2015 wic me webcast - ungerboeck€¦ · · 2015-04-21observation of client centered nutrition...

2015 WIC Management Evaluation Changes 4/21/2015

April 23, 2015 Webcast 1

2015WICManagementEvaluationChanges&MEReviewPresenter: Terri Riemenschneider, ME Program Area Lead

April 23, 2015

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WebcastMaterials• Slides from PowerPoint

• 2015 WIC ME Changes

• 2014 ME Overview

• ME Changes, 2015 (Word)

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MEMaterials• ME tools and materials can be found on the Michigan.gov/wic website under the WIC Providers section or at

• http://www.michigan.gov/mdch/0,1607,7‐132‐2942_4910_19205_21312‐256470‐‐,00.html

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PrevisitChecklist‐Confidentiality

MPR MPR/Indicator/Criteria Text ChangeDocumentation

required How to verify2.3a The WIC Program keeps the

names and addresses of clientsand other members of thepublic confidential, except tothe extent necessary to carryout the purposes of conductingan investigation, hearing orjudicial proceeding, or forreferral and outreach to otherpublic health and welfareprograms, where authorized inthe WIC Client Agreement. (7CFR 246.21(b), 246.26(d), FNSInstruction 800-1, MI-WICPolicy 1.03, 1.06, 9.02)

Documentation review of the Michigan WIC Employee Confidentiality and Compliance Agreement Signature Form for each employee who has MIWIC Access.

Review signed annual Michigan WIC Employee Confidentiality And Compliance Agreement Signature Form9.02a. (a)

Signed Michigan WIC Employee Confidentiality And Compliance Agreement Signature Form on file

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PrevisitChecklist‐ EligibilityVerificationMPR MPR/Indicator/Criteria Text Change

Documentation required How to verify

4.2a The WIC Program verifies theresidency, presence, proof ofpregnancy and income ofapplicants and clients at the time ofeach certification (annual incomeverification for migrant farm workersand their families) and verifiesidentity at the initial certificationaccording to policy. (7 CFR246.7(d), MI-WIC Policy 2.01, 2.02,2.03, 2.04, 2.05, 2.06, 2.07, 2.08,2.09, 2.10, 2.11, 2.12, 2.18, 2.19)

Included Auth. Person ID verification.

Observe certification process to determine if identity (client, initial certification only, Authorized Person/proxy ID must be verified (ID check or recognition) at each visit), residency, presence, proof of pregnancy and income verification was correctly completed. (a)

Check ID or recognize Authorized Person/proxy.

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PrevisitChecklist‐RiskAssessment


required How to verify4.3a Health and Diet Assessment: The

WIC Program screens health anddiet information at eachcertification and recertification,including elements on the ClientAssessment (CAR) Tool formanual risk assignment andreferrals. Infants and childrenshall also be screened duringinfant/child evaluations. (7 CFR246.7(e)(1), 246.7(g)(1)(iv), MI-WIC Policy 2.13, 2.14)

...including elements on the CAR tool for manual risk assignment and referrals

Demonstrate use of CAR Tool elements during certification.

Verify that CAR Tool Elements are reviewed during the certifications reviewed.

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PrevisitChecklist‐RiskAssignmentMPR MPR/Indicator/Criteria Text Change


4.3d Assignment of Risk: The WICProgram’s Competent ProfessionalAuthority (CPA) determines anindividual’s nutritional risk by

considering dietary, anthropometric,

hematological, and health historyassessments and assigns allapplicable risks. (7 CFR246.7(e)(2), MI-WIC Policy 2.13,2.14, 2.15, 2.16)

Evaluation includes… All applicable risks are assessed and accurately assigned, with required documentation. Non- applicable risks are not removed from the Nutrition and Health Summary screen. CPAs may document why the risk is not applicable in the Client Note. (d)Observe that

current Medical Documentation forms are used to document known diagnosis as risk. (d)

“Non-applicable” risks identified must be assigned. If not applicable, document in client notes why not applicable.

Medical Doc forms are used to assign known diagnosis as risk

Review client notes for documentation of non-applicable risks.

If client has MDF, verify the diagnosis is documented as a risk? 7

PrevisitChecklist‐Referral,ListofSubstanceAbuseResources


required How to verify5.1b The WIC Program advises and

refers each client, parent orcaregiver of the types of healthand community services that maybenefit the client, includingMaternal Infant Health Program(MIHP)/Healthy Start/NurseFamily Partnership, or similarprogram. referrals for all pregnantwomen and infants. (7 CFR246.7(b)(2), MI-WIC Policy 6.02,6.05)

Included similar home visiting programs along with MIHP, etc. for PG women and Infants

Referral documentation of offer of MIHP or other home visiting services.

Review referral documentation for PG and Infant clients.

5.1c The WIC Program makesavailable a list of local resourcesfor drug and other harmfulsubstance abuse counseling,prevention and treatment, wherethey are located, how they may beobtained, and why they may beuseful at the first WIC visit andthereafter as appropriate. (PublicLaw 101-147, MI-WIC Policy 6.02)

Written information is available in clinic regarding local substance abuse counseling, prevention, treatment and referral programs.

Written listing of Local Substance Abuse Referral and Treatment Agencies available.

Observe written listing of Local Substance Abuse Referral and Treatment Agencies available.

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PrevisitChecklist‐ ClientCenteredNutritionEducationMPR MPR/Indicator/Criteria Text Change


6.2 The WIC Program provides and documents client centered nutrition education that assists the client to achieve a positive change in health habits, improve nutritional status and prevent nutrition-related problems through use of the WIC supplemental foods and other nutritious foods. (7 CFR 246.11(b)(2), MI-WIC Policy 5.01)

Includes client centered approach to services.

Observation of client centered nutrition education. Evaluation questions have been updated to reflect client centered services.

Observation of client centered approach to services.

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PrevisitChecklist‐BFFriendlyClinicEnvironmentMPR MPR/Indicator/Criteria Text Change


6.5 The WIC Program creates apositive clinic environment, whichendorses breastfeeding as thepreferred method of infant feeding.(7 CFR 246.11(c)(8)(i), MI-WICPolicy 4.01, 4.02, 4.03)

NWA Breastfeeding Six Steps checklist is now available in the ME Tools to assist in evaluation of BF environment and services.

Observe that thefacility provides anarea conducive tobreastfeeding thatincludes comfortablechairs with arms,and is away fromthe entrance. (a)

Observe that the clinic is a breastfeeding positive environment (i.e., Breastfeeding friendly signage, breastfeeding posters in all client areas, no formula displayed). (a)

Suggest use of NWA checklist by LA to evaluate progress toward Breastfeeding Friendly.

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NationalWICAssoc.“SixSteps”

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HighRiskServices


required How to verify6.6a The WIC Program identifies and

offers high risk and Class III formula clients opportunity to meet with the Registered Dietitian (RD) for assessment and for development of an individualized care plan at each certification/evaluation. If the client refuses the opportunity to meet with the RD, this action must be documented in the client record at each offer. (MI-WIC Policy 2.13, 5.06)

Clarifies that high risk services need to be offered at each certification/evaluation.

Observation Verify that NCRD services were offered to High Risk clients at the certifications observed.

6.6b The WIC Program ensures that aRegistered Dietitian is accessibleto see high-risk clients. Atcounseling, the RD reviews theclient nutrition assessment andeither develops and implementsan individual care plan (ICP)based on client concerns. Or, theRD may document that a careplan is not needed. (USDA WICNutrition Services Standards(2013) MI WIC Policy 5 06)

Updated with ICP and current policy.

Observation that NCRD appointments are available on the schedule within 30 days of the date reviewed.

RD appointments available on the schedule within the next 30 days.

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HighRisk:ProblemList,FollowupMPR MPR/Indicator/Criteria Text Change


6.6c The CPA documents thenutrition high risk conditionand additional importantinformation for subsequentcounseling with R.D. in theProblem List tab. (MI-WICPolicy 2.13, 5.06)

Updated with current policy.

CPA Notes in Problem List anyadditional information for the RD.

Review Problem List Tab for CPA notes.

6.6e Appropriate follow-up is documented, preferably in the MI-WIC Care Plan follow-up tab. The RD closes the Individual Care Plan per policy 5.06.

New criteria based on policy.

Follow-up tab in the ICP or notes.

Review high risk client records for documentation of Care Plan follow up and closure. (e)

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ICP‐ Problemlist,Followupnotes

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WICFoodGuide/Inserts,FoodPkg.MPR MPR/Indicator/Criteria Text Change Documentation required How to verify

7.1 The WIC Program notifies clients about authorized foods and provides clients the authorized WIC Food Guide and current Inserts. (7 CFR 246.10, MI-WIC Policy 7.02, 8.06)

Wording change, including Food Guide Insert(s).

Observe that clients are provided with a WIC Food Guide and current Food Guide Insert(s),appropriate for family.

7.2b The WIC CPA makes available tothe client at least one food fromeach group based on clientcategory and type of food packageallowed. Foods are excluded orlessened if the client declines anyof the foods offered in the package,or if the CPA determines the foodis contraindicated for the client dueto the amount ofbreastfeeding/supplementation ora special medical problem. (7 CFR246.10(b)(2), 246.10(c), MI-WICPolicy 7.03, 7.04, 7.05)

Includes breastfeeding/ supplementation related to revised policies 7.03 and 7.04.

Food Package, Special Formula/Food Request Form, amount of Breastfeeding/formula feeding documented.

Food Package is customized based on clients’ needs.

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FoodPackageAssignmentMPR MPR/Indicator/Criteria Text Change

Documentation required

How to verify

7.3 The WIC Program provides special formulaand food packages to clients based onmedical documentation (7 CFR 246.10, MI-WIC Policy 1.07, 7.02, 7.03).

Wording change to incorporate Policy changes in 7.02 with Soy beverage and 2% milk.

Food Package, Special Formula/Food Request Form

Review record

7.3a The WIC Program CPA/RD approves andprovides special formula and food packagesas indicated for clients with special dietaryneeds, based on required documentation for:-Standard infant (Class I) formulas after 1 year of age.

-Soy beverage food package for children.

Risk, qualifying condition or reason needed inrecord.-2% milk food packages. Risk, qualifyingcondition or reason needed in record, whenapplicable. Medical documentation needed ifClass II or III formula included in foodpackage.-Hypoallergenic infant (Class II) formulas.-Specialty formulas (Class III).-Other special food packages as indicated per policy.

(7 CFR 246.10(c)(1), MI-WIC Policy 1.07,7.02, 7.03)

Added Soy, 2% milk food packages to list.

Same as above

Qualifying condition documented in record for 2% beverage food package assignment for children and women and soy beverage food package for children.

Same as Above

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Certificationobservation…MPR MPR/Indicator/Criteria Text Change


12.1a

Are all infants and children assessed and assessment documented for current immunization status using MI-WIC or other records? Circle what records are used to assess: MI-WIC MCIR Imms. Card Medical Record

Included “other” in list of options for review of immunization status.

Review of immunization documentation or MIWIC assessment

Utilize MIWIC/MCIR interface or other source to evaluate imms. Status.

12.1c

Does the LA provide the recommended immunization schedule to clients who are not up-to-date or don’t have a documented record? Includes MCIR record, verbal or written information. MI-WIC Policy 6.03Is the CDC Immunization website on the desktop to provide current recommendations and detailed information? If not, suggest they do?

Clarified that schedule does not need to be in written form, can give copy of MCIR record, CDC brochure or verbal imms. Schedule to client who is not up to date.

Recommended schedule provide to client who is not up to date with child’s immunization schedule.

Observe provision of immunization schedule to Auth. Person.

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Certification:Income,QualityAssurance‐LabProcedures


required How to verify4.2a Is family income calculated

using past 30 days of pay documentation? (exception: adjunct eligibility, migrant, homeless, works for cash, no income) (MI-WIC Policy 2.04)

Stated income review of 30 days of documentation.

30 days of income for verification.

Observe use of 30 days of income for verification.

Lab Work: Does all staff wear gloves when collecting blood? (optional: appropriate personal protective equipment -lab coat, gown, scrubs, apron)

Updated per Lab Manual

Observe use of gloves/personal protective equipment for lab procedures.

Lab Work: Does staff prepare testing supplies on a fresh drape/tissue for each client?

Updated per Lab Manual

Does staff cover work surface

If referral data is used, was it obtained within the last 6 months for a child or during their pregnancy or post-partumperiod?

Clarified question to state lab data interval.

Referral data for child not more than 6 months old or obtained while PG or B/NPP.

Observe that data meets timeframe requirements.

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Certification‐NocostMPR MPR/Indicator/Criteria Text Change


4.1b Are clients who are asked to pay for immunization or lead testing during their WIC visit told that refusal will not affect their WIC eligibility?

Clarified statement.

Observe that clients who must pay for lead testing or immunization administration are informed they can refuse these services and still be on WIC.

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Certification‐BFassessmentMPR MPR/Indicator/Criteria Text Change


6.5d At Cert and Infant Evaluation, does the CPA assess BF support and progress (PG & for both baby and mother) and provide education and support? (MI-WIC Policy 4.01)

Revised citation

6.5d Does the staff refer the breastfeeding mother to the CPA when she is changing food packages?

Revised citation

6.5d Does the staff record or update the Breastfeeding statistics at initial certification and when the BF status changes or at the Infant/Child Evaluation? See MedicalInformation /Breastfeeding Statistics Screen.

Revised citation

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Certification‐Clientcentered…MPR MPR/Indicator/Criteria Text Change


Does the CPA establish rapport with the client? (Welcome and engagement)

Updated language based on CCS model.

Observe CPA engaging client to establish rapport.

6.2c Does the CPA summarize therelevant information from the assessment and concerns identified and ask client what they’d like to work on? For current education, do the CPA and client discuss (a) topics and (b) client behavior changes based on client concerns?


Observe CPA summarizing the assessment gathered along with client’s concerns, to focus client education.

6.2c Are clients without concerns offered anticipatory guidance appropriate for category/age?


Observe CPA offering anticipatory guidance if mom has no concerns.

6.2c Does the CPA encourage the client to participate in nutrition education and highlight how the nutrition education meets the client’s needs? (MI-WIC Policy 5.01, 5.03)


Observe CPA offering NE options to meet client needs and concerns.

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Certification‐Referrals


required How to verify5.1b Are all pregnant women and

infants referred to MIHP/Great Start, Nurse Family Partnership, or comparable program, if available in the community? (MI-WIC Policy 6.05)

Noted changes in home visiting programs for women and infants.

Discussed/Referral to home visiting program for PG and infants.

Observe CPA offering program to PG women and infants.

6.5d Are pregnant and breastfeeding clients referred to a peer counselor or other breastfeeding support person (BF Peer, IBCLC, or LLL)?(MI-WIC Policy 4.01)

Clarified that all PG and BF clients should be offered BF support services.

Discussed/Referral to BF support service documented for all PG, BE/BP moms.

Observe CPA offering BF support services to all PG/BE/BP client.

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Certification‐FoodGuide/Inserts,NEPlan

MPR MPR/Indicator/Criteria Text ChangeDocumentatio

n required How to verify7.1b Does the local agency notify

clients of changes in the authorized Food Guide/Infant Food Insert in a timely fashion and provide materials as indicated? Staff should only issue Infant

Food Insert to clients who are receiving formula. or are older infants consuming solid foods. If not, suggest they do.

Clarified that Insert means Infant Food and Food Guide Changes Inserts to Food Guide.

Observe clients receiving Food Guide, Food Guide Changes and Infant Food Inserts

6.2d Is the NE Plan printed and given at each cert/recert/infant or child evaluation? (required) Best Practice: CPA reviews plan with client, noting plan and expiration of certification (on screen or printed).

Updated citation, Included Best Practice- to review NE Plan with client.

Client must be given printed copy of NE Plan at cert, recert, Infant/Child Evaluation.

Best Practice: Observe staff reviewing NE Plan with Client.

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Certification‐ClientCentered…


required How to verify

6.2a During assessment, does the CPA identify and explore client concerns? Are clarification questions asked in a caring/collaborative manner?Does CPA note questions and acknowledge that education will follow the completed assessment? Does the CPA review the assessment forms/ HHx questions/screens/CAR Tool elements with the client and if warranted, explores further?

Clarified that CPA staff must review elements on CAR tool for manually assigned risks or appropriate referrals. They don’t have to READ the questions to the client. The questions can be paraphrased or included as part of the assessment conversation.

Identify and assign all applicable risks, through use of screens and CAR tool elements.

Observe CPA including CAR tool elements in the assessment to determine manually assigned risks or appropriate referrals.

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RecordReview‐Nut.Ed./ReferralMPR MPR/Indicator/Criteria Text Change


6.2d NE Plan printed? F: No Communications file avail. 12/11/14-1/7/15, 2/26-4/3/14

Noted citation change and Communication file limitations

Review documentation of the NE Plan printed in the Family level Communications file, if outside date parameters noted.

Verify (if outside dates identified), the NE Plan was printed at cert/recert/eval.

6.2c NE content documented on NE pop up screen?

Citation change noted.

5.1b Other referrals documented, if applicable? (MIHP/Healthy Start, NFP/home visit program for I/PG, BE/BP, if available)

Included other Home visitation programs.

Documentation of discussed or referral to MIHP, etc.

Documentation of discussed or referral to MIHP, etc.

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RecordReview‐ComplianceMPR MPR/Indicator/Criteria Text Change


Compliance: ClientCompliance Log for past 24months to determine ifagency is adequatelymonitoring compliance.

Instructions change to review 2 years of log.

Review of compliance reports for past 24 months.

Use 24 months of report when performing compliance review.

10.1 Did the agency complete the investigation and document resolution as required?

Compliance Report Review

4 records to determine if completed within 4 months from report date.

Review Compliance Reports from Log

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RecordReview‐FormulaMPR MPR/Indicator/Criteria Text Change


7.3a Food Package/ Formula Approval Record Review7.3 a- Review at least 8-client records total (including some of each group designated below) and verify that the agency is following WIC Policy for formula approval and documentation. Use the & Formula Usage Report to identify clients on Class I, II or III formulas, and 2% Milk/Soy Beverage Ad Hoc Report clients on 2% milk or soy beverage food packages for review

Updating Review to incorporate 2% milk and soy beverage records.

Soy beverage and 2% milk ad hoc report

Review client records from reports to determine compliance.

Included risk criteria in review to compare with client records for clients assigned 2% milk food packages.

Using 2%, soy beverage Ad hoc reports, verify that allowed risk or documentation is found in client record.

Review client record for risk or required documentation for assignment of food package.

C1 Child: Client meets risk criteria of provider recommends 2%, overweight/obesity concern, family hx dyslipidemia, cardiovascular disease.

C2-C4 Child: Client meets risk criteria for at-risk of underweight, high-risk underweight, or inadequate growth.

Woman: Client meets risk criteria for pre-pregnancy underweight, postpartum underweight, low maternal weight gain or maternal weight loss during pregnancy. (WIC Policy 7.02)

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RecordReview‐CarePlanMPR MPR/Indicator/Criteria Text Change


6.6c 1. Problem list/purpose of session Updated High Risk Care plan checklists to reflect revised policy CCS and Advanced CPA trainings.

Review 5 client records identified as high risk with care plan.

Verify that care plan includes required documentation and follow up.

6.6b 2. Individual care plan (ICP) in record or RD documents that no care plan is needed

6.6b 3. ICP Includes

a. Subjective/Data review –summary of relevant data (growth, diet, meds, diagnosis, treatment, diet prescription, lab values)

b. Assessment- Major problem/topic(s) of client concerns, interests, actions. Document using Assessment Select checkboxes and/or Subjective/Assessment area of care plan.

c. Intervention Plan – Client Centered Counseling provided including the following:• Client’s desired outcomes• One to three simple, attainable behavior

changes• Practical interventions, including future

nutrition education• Indicators to monitor and evaluate the

client progress in follow-up6.6e d. Intervention Plan for follow-up or that follow-up

is not needed.

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6.6b 4 Plan saved by R.D. (R.D. electronic name and date).

Updated High Risk Care plan checklists to reflect revised policy CCS and Advanced CPA trainings.


Verify that care plan includes required documentation and follow up.Care Plan frozen? If not,

suggest they do shortly after ICP creation.

6.6e 5 NE documented (NE pop-up screen): Date, Method, Topic, Provider, Initials, Stage (opt), Evaluation, Behavior Change, Notes (if applicable).

6.6b Were Stage movement (opt), date achieved and other notes on previous NE follow up documented?

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Follow-up Documentation for

Individual Care Plan

Updated High Risk Care plan checklists to reflect revised policy CCS and Advanced CPA trainings.


Verify that care plan includes required documentation and follow up.

6.6e 6 Documented in record, preferably in Care Plan Follow-up area. Closure of Individual Care

Plan

6.6b 7 R.D. signature (electronic initials) and rationale if closing case (5.06)

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Referrals,Outreach,CivilRightsMPR MPR/Indicator/Criteria Text Change


5.1c Observe or ask how staff provides all newly enrolled clients a listing on local resources for drug and other harmful substance abuse counseling, prevention and treatment, where they are located and how they may be obtained, and why they may be useful.

Removed “and documents” provision of list. Clarified that staff are NOT to document on referral grid “Substance Abuse Services” for providing list.

Observe new clients being provided listing of local Substance Abuse Services.

5.6b Does the agency document outreach activities in the MI-WIC system or Outreach Log?? (MI-WIC Policy 6.01)

Removed “Outreach Log”.

Outreach activities documented in MI-WIC.

Verify outreach activities are documented in MI-WIC.

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Referrals,Outreach,CivilRightsMPR MPR/Indicator/Criteria Text Change


2.2a Is there documentation in the MI-WIC System (Admin/User Setup/Staff Information/training) of completion of the WIC Civil Rights training module LMS for new staff during orientation and for existing staff, at least annually? (MI-WIC Policy 1.09) Review all records with MI-WIC access.

Clarified requirement that ALL staff complete annual Civil Rights Training using the LMS module. New staff must also complete the Civil Rights Training in the LMS during orientation and annually thereafter.

LMS training certificate or score for all records with MI-WIC access.

Current LMS training certificate of completion for each staff member.

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Outreach,Referrals,CivilRightsMPR MPR/Indicator/Criteria Text Change


2.2a Was Online Civil Rights Training completed by all WIC Staff during the past year?(MI-WIC Policy 1.09)LMS-Michigan WIC Civil Rights Training (M0500-15) https://courses.mihealth.org/PUBLIC/cm0682/home.html?orgid=PublicReview Staff Training Documentation (MI-WIC)Did all new and experienced staff complete the required Civil Rights training in the past year?Updated date on USDA Non-discrimination statement (2/25/14)

Updated date on USDA non-discrimination statement.

Use of updated non-discrimination statement on outreach materials, WIC website

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Administration‐ImmunizationCollaboration



12.1d Immunization Policy (MI-WIC Policy 6.03) Only required if within a local health department. 1. Local agency immunization collaboration policies

may include the following:a. Immunization promotion methodologiesb. Coordination of services that addresses:

i. Assessment of children who are not up-to-date

ii. Provision of information to Pregnant women regarding needed vaccines during pregnancy

iii. Provision of information on recommended vaccination schedules

iv. Referral for servicesv. Administration of vaccines.

c. Provision of immunization training for WIC staff

2. Non-health department WIC agencies are encouraged to collaborate with local health departments within their jurisdiction to increase immunization rates.

Updated to reflect current Immunization Policy requirement-defining what LA collaboration policies may include.

Local Agency policy

Review LA immunization collaboration policy.

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Administration‐FoodPkg.Proration



8.1d Is the food package prorated if issuing “returned formula” instead of EBT benefits?

Updated citation. Clarified that proration occurs regardless of food or EBT benefit issuance.

Formula issuance log reflects benefits issued to clients.

Review client record and formula issuance log to determine if prorated amount of formula was given.

7.4c Does the LA issue (some) EBT benefits instead of issuing all returned formula to ensure participation is counted?If not, suggest they do.

Suggested action.

Formula issuance log reflects benefits issued to clients.

Review Returned Formula Issuance log

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Administration‐BreastfeedingMPR MPR/Indicator/Criteria Text Change


6.5a Does the agency evaluate educational materials to determine whether they present breastfeeding in a positive tone, are accurate, and are free of product names or images? (MI-WIC Policy 4.03)

Updated citation

5.01c review forms for all BF materials not supplied by USDA or MDHHS/WIC.

Review 5.01c for BF materials

6.5a Does the agency have a positive clinic environment – supporting breastfeeding as the preferred method of infant feeding? Positive BF posters prominently displayed

in each clinic room and area visible to clients

No formula/bottles displayed (MI-WIC Policy 4.03)

Updated citation

NWA “6 steps” checklist used to assess clinic environment.

Use NWA “Six Steps” checklist to assess clinic environment.

6.5b Does the agency orient and train all staff to be supportive of breastfeeding? (MI-WIC Policy 4.02) Clinic environment policies Program goals and philosophy regarding

BF Task appropriate info about BF Ways to promote, protect & support BF to

WIC Clients

Updated citation

Orientation and training logs

Review logs/orientation checklists to ensure staff are offered/provided BF support training.

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Administration‐BreastfeedingMPR MPR/Indicator/Criteria Text Change


6.5c Does the agency provide on-going breastfeeding training and staff activities at least quarterly? (MI-WIC Policy 4.02) How is this done? In-Service? Conferences? Including (but not limited to): Initiation and maintenance of BF Cultural diversity: sensitizing staff to their

own attitudes and beliefs about BF, ways to promote, protect & support BF

Information on State and national activities that promote, protect & support BF

Is training documented on staff training log/screen or meeting minutes?

Updated citation.

Quarterly training logs, meeting minutes.

Review training logs and supporting documentation to verify provision of quarterly BF training.

6.5e5b What breastfeeding promotion and support activities are available to clients prenatally and during the post-partum period? BF classes BF Group BF peer (WIC or MSUE)Other: (MI-WIC Policy 4.01, 4.03)

Renamed to BF peer (WIC or MSUE)

Class outline, BF staff and peer documentation of BF support activities

Review evidence of BF promotion and support activities provided in clinic.

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Administration‐Training,Compliance,HighRiskMonitoring


required How to verify3.1a Is staff training (i.e., Civil Rights,

Breastfeeding, Policy, etc.) ongoing and documented in the MI-WIC User Staff Information Screen/Staff Training pop-up?

Documentation of staff training in MI-WIC training pop-up screen.

Documentation of staff training in MI-WIC training pop-up screen.

Review staff training documented on MIWIC training pop-up screens.

10.1a Does the agency record all client fraud/compliance allegations on the Add Complaint Screen?(MI-WIC Policy 9.01, 9.02, 9.03)

Documentation of client abuse/compliance allegations and follow up in MI-WIC using Complaint Screen.

Document client compliance allegations in MI-WIC using Complaint Screen.

Verify documentation of client compliance allegations in MI-WIC using Complaint Screen.

6.6d Does the agency review high risk records to ensure that clients are referred for counseling as required? How often?Review monitoring data

Restating policy that High Risk records need to be reviewed to ensure services are being offered/provided according to Policy 5.06.

At least annual review of High Risk and Class III clients for evaluation of High Risk services.

Record review of ICP, referrals for High Risk services, Class III records for referral to RD. 38



NutritionEducationMPR MPR/Indicator/Criteria Text Change


6.4a Does the agency maintain lesson plans/modules for group education and self-directed activities? (MI-WIC 5.01e)

Updated to reflect current NE policies.

Lesson plans for group or self-directed nutrition education.

Review lesson plans to determine if they include required elements.

Does the agency offer internet education to clients who don’t need face-to-face EDU/NCRD? (i.e., low risk, established breastfeeding)

Observe that low risk clients are offered NE options including wichealth.org

How does the agency assist client access to wichealth.org? (circle)Brochure Posters NE Plan Word of mouth Demo Other:

Note: materials at michigan.gov/wic-Wichealth.org

Observe that wichealth.org outreach and support is offered to clients who are interested.

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NutritionEducation‐MPR MPR/Indicator/Criteria Text Change

Documentation required

How to verify

6.2b Does the agency follow up with clients who complete their wichealth.org? Y N If yes, when? (circle)

1. Use Online Ed Report-Contact the client 2. At the time on-site education occurs 3 Ask client to call 4. At next cert/eval/face to face visit

(Observe during certification)

Was the client with questions provided answers from qualified staff? When Internet education is reviewed with the client following the lesson, the initials and evaluation of the staff answering the questions must be entered. MIWIC Policy 5.07


On NE pop-up grid, document follow up from previous NE provided.

If follow up is immediate, verify that staff document follow up in client records.

Observe, perform record reviews to determine if follow up of previous topics is done and documented.

Education Mall/Self Directed Modules

6.2c Does the agency offer a variety of NE options for clients with no internet or low literacy? Circle options: Individual NE Group NE Ed Mall MIHP BF Peer Self Directed Other:_______________


Observe and interview staff for options available.

40



NutritionEducation


required How to verify6.2a Are the examples and suggestions

used appropriate for the target population (socioeconomic status, food preferences and cultural values)? (MI-WIC Policy 5.01)

Updated reference and policy language

6.4b Does nutrition education material stress positive relationship between nutrition, physical activity and health for nutritional needs of pregnant, postpartum and breastfeeding women, infants and children less than five years of age? (5.01)

6.5d Pregnant client – Is Breastfeeding education offered detailing the benefits of breastfeeding and the risks of not breastfeeding?PROVIDER:Was the contact documented? Y N

BF support screen NE grid

Citation corrected

41

NutritionEducation‐BFsupportobservationMPR MPR/Indicator/Criteria Text Change


6.5d Breastfeeding client – Was the client provided support for breastfeeding questions or problems?PROVIDER:Was the contact documented? Y N


Citation corrected

6.5d Pregnant client –Breastfeeding education offered detailing the benefits of breastfeeding and the risks of not breastfeeding?Peer:Was the contact documented? Y N


Citation corrected

42



NutritionEducation‐Materials


required How to verify6.4b Are nutrition education materials,

that are locally developed or obtained, evaluated for appropriateness using Exhibit 5.01C or equivalent local agency form? (State developed or provided materials exempt.)

Updated according to current policies.

Exhibit 5.01c checklists completed for materials used.

Review material evaluations.

6.2e Are nutrition education materials available that address the danger of using drugs or other harmful substances? (5.01)(i.e., Intro to WIC Program, materials that discuss avoiding drugs, alcohol abuse during pregnancy and while parenting)

More information regarding acceptable materials.

3.1 Is the presenter qualified to provide nutrition education? (MI-WIC Policy 1.07 or 1.09)

Updated for current Policy 1.07.

Credentials for NE providers.

Review credentials of NE providers.

43

NutritionEducation‐ICPMPR MPR/Indicator/Criteria Text Change


6.6b Was a nutrition assessment completed? (i.e. review of all pertinent data – Health history, growth/prenatal weight gain chart, lab, diet, medical status, client’s concerns and readiness for behavior change) Other: ______________________) Were the client’s MI-WIC Assessment statements checked if applicable (if not, suggest they do)?

Updated for current High Risk policy and Advanced CPA training.

ICP meets requirements for high risk counseling and documentation in Policy 5.06.

Observe that Counseling and ICP meets requirements for high risk counseling and documentation in Policy 5.06

6.6b Did the RD identify and summarize the client’s problems, concerns, needs and readiness for change?

6.6b Does the Subjective/Assessment include summary of client’s primary nutrition problems/concerns/needs, key information and motivation for change?

6.6b Was the client’s input central to the plan development?

6.6b Does the counseling provided build on or reinforce what the client already knows, with time for discussion/question and answers?

6.6b Was the counseling tailored to client’s cultural values, reading level, situation, etc.?

44



NutritionEducation‐ICP

MPR MPR/Indicator/Criteria Text

Change

Documentation

required How to verify6.6b Does the Intervention Plan developed with the client

include the following? a) Client’s desired outcomesb) One to three simple, attainable behavior changesc) Practical interventions, including future nutrition educationd) Indicators to monitor and evaluate the client progress in follow-up

6.6b Was the client’s understanding of the plan/steps evaluated? (How do I know when I am doing it right?)

6.6e Were follow-up activities planned and future needs discussed and documented?

Were additional referrals offered, if applicable?

6.6b Did the RD provide and document appropriate nutrition services in the care plan and on NE screens? (MI-WIC Policy 5.07) Is the client provided a copy of the Nutrition Education Plan? If not, suggest they do. (MI-WIC Policy 2.20)Does the RD “freeze” the Care Plan after completed?

6.6b From observations or discussions, does the counseling meet high risk guidelines? Comments:

45

RecordkeepingandAccountabilityMPR MPR/Indicator/Criteria Text Change


Does agency replace lost or stolen Michigan WIC Bridge cards in the clinic when the MIWIC record is “stop access “or within 5 days of expiration of benefits? (MI-WIC Policy 8.01 Benefit Issuance) Always replace in clinic Only replace if inactive/5 days of expireDo not replace cards in clinic

Took out citation. Clarified card replacement of inactive EBT accounts. Identify if agency allows clinic card replacement.

LA policy/procedure (written or verbal) for EBT card replacement.

Observe, ask what procedure is for clients who request EBT card replacement in the clinic.

46



PolicyUpdate‐Record,Staffing,CivilRights,RiskDeterminationPolicy Status Changes ‐ Feb 2014

1.06 Record

Retention

Updated Notification of annual destruction date, all client

related materials must be kept confidentially

1.07 LA Staffing Updated and

consolidated

Consolidated into ONE staffing policy for all staff types:

CPA, RD, BF …

Requirements/credentials will be incorporated into

Policy instead of Exhibits.

1.09 Civil Rights Updated Incorporated requirement for NEW applicants to show

staff picture ID when completing Voter Registration or

complete affidavit that staff sign. Also updated “short

version of non‐discrimination statement to “USDA is an

equal opportunity provider and employer”

2.04 Risk

Determination

Updated If indicated risk is NOT applicable, the CPA assigns the

risk and documents in note section as to why not

applicable.

2.04b High risk

codes

New format No update, brought into MI‐WIC format47

PolicyUpdate‐IncomeGuidelines2014Policy Status Changes‐May 2014

2.05 Updated Updated income guidelines to reflect WIC Income Eligibility

limits and collaborative referral income guidelines for

Healthy Kids, Healthy Michigan Plan, etc.

Please note‐ 2015 Policy has been submitted for

approval to USDA

$$$$$$$$$$$$$$$$$

Income Eligibility session at WIC

Conference, Tuesday, April 28

48



PolicyUpdate‐ FoodPackageChangesChanges‐September 2014

7.01 Food Package Determination

Updated Updated to reflect lowfat (skim, ½%, 1%) milk for C1, C2‐4 and women as well as cheese, InfantFormula, Food Guide Insert changes

7.02 Authorized WIC Foods

• 2% milk can be issued to C2‐C4, women with qualifyingcondition:

• Client meets risk criteria for at‐risk of underweight, high‐risk underweight, or inadequate growth.

• Client meets risk criteria for pre‐pregnancy underweight, postpartum underweight, low maternal weight gain or maternal weight loss during pregnancy.

• 2% milk can be issued to C1• Caregiver reports the health care provider

recommends 2% milk• Client overweight or obesity is a concern• Family history is positive for obesity, dyslipidemia, or

cardiovascular disease • Cheese‐most food pkg cannot exceed 1#/month• Infant formula‐Standard formula food pkg. now able to be

customized to 4‐5 mo package if medically fragile infant unable to eat solid foods.

• IBP‐first month‐ 1 can powder allowed all size pkg.Food Guide‐Insert created to reflect new foods and policy changes. Do not provide infant insert to BF women/infants unless formula or complementary foods issued.

7.03 Food Package for Qualifying Conditions

· Instructions for Michigan WIC Special Formula/Food Request Form

· Form DCH-1326 Michigan WIC Special Formula/Food Request Form

7.04 Maximum Food Package7.05 Customized Food Package

49

PolicyUpdate‐NutritionEducationPolicy Status Nutrition Services‐Changes

5.01 Nutrition Education Overview and Elements of Client-Centered Nutrition Education

Updated Provides overview of Nutrition Education policies. Identifies Client Centered Services approach to WIC Nutrition Education.

5.01A Nutrition Education Definitions

Has definitions of terms used in NE policies

5.01B Elements of Effective Client-Centered Nutrition Education

Identifies elements of effective Client Centered Nutrition Education

5.01C WIC Nutrition Education Materials Evaluation Form

Checklist to evaluate print or other materials used for client education to assure appropriate for WIC audience. (i.e., reading level, positive image of Breastfeeding, diverse population, etc….)

5.01D Sample Nutrition Education Plan Report

Provides sample image of NE Plan Report.

5.01E Nutrition Education Lesson Plans

Provides outline for Nutrition Education Lesson Plan development and evaluation.

50



PolicyUpdate‐NutritionEducationPolicy Status Changes‐November 2014

5.02 Nutrition Education Contacts

NEW Outlines number of NE contacts per certification period. (1/4 for all clients)

5.03 Nutrition Education at Certification/Recertification Appointments

NEW Identifies requirements for nutrition education provided at Certification/Recertification. Includes follow up of previous nutrition education.

5.04 Nutrition Education at Infant/Child Evaluation Appointments

NEW Identifies requirements for nutrition education provided at Infant or Child Evaluations. Includes follow up of previous nutrition education.

5.05 Interim Nutrition Education, Client Feedback and Support

NEW Identifies requirements for nutrition education that occurs between cert and evaluations.

5.06 Required Services for High Risk Clients

Updated Identifies requirements for nutrition counseling of high risk clients including, referral/scheduling with RD, documentation, follow up, monitoring.

5.06A High Risk Documentation Guidance

Updated Illustrates documentation of high risk services. 51

Policy Update‐NutritionEducationPolicy Status Changes‐November 2014

5.07 Documentation of Nutrition Education

Updated Outlines documentation of Nutrition Education process

5.07A Nutrition Education Documentation Grid

Illustrates requirements for NE documentation

5.08 Nutrition Education Collaboration

updated Provides framework for Nutrition Education collaboration.

5.08A Sample Nutrition Education Collaboration Agreement

Sample agreement assists in development of a usefulagreement for NE collaboration with MSUE or other agencies who provide education for WIC clients.

52



PolicyUpdate‐SystemManagementPolicy Status Changes‐November 2014

10.01 System Equipment Inventory

Updated Provides structure to meet inventory control requirements for equipment purchased with WIC funds.

10.01A

Sample Inventory Form

Form for documenting inventory.

10.02 System Equipment Maintenance and Replacement

Details equipment and maintenance requirements for purchase and disposal of WIC equipment.

10.02A

MI-WIC Workstation Configuration Procedures

Identifies system requirements for safe operation of the MI-WIC system.

10.03 System Security States required system security measures, role assignment, separation of duties.

10.03A

Creating a State of Michigan Single Sign On and Subscribing to MI-WIC

Illustrates how to subscribe to the MI-WIC system through Single Sign On process.

53

EntranceConferenceAgenda for ME (clinic schedule, nutrition education classes/HR counseling, exit conference, staff meetings)Schedule:

Nutrition Services Plan ‐ ObjectivesAdministration‐Orange Local Agency policies/procedures (pg. 1)‐ Returned formula,

Hematological, Immunization (if Health Dept.), MSUE Agreement, Disaster Plan

Timeframes/Reminders (pg. 2/3) How staff are Updated (pg. 3) Returned Formula (pg. 4) Computer Maintenance (pg. 4) Breastfeeding (pg. 6) Equipment (pg. 7) Staff Training & Confidentiality agreement (pg. 7) Dual Enrollment (pg. 7) Caseload (pg. 8) Compliance‐Who records (pg. 8) Lead Screening (pg. 9) MIHP Outreach (pg. 9) Fair Hearings‐any last 3 yr & How handle (pg. 9) High Risk Monitoring (pg. 10) Annual Review (pg. 10)

Mon Tues Wed Thurs FriCert/Recert/EvalPG or InfantsNutrition EdBreastfeeding High Risk

Clinic

54



EntranceConferenceActive Record Review _‐White Chart Review Single Certifier Review Dual Participation Report Review Breastpump Monitoring Reports‐ pump types? Compliance Report Review Ineligible and Short Cert Review EBT Card Security Roles Report Review‐Staff Credentials Formula Approval Review High Risk Record Review

Certification/Evaluation Observation‐Blue Observe 9 clients Certification/Eval Process (2 PG, IFF/NPP, IBE/BPE, C1/2, C3/4, and CEval) Lab/Anthropometric QA Review

Nutrition Education/High Risk –YellowTypes of Nutrition Education Provided: Class Individual WICHealth.org Nut Ed Mall

Nutrition Education Lesson Plan Review (pg. 1) WICHealth.org Self‐Directed Learner observations/interviews Observe Benefit Issuance NE Materials developed by LA & how evaluated Breastfeeding Education and Support Observations Observation of Nutrition Education Class or Individual Ed High Risk Counseling Observation & How monitored

Recordkeeping and Accountability – Green Benefits Issued prior to appt. (pg. 1) Who has “Benefit Re‐Issuance” role (pg. 1) Records Destroyed when and how (pg. 1) EBT Card storage (pg. 2)

Outreach Referrals and Civil Rights – Pink

How provide info on Medicaid, substance abuse, etc. (pg. 1) Outreach Log (pg. 1) Coordination with MIHP, Imm’s, etc. (pg. 1) Locally developed materials/Nondiscrimination statement (pg. 1) Multi‐lingual staff or other means of translation (pg. 2) Civil Rights Training (pg. 2) 3 Client Interviews

Project Fresh – Beige Complete with Project Fresh Coordinator

55

MEChecklistDay 1

Entrance Interview –

• See ME Entrance Checklist

• Set up plan for the week

• Get introduced to staff, find out roles, what is flow and who does what

• Check/ print out schedule‐highlight participants (pregnant women, breastfeeding duos) for staff to notify you when they arrive.

• Do observations‐ certifications, nutrition education, counseling, breastfeeding education

• Arrange /schedule for discussions with other staff i.e. Breastfeeding Coordinator, Nutrition Ed. Coordinator, WIC Coordinator, Project Fresh Coordinator, etc.

• Keep paper on clipboard for recording 1) issues, 2) Special Recognitions, and 3) questions or notes during observations

• Review issues or questions with WIC Coordinator as things come up

• Schedule ME Exit Meeting

Evening‐

• Review online records for all cert and HR observations, continue Record Review, and at least begin working on other reports (formula approval, breastpump monitoring review, High Risk Dual participation, single audit, etc.)

Day 2‐3 or 4

• Observations (1st priority)‐Certifications, Nutrition Ed, Breastpump issue, High Risk Counseling

• Discussions with staff‐Clerical, Lab, Breastfeeding Coordinator, Nutrition Ed Coord.

• EBT Reviews between observations

• Client Interviews (3 for Civil Rights and 2 for Nutrition Mall, if applicable)

• If you have MI‐WIC access, complete Reviews when there is down time or no‐shows

Evenings‐

• Review Tools‐what still needs to be completed for the following day(s) (flag with small sticky notes), Reports to review and complete (white and yellow Tools), review online records for observations

56



MEChecklist

Evening prior to Exit

• Review Tools and notes for Not Mets and record ‘Reason Not Met’ and ‘Recommendation’ on the Access program

• Also record Special Recognitions on Access program

• Mets can be recorded later (if time is short) as the Summary only prints out Not Mets Reason and Recommendation and any Special Recognition

• Save Summary to Flash Drive (easiest to take to a computer with a printer)

Exit Day (Day 4 or 5)

• Complete any area not completed

• Print Summary (copies based on number attending Exit)

• Review Special Recognitions with attendees

• Review Not Mets, why, and what your recommendations are to correct the problem

57

AccreditationCycle 6‐2015 Calendar

On‐site Review

Week

Local

Health

Department

WIC ME WIC Consultant

February 9‐13 Kalamazoo 2012 or

8/25/2014

Cheryl

March 2‐6 Branch‐

Hillsdale‐St.

Joe

2012 or 7/7/2014 Joyce

March 9‐13 Marquette 2012 or 6/9/2014 Joyce

March 23‐27 Lapeer 2012 or

9/22/2014

Kevin

April 20‐24 Delta‐

Menominee

2012 or

8/11/2014

Diane

May 4‐8 Chippewa 2012 or

8/25/2014

Eileen

June 1‐5 Muskegon 2012 or 8/4/2014 Eileen

July 20‐24 Tuscola 7/21/2014 Kevin

August 3‐7 Grand

Traverse

8/11/2014 Terri

September 21‐25 Huron 9/15/2014 Joyce

October 19‐23 Sanilac 6/9/2014 Regina

November 2‐6 DHD #4 9/23/2013 Regina

November 23‐27 St. Clair 7/28/2014 Eileen

November 30‐

December 4

Bay 8/26/2013 Joyce

• Consultant will enter “Special Recognition” comments from most recent completed ME for the WIC Accreditation Report.

58



Questions….Let’s take a quick 5 minute break then go over your questions.

After the questions, for those of you who are new to WIC, we will go over the 2014 ME cycle citations and give ideas for quality improvements.

59

Break• Back in 4 minutes….

60



Break• Back in 3 minutes

61

Break• Back in 2 minutes

62



Break• Back in 1 minute

63

Questions….Answers!!!

64



2014MEReview• Section for New Coordinators or Quality Improvement staff

• Presented at the WIC Coordinator Meeting in November, 2014

65

2015 wic me webcast - ungerboeck€¦ · · 2015-04-21observation of client centered nutrition...

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