Value Enhanced Nutrition Assessment VENA Overview Web Cast Presented by Tony Zech, RD, MBA State of Wisconsin WIC Pro

1.  Value Enhanced Nutrition Assessment (VENA) Overview Web CastPresented by Tony Zech, RD, MBA State of WisconsinWIC Program NutritionistNovember 14, 2008 Welcome to this VENA Overview Web Cast. VENA means Value Enhanced Nutrition Assessment. I am Tony Zech, State WIC Program Nutritionist. I will be your host and guide on your journey to implement VENA. It is my pleasure to provide you with this Overview and Background. Thank you for participating! I hope you enjoy this presentation and find it helpful! Welcome to this VENA Overview Web Cast. VENA means Value Enhanced Nutrition Assessment. I am Tony Zech, State WIC Program Nutritionist. I will be your host and guide on your journey to implement VENA. It is my pleasure to provide you with this Overview and Background. Thank you for participating! I hope you enjoy this presentation and find it helpful!

2. Two VENA Web Casts and Acknowledgements VENA Overview VENA Story Thank you to Kathleen Hoag, WIC Training Coordinator, and others that helped with these webcasts. This VENA Overview is the first of two VENA Webcasts. The second VENA webcast will be on the VENA Story and will include an Introduction, Demonstrations and Activities, and Key VENA Practices and Resources. I would like thank Kathleen Hoag, our WIC Training Coordinator and others that have helped make these VENA webcasts a reality! This VENA Overview is the first of two VENA Webcasts. The second VENA webcast will be on the VENA Story and will include an Introduction, Demonstrations and Activities, and Key VENA Practices and Resources. I would like thank Kathleen Hoag, our WIC Training Coordinator and others that have helped make these VENA webcasts a reality!

3.  Overview & Background of VENA  What is VENA? Why VENA? VENA Skills/Competencies This Presentation will provide you with some basic information about VENA, why VENA is beneficial, and what skills you will improve by implementing VENA. This Presentation will provide you with some basic information about VENA, why VENA is beneficial, and what skills you will improve by implementing VENA.

4. What is VENA? V – Value E – Enhanced N – Nutrition A – Assessment So, what is VENA? Value Enhanced Nutrition Assessment. (Presenter: state slowly, this is a multi-concept phrase): The guiding principle in VENA is to Strengthen and re-align the primary purpose of WIC nutrition assessment from determining eligibility to using the nutrition assessment as the bridge (use hands my right to my left to illustrate the bridge) to providing the most appropriate and effective nutrition education, referrals, and food prescriptions, in order to maximize WIC’s impact. In order to accomplish this, we need a strong bridge. We shouldn’t try to jump over the bridge (or not link the assessment to counseling), and we want to make sure the bridge is going in the right direction. We don’t want to build a bridge to no where! In case you’re thinking you already do this, you’re right, a lot of what’s in VENA has been policy in Wisconsin for decades. But, USDA has said that in some states, the CPA would stop after identifying one risk. They have more work to do than we do to implement VENA! So, what is VENA? Value Enhanced Nutrition Assessment. (Presenter: state slowly, this is a multi-concept phrase): The guiding principle in VENA is to Strengthen and re-align the primary purpose of WIC nutrition assessment from determining eligibility to using the nutrition assessment as the bridge (use hands my right to my left to illustrate the bridge) to providing the most appropriate and effective nutrition education, referrals, and food prescriptions, in order to maximize WIC’s impact. In order to accomplish this, we need a strong bridge. We shouldn’t try to jump over the bridge (or not link the assessment to counseling), and we want to make sure the bridge is going in the right direction. We don’t want to build a bridge to no where! In case you’re thinking you already do this, you’re right, a lot of what’s in VENA has been policy in Wisconsin for decades. But, USDA has said that in some states, the CPA would stop after identifying one risk. They have more work to do than we do to implement VENA!

5. Underlying Theme for Wisconsin’s VENA V – Value E – Every N – Nutritionist A – Always Here is Wisconsin, we have developed a new acronym for VENA and incorporated it into our resources and training. Our underlying theme for VENA is: Value Every Nutritionist Always! For example, we have developed a VENA toolkit with a colorful cover (show) that they can use as a handy reference that nutritionists can use for implementing VENA. Here is Wisconsin, we have developed a new acronym for VENA and incorporated it into our resources and training. Our underlying theme for VENA is: Value Every Nutritionist Always! For example, we have developed a VENA toolkit with a colorful cover (show) that they can use as a handy reference that nutritionists can use for implementing VENA.

6. VENA Toolkit Background Umbrella Questions Statements Skills Checklist FAQs Resources The toolkit and this webcast is part of WI WIC’s response to the national initiative. The toolkit and this webcast is part of WI WIC’s response to the national initiative.

7. VENA = Key Component of Quality WIC Nutrition Services VENA is part of the continuing national effort to improve nutrition services in the WIC Program – Revitalizing Quality Nutrition Services (RQNS). Other RQNS initiatives include: - BF Support – As part of USDA’s Loving Support Makes Breastfeeding Work campaign, two important projects are Loving Support through Breastfeeding Peer Counseling and Using Loving Support to Build Breastfeeding Friendly Communities. Food Package – final “Interim” Rule published in December 2007, with implementation required by August, 2009. - WIC Works Resource System - USDA’s web site that has a wealth of information related to WIC nutrition services and serves as on-online training venue. - Nutrition Services Standards – a wide range of performance practices used in the delivery of WIC Nutrition Services to promote quality nutrition services (on WIC Works). - Nutrition Education Policy and Guidance – USDA released this to States in ’06; guidance to states regarding internet nutrition education, etc. So, VENA is a part of a larger process with the overall goal of providing quality nutrition services to the people the WIC Program serves.VENA is part of the continuing national effort to improve nutrition services in the WIC Program – Revitalizing Quality Nutrition Services (RQNS). Other RQNS initiatives include: - BF Support – As part of USDA’s Loving Support Makes Breastfeeding Work campaign, two important projects are Loving Support through Breastfeeding Peer Counseling and Using Loving Support to Build Breastfeeding Friendly Communities. Food Package – final “Interim” Rule published in December 2007, with implementation required by August, 2009. - WIC Works Resource System - USDA’s web site that has a wealth of information related to WIC nutrition services and serves as on-online training venue. - Nutrition Services Standards – a wide range of performance practices used in the delivery of WIC Nutrition Services to promote quality nutrition services (on WIC Works). - Nutrition Education Policy and Guidance – USDA released this to States in ’06; guidance to states regarding internet nutrition education, etc. So, VENA is a part of a larger process with the overall goal of providing quality nutrition services to the people the WIC Program serves.

8. VENA Skills/Competencies We will do this by using VENA skills. The VENA initiative proposes that all WIC nutritionists be competent in these areas. Cultural sensitivity: Critical thinking: Rapport building: Knowledge of nutrition: Apply WIC requirements: For the purpose of this web cast we will only be focusing on the following four things: 1) the nutrition assessment process, 2) communication, 3) critical thinking and 4) rapport building.We will do this by using VENA skills. The VENA initiative proposes that all WIC nutritionists be competent in these areas. Cultural sensitivity: Critical thinking: Rapport building: Knowledge of nutrition: Apply WIC requirements: For the purpose of this web cast we will only be focusing on the following four things: 1) the nutrition assessment process, 2) communication, 3) critical thinking and 4) rapport building.

9. WHY VENA? Besides being a national and statewide initiative designed to improve the quality of nutritional services, why else do we need to implement VENA? Here are three other reasons: VENA will help us be more focused, more effective, and save time! Besides being a national and statewide initiative designed to improve the quality of nutritional services, why else do we need to implement VENA? Here are three other reasons: VENA will help us be more focused, more effective, and save time!

10. How VENA Works Establish Rapport Complete the Assessment Identify & Explore Concerns Set Goal(s) – use Stages of Change Close on a Positive Note There are many skills that are needed and will be improved as you implement VENA. This slide identifies four main VENA Process Skill Areas for Effective Assessment and Counseling. There are many skills that are needed and will be improved as you implement VENA. This slide identifies four main VENA Process Skill Areas for Effective Assessment and Counseling.

11. VENA Steps Build Rapport Review past care plan, risks, secondary education Review results of anthropometric, blood screening and health history Determine client concerns Review risks and problems - Determine root cause(s) The next two slides list the VENA process. Building Rapport is throughout the process, and that is why it is listed here first. Actually, all of these steps are fluid and that is why we haven’t numbered them. However, most of the steps on this slide are part of the nutrition assessment. (Provide example of weaning off the bottle as the root cause). All of these steps help build that strong bridge to counseling and healthier outcomes! The next two slides list the VENA process. Building Rapport is throughout the process, and that is why it is listed here first. Actually, all of these steps are fluid and that is why we haven’t numbered them. However, most of the steps on this slide are part of the nutrition assessment. (Provide example of weaning off the bottle as the root cause). All of these steps help build that strong bridge to counseling and healthier outcomes!

12. VENA Process (cont.) Use assessment information and health outcomes for the participant’s category to: Provide counseling/referrals Develop behavioral objective for the next contact Prescribe the food package Schedule appropriate secondary nutrition education Complete documentation The slide transitions to the counseling and documentation steps. As you will notice the scheduling appropriate secondary nutrition education is included. The nutrition education scheduled needs to be linked to the nutritional needs identified during the nutrition assessment. The next few slides will focus on a few of the key VENA skills. The slide transitions to the counseling and documentation steps. As you will notice the scheduling appropriate secondary nutrition education is included. The nutrition education scheduled needs to be linked to the nutritional needs identified during the nutrition assessment. The next few slides will focus on a few of the key VENA skills.

13. Critical Thinking A disciplined process of organizing and synthesizing information to evaluate and prioritize the information appropriately Apply to a desired goal Assess before counseling Critical thinking is a term that may be new to you, but as mentioned earlier, you do it all the time. Basically, critical thinking helps you make better decisions about what actions to take. This includes something that we all have a difficulty doing and is a key skill for VENA: Collecting all the information (i.e., completing your assessment) before drawing conclusions/deciding on a coarse of action (i.e., counseling). It also saves time: Example of how this saves time: If you try to go back and forth across the bridge from assessment to counseling, it will take you a lot longer than if you just go across it once. It takes longer to counsel after each problem than it does to counsel on one problem that may solve two or three other problems. Critical thinking is a term that may be new to you, but as mentioned earlier, you do it all the time. Basically, critical thinking helps you make better decisions about what actions to take. This includes something that we all have a difficulty doing and is a key skill for VENA: Collecting all the information (i.e., completing your assessment) before drawing conclusions/deciding on a coarse of action (i.e., counseling). It also saves time: Example of how this saves time: If you try to go back and forth across the bridge from assessment to counseling, it will take you a lot longer than if you just go across it once. It takes longer to counsel after each problem than it does to counsel on one problem that may solve two or three other problems.

14. This is a rather complicated scientific diagram of the critical thinking process. But, we all use critical thinking all the time! In many ways, we’re already experts at it; we just need to recognize it and make sure we use it during WIC nutrition assessments. When do we need critical thinking skills? - Asking “umbrella” questions. These are located in the VENA Toolkit (show) Knowing when to probe further (e.g., based on responses to the italicized CSHCN-related questions). Example: If they have feeding difficulty. Is the child chocking or gagging frequently—this may help identify CYSHCN. Knowing when to discard irrelevant information or redirect participant to the issue at hand. You will see a demonstration of how to do this in our VENA Story demonstrations webcast. Analyzing interrelationships between risk and getting to the root of the problem(s). Determining a participant’s stage of change. This is a rather complicated scientific diagram of the critical thinking process. But, we all use critical thinking all the time! In many ways, we’re already experts at it; we just need to recognize it and make sure we use it during WIC nutrition assessments. When do we need critical thinking skills? - Asking “umbrella” questions. These are located in the VENA Toolkit (show) Knowing when to probe further (e.g., based on responses to the italicized CSHCN-related questions). Example: If they have feeding difficulty. Is the child chocking or gagging frequently—this may help identify CYSHCN. Knowing when to discard irrelevant information or redirect participant to the issue at hand. You will see a demonstration of how to do this in our VENA Story demonstrations webcast. Analyzing interrelationships between risk and getting to the root of the problem(s). Determining a participant’s stage of change.

15. Rapport Building Establishing a relationship to build trust for a two way conversation. Another skill is building rapport with the participant so that they feel comfortable talking to you. Using an effective balance of open-ended and close-ended questions helps with both rapport building and critical thinking. Another skill is building rapport with the participant so that they feel comfortable talking to you. Using an effective balance of open-ended and close-ended questions helps with both rapport building and critical thinking.

16. Determining the participant’s stage of change (which can be done via active listening throughout the assessment as well as in structured ways) is essential for providing effective counseling and education. This helps you prioritize concerns in a client-centered way, a key VENA skill. It helps you work more in partnership with WIC participants to identify goals. Example: Use my fruit tie. Child doesn’t eat vegetables. Instead of starting with a goal related to vegetables, perhaps you could see if they could be offered fruit (such as cantaloupe) daily, which provides some of the nutrients they are missing by not eating Vit. A-rich vegetables. Determining the participant’s stage of change (which can be done via active listening throughout the assessment as well as in structured ways) is essential for providing effective counseling and education. This helps you prioritize concerns in a client-centered way, a key VENA skill. It helps you work more in partnership with WIC participants to identify goals. Example: Use my fruit tie. Child doesn’t eat vegetables. Instead of starting with a goal related to vegetables, perhaps you could see if they could be offered fruit (such as cantaloupe) daily, which provides some of the nutrients they are missing by not eating Vit. A-rich vegetables.

17. VENA Summary Adds Value and Enhances the WIC Nutrition Assessment Bridge to more appropriate and effective nutrition education, referrals, and food prescriptions, in order to maximize WIC’s impact

18. VENA Resources Wisconsin WIC Training Connection website (http://dhs.wisconsin.gov/WIC/WICPRO/training/index.htm) USDA WIC Works (http://www.nal.usda.gov/wicworks/WIC_Learning_Online/index.html) Here are some links to the VENA Resources our WIC Training Connection website and from USDA. Here are some links to the VENA Resources our WIC Training Connection website and from USDA.

19. Contact information and Thank you! Tony Zech, RD, MBA Wisconsin WIC Program Nutritionist 1 W. Wilson Street Madison, WI 53702 Ph. 608-266-3742 Email: anthony.zech@wisconsin.gov Thank you for watching and participating! I wish you the best on your VENA journey! Here is my contact information. Let me know if you have any questions or how I can help you. We will be doing another VENA webcast called the VENA Story. This will include an Introduction, Demonstrations and Activities, and Key VENA Practices and Resources. I hope you have enjoyed this webcast and found it helpful. Thank you for watching and participating! It has been my pleasure to be your guide and host for this webcast. I wish you the best on your journey to implement VENA! Here is my contact information. Let me know if you have any questions or how I can help you. We will be doing another VENA webcast called the VENA Story. This will include an Introduction, Demonstrations and Activities, and Key VENA Practices and Resources. I hope you have enjoyed this webcast and found it helpful. Thank you for watching and participating! It has been my pleasure to be your guide and host for this webcast. I wish you the best on your journey to implement VENA!