West Virginia WIC Policy & Procedure 11.03 Effective Date: 11/17/21 11.03 Competent Professional Authority POLICY: Per Federal Regulations a Competent Professional Authority (CPA) is defined as an individual on the staff of the Local Agency who is authorized to determine nutritional risk and prescribe supplemental foods. The following people are defined as a CPA: Physicians, Nutritionists (Bachelor’s or Master’s degree in Nutritional Sciences, Community Nutrition, Clinical Nutrition, Dietetics, Public Health Nutrition or Family and Consumer Sciences with emphasis in Nutrition), Dietitians, Registered Nurses, Physician’s Assistants, or State or locally medically trained health officials. Five levels of nutrition interventions have been developed for personnel who provide nutrition education. Levels 1, 2, 3, 4 and 5 correspond to increasing levels of complexity of the nutrition intervention as well as increasing competency and technical skills required to provide the intervention. PROCEDURE: A. The five levels are defined as: Level 1: Nutritionist Assistant Non CPA Lowest Intervention Level – Limited assessment, cannot certify participants or assign food packages. Provides follow up education to low risk participants under nutritionist's supervision. Must complete designated WIC Learning Online Modules (see Policy 11.01, attachment #2, Resource List). Level 2: Nutritionist Associate CPA Moderate Intervention Level – Expanded assessment, can certify some participants and assign food packages. Provides initial nutrition education to all participants and follow up education to low risk participants under nutritionist’s supervision. Must complete all WIC Learning Online Modules (see Policy 11.01, attachment #2, Resource List). Includes LPNs, dietetic technicians. Prior to becoming a Nutrition Associate CPA, the employee must be observed and approved by the State Office. Level 3: Nutritionist I CPA High Intervention Level – Expanded assessment, can certify all participants and assign food packages. This is beginning level work in public health nutrition. Provides nutritional assessment, education and counseling to individuals and groups. Serves as a resource on nutrition and dietetics to nurses, health educators and other health care providers in local health departments, local public and private health care facilities and the community. Work is governed by federal regulations and state policies and procedures. Performs related work as required. Serve as preceptor for Nutrition Assistant and Nutrition Associate. Level 4: Nutritionist II CPA Higher Intervention Level – Expanded assessment, can certify all participants and assign food packages. Provide initial and follow up nutrition education to low and high-risk participants. Preferred provider for high risk participants. Reinforces nutrition goals and objectives. Works with other community programs to integrate nutrition services. In some settings, may perform management functions (i.e. supervise WIC nutrition and Page 1 of 13

West Virginia WIC Policy & Procedure 11.03 Effective Date: 11/17/21 11.03 Competent Professional Authority administrative staff). Includes Registered Dietitians. Serve as preceptor for Nutrition Assistant and Nutrition Associate. Level 5: Nutritionist III CPA Highest Intervention Level –who plans, directs, supervises, and evaluates nutrition programs and services. Oversees collaboration of nutrition services with other community programs. Performs management functions for nutrition program staff. May include Registered and/or Masters prepared nutritionist with emphasis in public health nutrition. Serve as preceptor for Nutrition Assistant and Nutrition Associate. B. Persons Authorized to Serve as a CPA The following tables define the roles of Level 1 through Level 5 staff in more detail. TABLE 1 NUTRITION SERVICE LEVEL 1 Nutritionist Assistant/Non CPA Lowest intervention level Nature of Work Under general supervision, performs at the assistant level of providing services to clients, such as income eligibility determination, referrals to health and human service programs, basic nutrition education, and breastfeeding education. Employees receive general supervision from a designated higher-level III, IV, or V Nutritionist position. Performs related work as required. Distinguishing Characteristics Employees at this level are distinguished by the assignment of paraprofessional-level duties in an assistant level in public health nutrition. The Nutrition Assistant provides basic nutrition education to groups and individuals. Work is governed by federal regulations and state and local policies and procedures. Employees at this level are distinguished by the assignment of duties requiring independent judgment in application of regulations, policies and procedures and nutrition theories. Typically, employees at this level have direct contact with clients and community service providers. Employees in this class do not have supervisory responsibilities. Examples of Work • Assists in providing general information about healthful foods, food buying and food preparation • Assists in nutrition education activities • Assists the nutritionist in preparation of materials and lesson plans • Orders and maintains nutrition education outreach materials/aids and supplies • Provides appropriate referrals • Collects and records routine information • Assists with the issuance, documentation and security of EBT food benefits • Maintains and calibrates equipment Page 2 of 13

West Virginia WIC Policy & Procedure 11.03 Effective Date: 11/17/21 11.03 Competent Professional Authority • Explains procedure for collecting measurements to clients • Acquiring and plotting anthropometric measurements • Acquiring and recording hematological measurements • Documents measurements (i.e. anthropometrics and blood work) • Explains WIC services to (potential) clients • Tracks enrollment and participation • Contacts clients for visits and missed appointments • Schedules appointments • Provides community outreach • Issue/clean breast pumps • Purchase foods for nutrition education class/ prepare snack samples • Use of Shopper’s Guide Food List and WIC food benefits Knowledge, Skills and Abilities • Ability to learn federal and state regulations, laws, standards, and statutes governing program or technical area. • Knowledge of West Virginia WIC Program policies and procedures related to certification, breastfeeding, nutrition education and food packages. • Knowledge of basic mathematics. • Ability to conduct client interviews to obtain accurate information necessary to determine WIC program eligibility. • Ability to perform nutrition and breastfeeding screening and identifying problems which place clients at nutrition risk. • Ability to provide nutrition and breastfeeding education for clients relevant to their identified nutrition risks. • Ability to apply WIC Program policies and procedures to individual client problems or needs. • Ability to use WIC computer system and Microsoft Office. • Ability to communicate well, both orally and in writing. • Ability to explain WIC Program, health and nutrition and breastfeeding information to clients. Minimum Qualifications for Nutrition Assistant High school graduate or equivalent Special Requirement for Nutrition Assistant Must complete designated WIC Learning Online Modules (see Policy 11.02 WIC Training Modules and Policy 11.02 Attachment #2, Resource List) Staff Requirements Completes WIC Learning Online Modules (See Policy 11.02 and Policy 11.02, attachment #2, Resource List) • Communicating with Participants • Using Active Listening in Workplace • Confronting Your Assumptions • Feeding Infants: Nourishing Attitudes and Techniques • Value Enhanced Nutrition Assessment Page 3 of 13

West Virginia WIC Policy & Procedure 11.03 Effective Date: 11/17/21 11.03 Competent Professional Authority • WIC 101 • WIC Baby Behavior • USDA Breastfeeding Curriculum (2020) – Level One • HemoCue Training (see Policy 11.02 Attachment #2 Resource List) • Making a Difference: Mandate to Report, Responsibility to Prevent Child Abuse & Neglect (see Policy 11.02 Attachment #2 Resource List • Security Training (see Policy 11.02 Attachment #2 Resource List) • Civil Rights Training (see Policy 11.02 Attachment #2 Resource List) TABLE 2 NUTRITION SERVICE LEVEL 2 Nutritionist Associate/CPA Moderate intervention level Nature of Work Under general supervision, performs at the associate level of work providing paraprofessional services to clients, such as income eligibility determination, health screening, and referrals to health and human service programs, basic nutrition education, and breastfeeding education. Employees receive general supervision from a designated higher-level III, IV, or V Nutritionist position or the State Office. Performs related work as required. Distinguishing Characteristics Employees at this level are distinguished by the assignment of paraprofessional-level duties in an associate level in public health nutrition. The Nutrition Associate provides basic nutrition and breastfeeding assessment, education, and counseling to groups and individuals. Work is governed by federal regulations and state and local policies and procedures. This employee certifies participants in the WIC Program, and provides breastfeeding counseling to WIC participants. Employees at this level are distinguished by the assignment of duties requiring independent judgment in application of regulations, policies and procedures and nutrition theories. The employee is responsible for the development and implementation of care plans for low-risk clients. Typically, employees at this level have more direct contact with clients and community service providers. Employees in this class do not have supervisory responsibilities. Examples of Work • Performs and records height and weight measurements. • Performs and records biochemical measurements, such as hemoglobin. • Screens the health, breastfeeding, and/or nutrition status of clients and identifies problems that place them at nutritional risk. • Issues, educates on usage of, and tracks electric breast pumps. • Determines WIC eligibility and completes certifications; issues WIC food benefits to certified clients. • Provides general health, breastfeeding, and nutrition information to low-risk clients through individual and group sessions. • Evaluates the need for and refers clients to other health, food assistance Page 4 of 13

West Virginia WIC Policy & Procedure 11.03 Effective Date: 11/17/21 11.03 Competent Professional Authority and social service programs. • Enters client data into automated health files. • Provides basic and complex breastfeeding information, encouragement, and counseling to WIC pregnant and breastfeeding mothers in WIC clinics, by telephone, and/or hospital visits at scheduled intervals. • Educates mothers about breastfeeding benefits and how to prevent and handle common breastfeeding problems, as well as providing assessment, education, and support for breastfeeding complications. Knowledge, Skills and Abilities • Ability to learn federal and state regulations, laws, standards, and statutes governing program or technical area. • Knowledge of West Virginia WIC Program policies and procedures related to certification, breastfeeding, nutrition education and food packages. • Knowledge of basic mathematics. • Ability to conduct client interviews to obtain accurate information necessary to determine WIC program eligibility. • Ability to perform nutrition and breastfeeding screening and identifying problems which place clients at nutrition risk. • Ability to provide nutrition and breastfeeding education for clients relevant to their identified nutrition risks. • Ability to apply WIC Program policies and procedures to individual client problems or needs. • Ability to use WIC computer system and word processing. • Ability to collect and compile accurate information to develop a nutrition care plan. • Ability to communicate well, both orally and in writing. • Ability to analyze complex situations and uses sound judgment in decisions related to nutrition and breastfeeding services. • Ability to explain WIC Program, health and nutrition and breastfeeding information to clients. Minimum Qualifications for Nutrition Associate Training: Associate’s degree from a regionally accredited college or university in food or nutrition-related field, food service management, dietary management, LPN, or related field. Substitution: Additional experience as described below may be substituted for the training on a year for year basis. Experience: One year of full-time or equivalent part-time paid experience in nutrition. Special Requirement for Nutrition Associate Competency-based/on-the-job training for certifying low-risk participants in WIC Program, or equivalent experience providing nutrition education. Staff Requirements Completes WIC Learning Online Modules: (see Policy 11.02 WIC Training Modules and Policy 11.02 Attachment #2 Resource List) • Communicating with Participants Page 5 of 13

West Virginia WIC Policy & Procedure 11.03 Effective Date: 11/17/21 11.03 Competent Professional Authority • Using Active Listening in Workplace Situations • Confronting Your Assumptions • Feeding Infants: Nourishing Attitudes and Techniques • VENA • WIC 101 • WIC Baby Behavior • USDA Breastfeeding Curriculum (2020) – Levels One and Two • HemoCue Training (see Policy 11.02 Attachment #2 Resource List) • Making a Difference: Mandate to Report, Responsibility to Prevent Child Abuse & Neglect (see Policy 11.02 Attachment #2 Resource List) • Security Training (see Policy 11.02 Attachment #2 Resource List Civil Rights Training (see Policy 11.02 Attachment #2 Resource List) Prior to becoming a Nutrition Associate CPA, the employee must be observed and approved by the State Office. TABLE 3 NUTRITION SERVICE LEVEL 3 Nutritionist I /CPA High intervention level Nature of Work Under general supervision, performs beginning level professional work by promoting and presenting public health nutrition programs. Performs related work as required. Public contact and travel are required. Distinguishing Characteristics This is beginning level work in public health nutrition. The Nutritionist 1 provides nutritional assessment, education and counseling to individuals and groups, primarily prenatal and pediatric clinics, with emphasis on participants in the Special Supplemental Food Program for Women, Infants, and Children (WIC). Serves as a resource on nutrition and dietetics to nurses, health educators and other health care providers in local health departments, local public and private health care facilities and the community. Work is governed by federal regulations and state policies and procedures. Performs related work as required. Examples of Work • Evaluates and certifies the eligibility of applicants for participation in the WIC Program. • Assesses and documents nutritional risk status of participants. • Counsels participants concerning diet and food selections. • Recommends a WIC food package tailored to the participant's needs. • Prepares and presents nutrition classes to WIC participants, as well as other interested groups. • Refers WIC participants to appropriate health and social agencies for additional assistance. Page 6 of 13

West Virginia WIC Policy & Procedure 11.03 Effective Date: 11/17/21 11.03 Competent Professional Authority • Serves as a resource on nutrition and dietetics to the staff of local health departments, local health care facilities, community health and human service agencies. • Distributes current nutrition promotional/educational materials. • Attends in-service training, meetings, seminars and workshops pertaining to current practices in the field of nutrition. Knowledge, Skills and Abilities • Knowledge of the principles and practices of dietetics and nutrition, as related to public health and individual and family food needs. • Knowledge of the organization of community health services, food services, food assistance and nutrition education resources. • Knowledge of developments in the field of public health as related to nutrition. • Skill in interviewing participants, assessing their nutritional status and counseling concerning nutrition. • Skill in conducting group nutrition education sessions. • Ability to establish and maintain effective working relationships with professional and lay groups concerning the development of nutrition programs. • Ability to communicate effectively, both orally and in writing. • Ability to create and develop educational and instructional materials effectively. • Ability to assess and evaluate nutritional requirements according to standard protocols of care. Minimum Qualifications Training: Complete all WIC Learning Online Modules (see Policy 11.02 WIC Training Modules and Policy 11.02 Attachment #2 Resource List). Also completes all other listed trainings (see Policy 11.02 WIC Training Modules and Policy 11.02 Attachment #2 Resource List). Graduation from a four-year college or university with a bachelor's degree in foods and nutrition, dietetics or public health nutrition; or a bachelor's degree in a related field with 12 hours in nutrition. Completes USDA Breastfeeding Curriculum (2020) – Levels One, Two and Three TABLE 4 NUTRITION SERVICE LEVEL 4 Nutritionist II / CPA Higher intervention level Nature of Work Under limited supervision, performs professional work at the full-performance level by promoting and presenting public health nutrition programs. Performs related work as required. Public contact and travel are required. May be required to supervise. Page 7 of 13

West Virginia WIC Policy & Procedure 11.03 Effective Date: 11/17/21 11.03 Competent Professional Authority Distinguishing Characteristics This is professional, full performance level work in public health nutrition. Performance at this level requires greater technical skills, more independent judgment and work involving planning and organizational skills. Examples of Work • Provides therapeutic dietary counseling and nutritional assessments for medically high-risk clients, such as in prenatal and pediatric clinics. • Provides nutrition counseling services to Intermediate Care Facilities or other outside agencies. (Must be a Registered Dietitian Nutritionist and Licensed Dietitian with the West Virginia Board of Licensed Dietitians [WVBOLD]). • Provides nutrition counseling under contract through Medicaid reimbursable Programs. (Must be a Registered Dietitian Nutritionist and Licensed Dietitian with the West Virginia Board of Licensed Dietitians [WVBOLD]) . • Conducts in-services, presentations, and provides consultation on nutrition topics to groups and organizations. • Develops menus for regular and therapeutic diets for patients or residents of a facility. • Conducts staff in-services and training. • Acts as Nutrition Education Liaison responsible for developing, implementing and evaluating the Nutrition Education Program for a multi-county area. • Acts as Breastfeeding Coordinator responsible for developing, implementing and evaluating a multi-county Breastfeeding Promotion Program. Knowledge, Skills and Abilities • Knowledge of the principles and practices of dietetics and nutrition, as related to public health. • Knowledge of the organization of public health services, food services, food assistance and nutritional education resources. • Knowledge of developments in the field of public health as related to nutrition. • Skill in interviewing medically high-risk clients, assessing their nutritional status and counseling concerning nutrition. • Skill in program management and coordination. • Skill in conducting training in-services. • Ability to establish and maintain effective working relationships with both professional and advocate or constituent groups. • Ability to collect, analyze and evaluate data and technical information. • Ability to communicate effectively, both orally and in writing. • Ability to write goals and objectives in planning and developing broad range nutrition programs. Minimum Qualifications Training: Graduation from an accredited four-year college or university with a bachelor's degree in foods and nutrition, dietetics or public health nutrition; or a bachelor's degree in a related field with 12 hours in nutrition. Page 8 of 13

West Virginia WIC Policy & Procedure 11.03 Effective Date: 11/17/21 11.03 Competent Professional Authority Experience: One year of full-time or equivalent part-time paid employment as: dietitian or nutritionist employed by a health or welfare agency, food clinic, hospital, child development center, school system, nutrition council; teacher of foods or nutrition in an accredited school or college; agent or food and nutrition specialist in the Agricultural Extension Service; or research worker in foods or nutrition. Substitution: Graduation from a Coordinated Undergraduate Program in dietetics, completion of an AP4 Program in nutrition or dietetic internship approved by the Academy of Nutrition and Dietetics (AND) and Licensed Dietitian status with West Virginia Board of Licensed Dietitians (WVBOLD), or a graduate degree from an accredited college or university in a related field may be substituted for the required year of experience. Note: Preference in hiring may be given to an applicant who has current Registered Dietitian Nutritionist status with the AND and WVBOLD. Special Requirements Completes all WIC Learning Online Modules and all other listed trainings as part of orientation (see Policy 11.02 WIC Training Modules and Policy 11.02, Attachment #2 Resource List). Completes USDA Breastfeeding Curriculum (2020) – Levels One, Two and Three TABLE 5 Nutrition Service Level 5 Nutritionist III/CPA Highest intervention level Nature of Work Under administrative direction, performs supervisory and/or administrative duties at the full-performance level. Assists in the planning, organizing and management of a public health nutrition program in a large geographic region, or oversees a nutrition program in a specialty area at the state level. Supervises and trains other nutritionists or food service staff. Performs related work as required. Distinguishing Characteristics Work at this level, includes formally delegated supervisory responsibility for planning, assigning, reviewing and approving the work of nutritionists, support and technical staff. Administrative duties include responsibility for, or assisting in, coordinating the activities of the central office and field staff; coordinating specialized nutrition programs; coordinating statewide training and continuing education programs; developing plans and executing policies for directing the work of others; and interpreting program policies for staff and others. Page 9 of 13

West Virginia WIC Policy & Procedure 11.03 Effective Date: 11/17/21 11.03 Competent Professional Authority Examples of Work • Plans and manages the work of nutrition staff; recruits and interviews support staff; conducts annual reviews of employee performance; plans and conducts conferences with staff. • Develops, writes and implements policies and procedures for program administration. • Assists with delegated administrative tasks, while under the direction of the agency Nutrition Director, such as in the administration of Women, Infants and Children (WIC) Program and/or other public health nutrition programs, which includes managing and supervising nutrition education programs, certification, monitoring and internal reviews. • Assesses staff training needs and plans and provides for continuing education opportunities. • Designs, develops and produces nutrition education materials for distribution in a large geographic area or statewide. Reviews, prepares and compiles educational materials and public information releases for distribution throughout the region or state. Reviews and monitors staff activities for compliance with state and federal regulations. • Develops, implements and evaluates in-services and training for staff. Provides technical expertise to nutrition professionals on nutrition and diet-related health problems. • Participates in developing an operational plan for delivery of nutrition services in the regional area or statewide. • Oversees the provision of contractual nutrition services. • Reviews, monitors, and approves local nutrition education or breastfeeding plans at the state level. Knowledge, Skills and Abilities • Knowledge of the principles and practices of dietetics and nutrition as related to public health. • Knowledge of the organization of public health services, food assistance and nutritional education resources. • Knowledge of developments in the field of public health as related to nutrition. • Knowledge of current state and federal regulations related to public health nutrition programs. • Ability to manage programs. • Ability to work with various mass media. • Ability to plan, organize and evaluate public health nutrition programs. • Ability to supervise professional and support staff. • Ability to establish and maintain effective working relationships with both professional and lay groups. • Ability to collect, analyze and evaluate data and technical information. • Ability to communicate effectively, both orally and in writing. • Ability to create and develop educational and instructional materials. Page 10 of 13

West Virginia WIC Policy & Procedure 11.03 Effective Date: 11/17/21 11.03 Competent Professional Authority Minimum Qualifications Training: Graduation from a four-year college or university with a bachelor's degree in foods and nutrition, dietetics or public health nutrition; or a bachelor's degree in a related field with 12 hours in nutrition. Experience: Three years of full-time or equivalent part-time paid employment as: dietitian or nutritionist employed by a health or welfare agency, food clinic, hospital, child development center, school system, nutrition council; teacher of foods or nutrition in an accredited school or college; agent or food and nutrition specialist in the Agricultural Extension Program; or research worker in foods or nutrition. Substitution: Graduation from a Coordinated Undergraduate Program in dietetics, completion of an AP4 Program in nutrition or dietetic internship approved by the Academy of Nutrition and Dietetics (AND), or a graduate degree from an accredited college or university in a related field may be substituted for one year of the required experience. Note: Preference in hiring may be given to an applicant who has current Registered Dietitian Nutritionist (RDN) and Licensed Dietitian with West Virginia Board of Licensed Dietitians (WVBOLD) status. Staff Requirements Completes all WIC Learning Online Modules and all other listed trainings as part of orientation (see Policy 11.02 WIC Training Modules and Policy 11.02 Attachment #2 Resource List). Completes USDA Breastfeeding Curriculum (2020) – Levels One, Two and Three C. Employment of a Qualified CPA 1. The Local Agency is responsible for assuring that qualified staff is selected, that they attend all mandatory training and that they receive continuing education necessary to function as a CPA. a. The Local Agency or Parent Agency will maintain a file of these CPAs which must include: i. Resume, completed Local/Parent Agency application, or completed WV State Civil Service Application ii. Official transcripts proving attainment of the appropriate education level iii. A copy of license, certification or registration—i.e., R.N., R.D., I.B.C.L.C., etc. iv. Response letter from the WV State Civil Service classification if the employee is hired through that system. Page 11 of 13

West Virginia WIC Policy & Procedure 11.03 Effective Date: 11/17/21 11.03 Competent Professional Authority v. Title and job description for position being hired D. Employment of a CPA who is not qualified a. The Local Agency Director will submit to the State Agency Nutrition Coordinator a request for approval of a person who does not meet criteria outlines above in B. Persons Authorized to Serve as a CPA prior to their functioning as a CPA. The request must include the following: a. Resume, completed Local/Parent Agency or completed WV State Civil Service Application b. Official transcripts proving attainment of an associate, baccalaureate or master’s degree from an accredited college or university OR c. Official professional school transcripts proving attainment of certification or degree d. Notarized copy of license, certification or registration—i.e.. L.P.N., etc. e. Response letter from the WV State Civil Service listing civil service classification, if the Local Agency employee is hired through that system f. Title and job description for position being hired g. A six-month action plan outlining competency-based training to be provided by the Local Agency and the mandatory training to be scheduled by the State Agency (see Policy 11.01 WIC Staff Training). Competency-based training requires that the trainee demonstrates competency in skills learned during training before she/he practices as a CPA. All competency-based training must be done by a qualified CPA or State Agency designee and must have an evaluation component, including actual WIC case studies. 2. The State Agency Nutrition Coordinator will review the submitted request and respond within fifteen (15) working days of receipt of the above information. If the State Agency Nutrition Coordinator approves the Local Agency request, the Local Agency Director must sign off and date each competency-based skill completed as outlined in the submitted action plan. Upon final completion of the action plan by the employee, the original is to be sent to the State Agency Nutrition Coordinator who will then issue a Certificate of Completion certifying this individual as a CPA. 3. This six-month period is considered a probationary “on-the-job” training whereby the employee may gradually assume responsibilities of a CPA as they are completed and signed off by the Local Agency Director. Page 12 of 13

West Virginia WIC Policy & Procedure 11.03 Effective Date: 11/17/21 11.03 Competent Professional Authority 4. The Local Agency or Parent Agency will maintain a file of these CPA’s which must include all of the items listed above in section D. Employment of a CPA Who is Not Qualified. C. Computerized Care Plans 1. Only a CPA and Local Agency Director will be allowed to enter, retrieve or view computerized Care Plans (see Policy 2.19 Electronic Signatures for the CPA). D. Continuing Education Requirements 1. The West Virginia WIC Program requires that each WIC CPA read and study or will attend the next scheduled Local Agency Breastfeeding Peer Counselor Training Program within the first (6) months of employment. 2. Each CPA with at least (1) year of experience is required to receive a minimum of twelve (12) hours per fiscal year (October 1 through September 30) of continuing education (see Policy 11.01 WIC Staff Training). REFERENCES: 1. WIC Regulations 246.2, Definitions (Competent Professional Authority) 2. WIC Nutrition Standards, August 2013 3. West Virginia Board of Licensed Dietitians (WVBOLD), Frequently Asked Questions, www.wvbold.com Page 13 of 13