. Makes appropriate food package selections and correctly records them in the data system. 6. Identifies appropriate food benefits to be issued. 7. Coordinates food benefit issuance with nutrition education. 8. Schedules appropriate appointments for participants. 9. Enters data accurately. 10. Locates and utilizes needed reports. TWIST Training Manual TWIST CPA Training Certifier’s Guide

Competent Professional Authority (CPA): Requirements, Continued 660.21 10. Nutrition Education

Competency Area: Provides appropriate targeted Nutrition Education for WIC participants using principles of participant centered education in both individual and group settings. Knowledge Required Competency Training Methods Marketing 1. Positively promotes nutrition education to WIC participants. Intro to WIC Module Principles of participant centered education

Adult Learning Theory

Elements of effective nutrition education 2. Uses and demonstrates key educator behaviors of participant- centered education. 3. Understands the factors that influence an individual’s food behavior. 4. During a given visit, selects with the participant, a limited number of issues to discuss from all the potential nutrition issues. 5. Uses assessment information to select nutrition education concepts that engage the participant in setting individual, simple and attainable next steps to improve their health outcomes. 6. Provide participants with clear and relevant “how to” actions and ideas to accomplish participant-identified next steps 7. Focuses nutrition education on participant strengths and interests. 8. Provides health-outcome based anticipatory guidance. 9. Uses effective counseling methods or teaching strategies that are relevant to the participants’ nutritional risk and interests and are easily understood. 10. When providing nutrition education, assesses the effectiveness of previous interventions on behavior change. 11. Selects research-based education materials based on the WIC Participant Centered Education Online Course

Breastfeeding Level 2 Training

Competent Professional Authority (CPA): Requirements, Continued 660.22 Knowledge Required Competency Training Methods participants’ language, culture, literacy level and interests and effectively presents the material to the participant. 12. Maintains an environment that promotes good nutrition and health. 13. Uses counseling strategies to build participant self-efficacy. Providing Group Nutrition Education – Only required for CPAs teaching classes Adult Learning Theory Facilitation techniques 14. Develops and prepares session guides, activities, and materials based on adult learning theory, participants’ needs, interests, age, and abilities. 15. Effectively facilitates group nutrition education sessions. 16. Engages participants in hands-on learning to achieve positive health outcomes. 17. Uses creative facilitation strategies that build on participants learning styles (ways of learning), strengths, prior knowledge, and skills. 18. Creates a respectful learning environment in which participants in a group feel comfortable participating. 19. Provides positive reinforcement in a group setting. 20. Improve group offerings and facilitation skills/techniques using evaluation results. 21. Appropriately uses audiovisual equipment and materials. 22. Organizes and maintains education materials, supplies, and equipment. Providing Participant Centered Groups Module

Competent Professional Authority (CPA): Requirements, Continued 660.23 11. Community Resources and Referrals

Competency Area: Identifies community resources and refers WIC participants for appropriate services. Knowledge Required Competency Training Methods Community resources and referral process 1. Identifies key referral resources available to WIC staff. 2. Considers social determinants of health and determines the most effective referrals to provide. 3. Gives participants appropriate referrals into health care. 4. Gives participants appropriate referrals to community resources, including mandatory referrals to OHP, drug and alcohol services. 5. Documents referrals appropriately. 6. Follows up with participants on the outcome of referrals made. Certifier’s Guide Intro to WIC Module

Immunization schedule 7. Screens participants’ immunization records and refers appropriately. Certifier’s Guide Community partnerships 8. Knows community demographics, resources, needs and issues. Certifier’s Guide

Competent Professional Authority (CPA): Requirements, Continued 660.24 References Value Enhanced Nutrition Assessment (VENA) in WIC – The First Step in Quality Nutrition Services notebook, USDA - FNS, June 2006, Appendix D: Essential Staff Competency Tables for WIC Nutrition Assessment* Nutrition Services Standards, USDA – FNS, August 2013 WIC Nutrition Education Guidance, USDA – FNS, All States Memorandum 06-24, January 2006 “Personal Attributes and Job Competencies Needed by EFNEP Paraprofessionals as Perceived by EFNEP Professionals”, Journal of Nutrition Education and Behavior, Volume 35, Number 1 Food Stamp Nutrition Education Paraprofessional Nutrition Educators Core Competencies, Draft presented at the 2006 Society for Nutrition Education Conference Paraprofessionals in the WIC Program: Guidelines for Developing a Model Training Program, United States Department of Agriculture, Food and Nutrition Service, FNS269, 1993. Regulations associated with core competency areas

CPA Core Area Regulation (CFR) Other 1. Program Integrity 246.7(j) 246.8

2. WIC Program Overview 246.12

3. Principles of life-cycle nutrition • Prenatal (maternal) • Breastfeeding • Infant • Child/toddler • BF promotion and Support • Postpartum women • Family food environment

246.11(c)(2)

4. Nutrition Assessment process • Risk Criteria • Diet Assessment

246.7(e)

Competent Professional Authority (CPA): Requirements, Continued 660.25

CPA Core Area Regulation (CFR) Other 5. Anthropometric and hematologic data collection • Anthropometric • Biochemical

Standing orders 6. Communication • Customer Service • Counseling • Health literacy • Trauma and resilience informed practice

House concurrent resolution 33 7. Multicultural and socioeconomic awareness

REAL-D OARs 8. Critical thinking • Medical/health/economic/social influences • Food package assignment • Individual care plans

246.10(b)(2)(iii) 246.11(e)(5)

9. Technology Literacy

10 Nutrition Education • Nutrition-focused Counseling • Providing group nutrition education

246.11(c)(2)

11 Community Resources and Referrals 246.7(b)