ITCA WIC JUNE 2014

Goal Setting

Summary

Objectives

Learn tips on how to help our clients set simple and effective nutrition goals that they can use to improve their own health and that of their children and families.

Topics that will be covered:

• How to keep goals simple and realistic

• How to make goals specific

• How to get clients to set their own goals

Explain Nutrition Education

Explain to the client why we provide nutrition education (before or after Health Assessment).

Sample wording: One of our main goals at WIC is to help

[you/your child] eat well in order to stay healthy or become healthier. So whenever we see you we try to go over a nutrition topic since it’s a huge part of [your/your child’s] health and most doctors don’t have enough time to discuss it.

Increase Client Interest

Explain to the client why we have them set goals (optional).

Sample wording: Each time we see you we try to go over tips on

how to keep healthy or improve your health and your family’s. We try to help our families set easy goals for themselves or their kids that are related to health and nutrition. Then next time you come in we can ask you about them and see how it went and if they helped.

What’s another way we can help increase client involvement/interest in the appt?

PCS tools for goal setting

The PCS tools are written to help clients determine what their main interests/concerns are. Many of the tools come with sample wording that is written in a way that helps clients come up with their own goals.

1. Blank circle charts2. Illustrated circle charts3. Magic Wand 4. Card Sort5. Face Cards

Steps in Goal Setting

Scenario: mom c/o child’s poor appetite; you find they drink lots of milk/juice.

1. Affirm It seems you are concerned that your child is not eating enough to

grow up healthy.OR It seems like you really pay attention to how your child eats and it’s

important to you that they eat healthy – that’s great.

2. State Fact & ask for Feedback (point out facts on a handout if you’d like)

The recommended amount of juice for kids is 4-6 ounces a day. The recommended amount of milk is 2-3 8-oz glasses. Kids who drink more than that can be too full to eat enough solid foods and may not get enough nutrients they need.

What do you think about that?

Goal Setting Steps (cont)

3. Ask additional questions that will help the client think of a goal.

How do you feel about limiting the amount of milk or juice he drinks?

What types of things have you already tried?* What would be the easiest way for you to limit his

milk & juice? What is one thing you can try this week to cut back on

his milk or juice?If client cannot think of anything, ask “Would you

mind if I offered some suggestions that other WIC parents have told me worked for their kids?”*Remember to provide positive reinforcement for things they are

currently doing or have already done.

Goal Setting Steps (cont)

4. Offer NE/Go over handout List a few ideas.

making water fun, diluting; offering it in smaller/more fun cups; ice cubes/fruit slices/splash of juice

5. Finalize goal Which one of these things do you think you could

try out this week/today?

6. Conclude with positive reinforcement Great, that sounds like a good thing to try. I’ll write

it down so when you come in next time we can ask you how it went and if it worked or not. If not, we can come up with some more ideas together.

Steps in Goal Setting, Scenario #2

Scenario: PG client says she’s thinking of both BF and formula feeding in case she does not produce enough milk.

1. Affirm Ex: It seems like you want to try BF but are worried you may not

be completely successful. That’s great that you want to give your baby the best/healthiest milk out there.

2. State Fact & Ask for Feedback Women who want to BF do best if they avoid formula at least the

first few weeks. This helps your body make enough milk. After about a month it is easier to do both formula and breastfeeding without your milk supply decreasing. And by then BF is usually much easier so many women avoid formula altogether.

How does that sound to you?

Goal Setting Steps (cont)

3. Ask additional questions that will help the client think of a goal (in this case producing enough milk to successfully BF)?

What do you think it will take to make BF successful for you?

What do you think you can do to help your body make enough milk?

Provide suggestions if needed Would it be alright if I made some additional

suggestions that women have told me helped them when they were breastfeeding for the first time?

Goal Setting Steps (cont)

4. Offer NE/Go over handout List a few ideas:

letting the hospital know plans; tips for hospital; reading materials

5. Finalize goal Which one of these things do you think you could

try out before your next visit?

6. Conclude with positive reinforcement That’s great that you are thinking about giving

your baby the best milk possible. It’s a great gift that only you can give.

Things to remember when helping clients set goals

Did the client say this is what they want to do?

Is there a specific thing the client says they will do by the next time you see them?

Is the goal simple, or too difficult?

When is the client going to start?

How many times a day/week will they do this?

When is the client going to stop?

Ea t more f r u i t s and vege ta b les .

Have who le g ra ins , da i r y and f / v eve ry day.

Keep ea t i ng vege tab les ; have l o t s o f l i qu ids

Snacks b /w mea l s , cheese a nd c racke r s , yogur t

Making goals more specific and easy to measure progress on:

General Specific

Have vege tab les o r f r u i t s once a day.

Have a t l eas t one i t em f rom eve ry f ood g roup da i l y.

I nc rease vegg ie i n take to tw i ce a day. I nc rease wa te r i n ta ke by 1 ex t ra cup a day.

Have a sna ck b /w bk f s t & l unch , and b /w l unch & d inne r. A t l ea s t one snack w i l l con ta in a se rv i ng o f da i r y.

How can we make these goals even more specific?

Goal Practice

1. Some ways to meet goals are very general and do not give a client something specific to try when she gets home.

GOAL: JUICE INTAKE

WAYS TO MEET GOAL:General: Give less juice; offer water when thirstySpecific: Limit juice to once a day during a meal or snack-let the child decide which one. Offer water other times child is thirsty.

Goal Practice

GOAL: HEALTHY SNACKS

WAYS TO MEET GOAL:General: offer healthy snacks; offer f/v for snacks instead of chips and candySpecific: Replace one unhealthy snack a day (chips or candy) with one snack that contains fruit or vegetables. Start after the WIC checks are cashed this week.

Goal Practice

2. Some ways to meet goals are very long or detailed and might overwhelm the client.

GOAL: EAT HEALTHY DURING PREGNANCY

WAYS TO MEET GOAL:General: Eat veggies every day. Eat more whole grain foods. Have smoothies, yogurt or cheese if you don’t like milk.Specific: Have at least one serving from every food group each day: fruit, veggies, dairy, meat/beans/eggs, whole grains.

Goal Practice

3. Some groups can be difficult to make goals for, such as young infants, or BF goals for PG women.

GOAL: TO BF (PG CLIENT)

WAYS TO MEET GOAL:General: breastfeed in the hospital; avoid formula, bottles, pacifiersSpecific: 1. At your next OB visit, let the doctor and nurses know you plan to BF and request that they avoid formula, bottles and pacifiers. 2. Ask if you can schedule a lactation nurse to help after delivery.

Goal Practice

GOAL: FORMULA AMOUNTS

WAYS TO MEET GOAL (LIMITED BF INFANT):

General: feed baby when he shows hunger; continue to try to breastfeedSpecific: 1. Feed baby when he first shows he’s hungry (sucks on hands, gets very active or fussy). 2. Start each feeding with breastfeeding. Only give formula if BF did not produce enough milk.

Sample wording to increase involvement

What is one thing you can try when you leave here today?

Which of these would you like to try?What do you think you need to change to

reach your goal?Which one would you like to try this month?When can you start?How often would you like to do this?

Questions? Difficult scenarios?

Request for Materials?