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Guided Goal Setting: The Logical Next Step to VENA. Presented by: Shirley H. Sword, MS, RD, LDN PA Department of Health – Division of WIC October 14, 2010. Objectives. To gain insight on the history of the development of Guided Goal Setting

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Guided goal setting the logical next step to vena l.jpg

Guided Goal Setting: The Logical Next Step to VENA

Presented by:

Shirley H. Sword, MS, RD, LDN

PA Department of Health – Division of WIC

October 14, 2010

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  • To gain insight on the history of the development of Guided Goal Setting

  • To understand the research behind development of the Guided Goal Setting Module

  • To learn the local agency perspective on how Guided Goal Setting is working in the clinics

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Facts and Figures About PA

  • 9th Largest WIC Program

  • 44,817 square miles

  • 274 people per square mile

  • One-third of our 12.4 million residents live in rural areas, the largest non-urban population in the nation

  • 2nd highest percentage of residents >65 years old in the country

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Facts and Figures About PA WIC

  • 67 Counties

  • 24 Local Agencies

    • Community Action Programs

    • Medical Centers

    • County Health Departments

    • Private, Non-Profits

  • 265,000 Monthly Caseload

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Service Delivery System

  • 329 Total WIC Clinics

    • 116 Primary Sites

    • 213 Satellite Sites

  • Users in total - 832

    • 383 CPAs

    • 449 Non-CPAs

  • 1767 WIC Authorized Stores

  • On-site, On-demand Check Printing

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Special Project Grants

  • Special funding from USDA for special State projects of regional or national significance to improve the services of the program

  • Address issues of critical and timely importance

  • Requires a rigorous evaluation component

  • Results are widely disseminated to other States

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Development and Evaluation of Guided Goal Setting (GGS) as a Behavior Change Approach and Monitoring Protocol in Pennsylvania WIC

Our Special Project Grant

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Partners in This Project

  • PA WIC

    • Shirley Hsi Sword, Project Director

  • Indiana U of PA

    • Stephanie Taylor-Davis, Principal Investigator

    • Mia M. Barker, Co-Investigator

    • William F. Barker, Evaluator

    • Pao Ying Hsiao, Research Assistant

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Goals of this Project

  • To enhance the quality of WIC services provided to PA WIC participants

  • To further VENA initiatives via an evaluated and measurable, participant-centered nutrition education counseling approach that:

    • Maintains continuity from visit to visit

    • Empowers participants

    • Benefits the participant

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The Basis for Goal Setting

  • Straight-forward behavioral change approach that accommodates a variety of achievement levels

  • Emphasizes small, progressive steps that are concrete

  • Relevant to address emerging prevention-oriented public health concerns

  • Supported in scientific and behavioral literature with a variety of populations and topic areas

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Guided Goal Setting (GGS): Defined

An approach used by the nutritionist in conjunction with the participant that involves critical thinking based on assessment to develop strategies for goal setting to achieve desired participant outcomes

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Central Mission

  • Identification, development, implementation, and evaluation of GGS as a WIC counseling method to:

    • Increase participant-centered approach

    • Enhance staff competency and critical thinking skills

    • Assess participant commitment to food-based behavior change

    • Extend nutrition education by supplementing contact points with targeted reinforcements

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Results by Year2005-2008


Special Project Grant

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Goals by Year

  • Year 1: “Profile Identification and WIC Evaluation”

    • Assess the state of being in PA WIC with respect to goal setting as a nutrition education counseling approach

  • Year 2: “Guided Goal Setting Practices & Assessment”

    • Formalize the GGS process through development and pilot testing of a training module and assessment tools

  • Year 3: “Improvement – Nutrition Education & Outcomes”

    • Project 1 = Provide standardized training to nutritionists to improve staff competency

    • Project 2 = Run an experimental protocol with GGS that uses reinforcement and is participant-centered and individualized

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Year 1 Projects

  • Interview and survey WIC staff to identify nutrition education best practices and barriers to best practices (n=147)

  • Survey WIC participants (not initially in proposal) (n=4665)

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Year 1: Data Collection

  • Demographic Survey

  • Written Surveys

  • Semi-structured interviews

    • Face-to-face

    • Telephone

  • Nutrition Education Services Survey

  • Director Survey

  • Nutrition Education Coordinator Survey

  • WIC Participant Survey

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Results:Year 1 – Staff Insights

  • Common themes for implementing:

    • Time

    • Environment

    • Distractions

    • Training

    • Resources

    • Attitudes about goal setting

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Results:Year 1 – Staff Insights

  • Best practices:

    • Participant-centered

    • Committed and knowledgeable staff

    • Receptive participants

    • Good assessment with critical thinking

    • Personalizing process

    • Establish expectation for goal setting

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Results:Year 1 – Staff Insights

  • Attributes:

    • Knowledge

    • Professional behaviors with participants

    • Professional behaviors within WIC

    • Program beliefs

    • Other

    • Professional values

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Results:Year 1: Participant Insights

  • Participant attitude different than staff perceptions

  • Liked best

    • Helpful suggestions from nutritionist

    • Caring Staff

    • Handouts and brochures

    • Recipes

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Results: Participant Insights (cont’d)

Participant Response (n=4,665) Regarding What They Like About WIC Nutrition Information

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Collective Voice:Year 1 Findings





  • TIME

  • Staff issues

  • Perceptions

  • Participant issues

  • Training issues

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Year 2 Projects

  • Develop & test a standardized, yet flexible, theory-based, user-friendly training module and associated instrumentation that will strengthen staff skills and competencies to facilitate the GGS Process

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General Concept of GGS Module Development


Nutrition Ed


Agency Staff



LA Directors

GGS Module Units & Objectives

GGS Practices Assessment Instruments

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Additional Year 1 Project Findings Incorporated

  • “Key principles, assumptions and expected components of a GGS contact” document

  • Recommendations regarding time and delivery system to support nutritionist and paraprofessional training

  • Best practices and success story reports from semi-structured interviews

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The GGS Module

  • Ten, 15 to 20-minute hands-on units

  • Activity rich

  • Case study oriented

  • Learner workbook

  • Evaluations: pre, one minute, post, workshop evaluation, and 6 week follow-up with “skill set use”

  • Pilot tested using facilitated group training

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GGS Module: Units 1-5

  • Definition and Relevance

  • Counseling Strategy for Behavior Change

  • Assessment and the Contribution of the WIC Staff

  • Personalizing the Process

  • Linking Risk Codes to Participant Goals

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GGS Module: Units 6-10

  • The Team Approach and Goal Priority

  • Structure of Measurable Goals

  • Documentation

  • Follow-Up and Goal Achievement

  • Action Plan

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Year 3 Projects

  • Staff Training using GGS module

  • Experimental protocol to test effectiveness of GGS with participants

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Year 3 Results: Staff Training

  • Alpha testing (February 2008)

    • n=10

  • Beta testing (July 2008)

    • n=12

Pre- and post-training surveys

One minute evaluations for each unit

Overall workshop evaluation

Six week follow-up “skill set use” survey

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GGS Evaluation:“Most Important Things Learned”

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GGS Evaluation: “Least Important Things Learned”

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GGS Evaluation:“How Use Information”

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Suggestions after Pilot Testing

Based on α Site

Based on β Site

Spend more time on the last five units and less time on the overview

Split into two sessions

More examples of goals and documentation

Fewer evaluations or group them

Good information but could go at faster pace

  • Modified the units to make them more consistent in presentation style

  • Added a small amount of time to each unit

  • Most substantial revision was to Unit 6 – TEAM approach

  • Modified the way the documentation template was introduced in Unit 8

  • Added the ‘Modified’ response option to Skill Set Survey Instrument

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Conclusions after Pilot Testing

  • By establishing a baseline and a consistent structure for participant goal setting within PA WIC, there are now parameters upon which to evaluate the nutritionist-participant interaction and assess the efficacy of this counseling method to support participant behavior change.

  • The GGS Training Module and Assessment Instruments provide a mechanism to address staff (both CPA/Nutritionist and Other Staff) competency to facilitate the goal setting process with WIC participants.

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Staff Reaction

  • Better working relationship with the clients

  • More open communication between staff and clients

  • More aware of the client’s perception of their family’s nutritional needs

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Client Reaction

  • “Your nutritionist was very well informed and offers great ideas and information.”

  • “Staff was very friendly and explained everything in detail and offered excellent help.”

  • “Staff made us feel comfortable with her advice and help.”

  • “The Staff spoke to me, not at me.”

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Hurdles to Cross

  • Don’t jump to conclusions!

  • Set small, achievable goals

  • Time

  • Documentation

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Effect on Clinic Operations

  • No change in staff duties

  • No operational changes within the clinic

  • Continuing education for professional and paraprofessional staff

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  • USDA, Food and Nutrition Service

  • FNS Project Officers

    • CherisaToomer (May 2007 – December 2008)

    • Carol Stiller, MS, RD (September 2005 – April 2007)

    • Home Nursing Agency staff and participants

    • Adagio Health, Inc.

  • PA Department of Health, Bureau of Information Technology and Ciber, Inc.

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Contact Information

Shirley H. Sword, MS, RD, LDN

Stephanie Taylor-Davis, PhD, RD, LDN

Mia Barker, PhD

Tracy Kelley