820.1 Policy 820 Quarterly Nutrition Education Contacts October1, 2025 (Revised) POLICY Nutrition-focused education must be provided at least quarterly to all adult participants, to the parent or caregiver of infant and child participants, and to the children themselves when possible. PURPOSE

To ensure that appropriate nutrition-focused education is made available to all participants on a routine basis and to establish standards for nutrition education contacts. RELEVANT REGULATIONS 7 CFR §246.6 ¶(b)—Goals 7 CFR §246.11 ¶(c)(4) and (7)—State agency responsibilities, ¶(e)—Participant contacts ASM 06-24—WIC Nutrition Education Guidance OREGON WIC PPM REFERENCES ♦ 510—WIC Cardholder Requirements ♦ 635—Participant Notification: Eligibility and Rights & Responsibilities ♦ 645—Certification Periods ♦ 646—Mid-Certification Health Assessment ♦ 660—Competent Professional Authority: Requirements ♦ 661---High Risk Caseload Management ♦ 670—Risk Criteria: Overview ♦ 675—Risk Criteria: Codes and Descriptions ♦ 810—Nutrition-Focused Education and Counseling ♦ 840—Documentation of Nutrition-Focused Education and Counseling BACKGROUND The WIC Program is a public health nutrition program which aims to improve the life-long health of its participants through breastfeeding and nutrition education. Local agencies are required to provide nutrition education and counseling to program participants. Providing quarterly nutrition-focused educational opportunities is key to helping families achieve positive health outcomes. DEFINITIONS Certification period: Length of time participant will be enrolled in WIC and receive WIC benefits. Refer to 645—Certification Periods.

Quarterly Nutrition Education Contacts, Continued 820.2 High-Risk Participant: A participant with a health risk that has been identified to meet one of the state’s high-risk criteria. Refer to 661--High Risk Caseload Management Individual care plan: A written plan that outlines actions that will assist the participant in assuming responsibility for improving identified health-related problems on a prioritized basis. Nutrition-Focused Counseling: An interactive helping process focused on eating behaviors, physical activity, and lifestyle, designed to improve health status and help participants to achieve their personal goals. Nutritional risk: A health or dietary condition that indicates a nutrition-related health problem or need and is required for program eligibility. Quarterly nutrition education: Nutrition education opportunities that are offered at least every three months (quarterly) in an individual or group setting. Includes nutrition education provided during a mid-cert health assessment, online lesson, or counseling with the WIC Nutritionist. Self-paced lessons: Materials designed to be completed individually at the participant’s own speed. WIC Nutritionist: A professional who meets one of the following qualifications: a Registered Dietitian Nutritionist (RDN) with the Academy of Nutrition and Dietetics (AND), or eligible for AND registration; a master’s or doctoral degree in the field of nutrition from an accredited college or university; or an Oregon Licensed Dietitian (LD). SECTION LIST 1.0 First contact in certification period 2.0 Quarterly nutrition education contacts 3.0 Group nutrition education 4.0 Online nutrition education using WICHealth.org 5.0 Self-paced lessons 6.0 Locally developed online or self-paced nutrition education lessons 7.0 Using partners to enhance WIC group education onsite 8.0 Nutrition education provided offsite by non-WIC programs 9.0 Alternative methods of providing quarterly nutrition education PROCEDURE First contact in certification period 1.0 The first nutrition education contact is made at the time of certification (or recertification) and is an interaction between the participant and the WIC certifier. It includes the following Competent Professional Authority (CPA) actions: • Targeting nutrition-focused counseling to the participant’s specific nutrition needs and interests. • Assisting the participant with identifying next steps for specific behavior change. • Establishing a connection between the participant’s program eligibility, assessment information and desired health outcomes. 1.1. The nutrition-focused counseling provided should match the interest, motivation level (stage of change), and cultural or language needs of the

Quarterly Nutrition Education Contacts, Continued 820.3 participant, parent or caregiver. Document the nutrition education provided in the participant’s record. 1.2. Help the participant to self-identify one or more behavior changes, or “Next Steps” that the participant will take during the certification period, and document this in the participant’s record. Staff should also review and update the status of any previous “Next Steps” at each mid-certification and recertification visit. 1.3. Close the certification (or recertification) appointment with a summary that includes the participant’s program eligibility, assessment information and a health outcome statement. 1.3.1. Use plain language to inform the participant of the reason for enrollment on the program, emphasizing the connection between nutrition and health and how WIC can help. 1.3.2. Do not share specific risk factors; instead, explain the reasons why the participant qualifies for WIC in a positive way that relates to health/nutrition and is easy to understand. For example: “Your child is being enrolled in the WIC Program, so we can help with his nutrition and watch his growth and weight gain over the next year.” For more information, see policies 635—Participant Notification: Eligibility, Rights and Responsibilities, 670—Overview of Risk Criteria and Priorities and 675—Risk Criteria: Codes and Descriptions. Quarterly nutrition education contacts 2.0 WIC participants, parents or caregivers shall receive a minimum of four nutrition education contacts during the 1-year certification period. These occur at the following times: certification, quarterly contact, mid-certification health assessment, quarterly contact. After recertification, the process repeats. See 646—Mid-Certification Health Assessment for additional details. 2.1. The CPA works with the participant to identify and choose a quarterly nutrition education contact most appropriate to the nutritional risk status of the participant. 2.2. High-risk participants receive contacts according to the individual care plan developed by the WIC Nutritionist. See 661—High Risk Caseload Management The WIC Nutritionist sees high-risk participants at least twice in each one-year certification period. 2.2.1. High risk participants may take alternate or low risk nutrition education when they have already seen the WIC Nutritionist for the required two appointments. For example, the participant has seen the WIC Nutritionist for a quarterly follow up and the mid- certification. 2.3. Schedule participants who are not high-risk for either online learning, a self- paced lesson, group sessions or an individual appointment.

Quarterly Nutrition Education Contacts, Continued 820.4 2.3.1. The quarterly contact must relate to the participant’s nutritional risk(s) and individual nutritional needs, and respect cultural and individual preferences. 2.4. All nutrition education contacts must include two-way communication with participants, including appointments that utilize audiovisual and/or printed nutrition education materials, online or self-guided materials, or electronic communication tools such as secure email, text messaging, phone or interactive video technology. Group nutrition education 3.0 A session guide must be developed and on file for all group nutrition offerings. The session guide provides an outline of the group topic and the content to be covered. 3.1. Local program session guides for nutrition groups, including walk-in style classes/fairs, must be kept on file at the local program and should include measurable goals and learning objectives. See the Oregon WIC Training Module “Providing Participant Centered Groups” for more information. 3.2. Local programs will enter group titles, duration, language and dates offered into the data system to assist with documentation of participant attendance. 3.3. A session guide providing an outline of the class topic and content must be on file and available to view during biennial reviews. Include the following elements in the session guide: • Target audience • Overall goal or purpose • Specific objectives and/or activities to be included • Key content points Online nutrition education using WICHealth.org 4.0 All local agencies must offer the option of online nutrition education using the WICHealth.org platform. Online lessons from WICHealth.org may be used to provide quarterly nutrition education for those who are eligible. Each lesson has an interactive component that fulfills requirements for two-way communication. Pregnant, breastfeeding and postpartum participants, parents, foster parents or caregivers must: • Be low or medium risk • Express an interest in the online nutrition education option • Have access to an appropriate device for completing online lessons • Be able to read and comprehend English or Spanish

4.1. To offer online nutrition education, the WIC CPA will: 4.1.1. Determine if the participant is eligible for online nutrition education and whether it is an appropriate option for that participant or family. 4.1.2. Explain the process for completing the online lesson, including written instructions on how to access the lesson.

Quarterly Nutrition Education Contacts, Continued 820.5 4.1.3. Schedule the online lesson into the participant’s record. 4.2. When the participant has completed the lesson, a designated WIC staff member (CPA or any staff member who has completed the training necessary to fill this role. See details in section 4.3) will do the following: 4.2.1. Electronically verify lesson completion via WIC Health. Participants are not required to provide a certificate of completion. 4.2.2. Review the section of the certificate that displays the participant’s Action Statement and any questions they recorded. 4.2.3. Contact the participant to follow-up on any questions asked. If there are no questions, proceed to benefit issuance. If unable to reach the participant, document the questions in the participant’s record. 4.2.4. Once the online lesson has been verified, check the timing for benefit issuance. Food benefits may be scheduled or issued for a time frame not to exceed 3 months. 4.2.5. Schedule the next appointment or appointment request. 4.2.6. Document attendance and the name of the lesson taken in the appropriate fields in the participant’s record. See 840— Documentation of Nutrition-Focused Education and Counseling for further details. 4.2.7. The specific online nutrition lesson may be used only once as a quarterly nutrition contact. The same lesson may not be used multiple times for the same participant. 4.2.8. Only one lesson needs to be completed per family. Document completion of the lesson in each family members record. 4.3. WIC staff members involved in verifying online quarterly nutrition contacts must receive training on how to fill this role effectively. At a minimum, training is to include the following elements: 4.3.1. Knowledge of state policies ♦810, ♦820 and ♦840 on the provision of nutrition education. 4.3.2. Knowledge of the local agency’s policy and procedures which are to be followed in the provision of online nutrition education, including documentation in the WIC data system. 4.3.3. Familiarity with the WICHealth.org website, including the format and topic areas, the names of the lessons available, how to access the lessons, and how to use the look-up features to electronically verify lesson completion for WIC participants. 4.3.4. Review the content of at least three lessons in different topic areas on the WICHealth.org website. 4.3.5. Knowledge of how to refer the participant to a CPA or health professional in the agency if the participant has questions or requests information outside of the staff member’s scope of practice.

Quarterly Nutrition Education Contacts, Continued 820.6 4.4. Additional information and staff resources for providing online nutrition lessons can be found on the Oregon WIC website. 4.4.1. Participants may be referred to this webpage: https://www.oregon.gov/oha/ph/HealthyPeopleFamilies/wic/Online NutritionEducation/Pages/index.aspx 4.4.2. Staff resources are available here: https://www.oregon.gov/OHA/PH/HEALTHYPEOPLEFAMILIES/WI C/Pages/ne-resources.aspx#online Self-paced lessons 5.0 Self-paced lessons provide nutrition information in a written format. The self-paced lessons offered by the State agency can be found at oregon.wicresources.org. Each title is a lesson topic. See section 6.5 for information on self-paced lessons developed by the local agency. 5.1. Self-paced lessons may be offered to low and medium risk participants, and to parents, foster parents, or caregivers of low or medium risk infants and children. 5.2. A CPA (or any staff member who has completed the training necessary to fill this role) will determine if the participant is eligible for a self-paced lesson and whether it is the best option for that participant or family. If appropriate, the WIC staff member will: 5.2.1. Explain the process for completing the self-paced lesson. 5.2.2. Review with the participant what was learned or what the participant plans to do differently after completing the self-paced lesson via two-way communication with the participant. 5.2.3. Document lesson completion in the participant’s record, including the specific lesson the participant completed. Each lesson may be used only once as a quarterly nutrition contact. The same lesson may not be used multiple times for the same participant. See 840—Documentation of Nutrition-Focused Education and Counseling for specific details. 5.2.4. Only one lesson needs to be completed per family. Document completion of the lesson in each family members record. Locally developed online or self-paced nutrition education lessons 6.0 Local agencies interested in developing their own online or self-paced lessons to meet quarterly nutrition education requirements for participants shall use the procedure outlined below. State approval must be obtained before implementing a lesson. 6.1. Create a draft of the nutrition lesson that includes the elements below. • Target audience • Overall goal or purpose • Specific objectives and/or activities to be included; if lesson is online, include specific websites that participants will be directed to visit

Quarterly Nutrition Education Contacts, Continued 820.7 • Key content points • Estimate of time needed to complete the lesson • Activity or questions participants will complete 6.2. Ensure that the content of the lesson is accurate, and that only evidence- based information and/or reputable websites are used. 6.3. Follow health literacy principles when designing the lesson, including font size, white space and reading level. Consider the readability and design of any website that is recommended for online lessons. 6.4. Include a plan for how your agency will determine which participants will be offered the lesson, how it will be explained, how participants will inform WIC staff of lesson completion, and how it will be documented in the data system. 6.5. The local agency WIC Nutritionist must review and approve the lesson prior to submission to the State agency. 6.6. Complete the Local Agency Approval Form for Self-Paced or Online Lesson, with the required information. Submit it, along with the self-paced lesson or link to the online lesson, to your state assigned nutrition consultant. The lesson will be evaluated by several state staff. Allow 2-3 weeks for this review. 6.7. If modifications are needed, it will be returned to the local agency for revision and will need to be re-submitted before final approval is given. 6.8. Once approved, let the State agency know if your agency gives permission for the lesson to be shared with other local agencies. 6.9. Titles of lessons that are approved for statewide use will be added to the nutrition education topics list in the WIC data system to simplify the documentation process. Using partners to enhance WIC education onsite 7.0 Community experts who have special knowledge or nutrition expertise may either assist or provide education in the local agency. 7.1. The community expert must be a health professional (e.g. Nurse, Dental Hygienist), be supervised by a qualified RDN/nutritionist or health professional or Expanded Food and Nutrition Education Program (EFNEP) staff) or be an OSU Extension Master Gardener. 7.2. A session guide providing an outline of the topic and content must be on file and available to view during biennial reviews. Include the following elements in the session guide: • Target audience • Overall goal or purpose • Specific objectives and/or activities to be included • Key content points • Community expert’s name and credentials

Quarterly Nutrition Education Contacts, Continued 820.8 7.3. For individual nutrition education (example Dental Hygienist) key content points and activities provided by the partner and the credentials of the staff providing nutrition education may be listed in the MOU instead of creating a session guide. 7.4. A written agreement between the local WIC agency and partnering agency is not required if WIC staff are present in the nutrition education group. If the partnering agency is providing nutrition education and a WIC staff member is not present, a written agreement is required 7.5. Partnering with EFNEP requires more consideration due to funding restrictions. Complete a Memorandum of Understanding (MOU) which includes a list of responsibilities of each party. 7.5.1. EFNEP must avoid duplicating efforts with WIC. At the WIC clinic, OSU Extension EFNEP staff may jointly teach a lesson with WIC staff or may teach a single nutrition education lesson from the EFNEP series. Examples of appropriate lessons taught by EFNEP staff include those on shopping or food preparation, rather than breastfeeding or infancy which is to be covered by WIC staff. • If EFNEP staff provide a single day event and/or stand-alone lesson with a Food Hero food demo or food related activity for recruitment purposes, this cannot be used as a WIC education contact. Nutrition education provided offsite by non-WIC programs. 8.0 An outside agency may be used to provide group nutrition education opportunities for participants, provided the arrangement has been coordinated ahead of time and all the necessary requirements are in place. Examples of outside agencies include Head Start, OSU EFNEP nutrition series classes, Master Gardener Program and Cooking Matters class. 8.1. Local WIC programs interested in partnering with an outside agency to provide nutrition education must ensure the following: 8.1.1. The nutrition topic must be appropriate for the WIC population. 8.1.2. The staff providing the nutrition education must be a health professional or be supervised by a qualified RDN/WIC nutritionist or a health professional. See 660—Competent Professional Authority: Requirements. 8.1.3. A session guide providing an outline of the class topic and content must be on file and available to view during biennial reviews. Include the following elements in the session guide:  Target audience  Overall goal or purpose  Specific objectives and/or activities to be included  Key content points  Presenter name and credentials

Quarterly Nutrition Education Contacts, Continued 820.9 8.1.4. For individual nutrition education (example Dental Hygienist) key content points and activities provided by the partner and the credentials of the staff providing nutrition education may be listed in the MOU instead of creating a session guide. 8.2. A written agreement between the local WIC agency and the partnering agency is required. Details such as the class date, topic, facilitator, and names of those in attendance will be documented, and how/if WIC benefits will be issued on site, must be included. 8.3. Keep a copy of the agreement on file at the local program for monitoring purposes. 8.4. Participants referred to nutrition education provided by an outside agency must meet the following eligibility criteria: 8.4.1. The nutrition education opportunity relates to the participant’s nutritional risk(s), individual nutrition needs, and cultural preferences. 8.4.2. The participant expresses an interest in the education opportunity. 8.4.3. The participant is a low or medium risk pregnant, breastfeeding or postpartum participant, or the parent, foster parent or caregiver of a low or medium risk infant or child. 8.5. Coordinate benefit issuance to ensure participants receive benefits in a timely manner. If a WIC staff member (and necessary computer equipment) is available to attend the event, benefits may be issued on site. An alternative is to provide the WIC agency, or an individual participant, with forms verifying participant attendance, so that benefits may be issued by local WIC staff off site. 8.6. Document nutrition education provided accurately. See 840—Documentation of Nutrition-Focused Education and Counseling for sample forms and details on how to appropriately document nutrition education attendance in the WIC data system. Alternative methods of providing quarterly nutrition education 9.0 Alternative methods to interact with participants may be used to provide quarterly nutrition-focused counseling. These methods, which do not use face-to-face communication, include: • Telephone contacts • Interactive video technology • Texting using an approved HIPAA-compliant service • Other methods, such as secure email or a secure electronic chat feature 9.1.1. Nutrition-focused counseling provided by an alternative method must meet the same requirements as contacts that are face-to- face. See 810—Nutrition-Focused Education and Counseling for specific details. 9.2. Ensure that any alternative communication methods used at the local agency occur in an environment that promotes effective communication, and protects

Quarterly Nutrition Education Contacts, Continued 820.10 the confidentiality of participant information, such as an approved HIPAA- compliant service on a secure platform. 9.2.1. Contact the participant in advance to schedule the appointment. Schedule the same amount of time for the follow-up as would occur in a face-to-face appointment, to ensure there is adequate time to complete all program requirements. 9.2.2. Schedule the contact at a time when the participant is available and has time to talk or text. If the participant is not available at the designated time, reschedule the contact. 9.3. Prior to the appointment, review the participant’s record to see previous goals, items on which to follow-up, and possible ideas for nutrition-related conversation topics. This preparation will be helpful if the participant is unsure of what to discuss. 9.4. When contact is made, verify the identity of the caller to ensure it is the first or second cardholder. See 510—WIC Cardholder Requirements for details. 9.5. Use participant centered skills to establish rapport, ask questions, and learn what nutrition topics are of interest to the participant. This applies to all methods of communication, including written forms such texting or secure email. 9.6. When finished, document the conversation in the participant’s record, indicating the topics discussed, and next steps, if applicable. See 840— Documentation of Nutrition-Focused Education and Counseling for further details. REFERENCES 1. Oregon WIC Nutrition Education Guidance: https://www.oregon.gov/oha/ph/HealthyPeopleFamilies/wic/Documents/nutr-ed/2010- ne-guidance.pdf POLICY HISTORY Date * Major Revision, Minor revision 10/5/2018 Released 7/1/2019 Major Revision 10/01/2025 Minor 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

Quarterly Nutrition Education Contacts, Continued 820.11

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Quarterly Nutrition Education Contacts, Continued 820.12 END SHEET - OTIS Revision Tracking Sheet

Policy 820 – Quarterly Nutrition Education Contacts Designated Writer – Lauren Reviewer(s) – Perla

Expectation is that this Policy will require two versions (based on which MIS is in use): ☐ YES ☐ NO Expectation that this Policy will require updating during 2023 to current version regardless of MIS in use: ☐ YES ☐ NO

Anticipated Changes to OTIS Historical Notes Retained from Earlier Tracking

Updated Notes Regarding OTIS changes (potential, probable, uncertain, known)