Value Enhanced Nutrition Assessment (vena) in wic the First Step in Quality Nutrition Services Implementation Guidance



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Value Enhanced Nutrition Assessment (VENA) in WIC

The First Step in Quality Nutrition Services
Implementation Guidance
The implementation of VENA will be a gradual process determined by each State agency’s current nutrition assessment process and staffing, within the timeframe noted below. The Food and Nutrition Service (FNS) Regional offices are available to provide technical assistance to State agencies throughout the VENA implementation process.
This guidance organizes the VENA implementation process into two phases. The VENA implementation process for each State agency begins with an evaluation and comparison (Phase I: VENA Self-Evaluation) of current nutrition assessment policies and practices to the process and content of a value enhanced WIC nutrition assessment as described in the VENA Guidance. Phase II is the development of a VENA Implementation Plan. This two-phase process should enable all State agencies to implement VENA by Fiscal Year (FY) 2010.
The following is a detailed description of the two phases of VENA Implementation and the required information to be submitted to FNS. In addition, (optional) forms are included for submitting the VENA Self-Evaluation results and the VENA Implementation Plan.
VENA IMPLEMENTATION
Phase I: VENA Self-Evaluation
Purpose
The purpose of the self-evaluation is to assist WIC State agencies in establishing the baseline of current WIC nutrition assessment practices (in the context of a value enhanced nutrition assessment). The VENA initiative establishes standards for WIC nutrition assessment with the intention of strengthening the nutrition assessment process. The nutrition assessment serves as the basis from which other nutrition services can be personalized to best meet the participant’s needs.
Outcome
Completion of the self-evaluation by a State agency will produce a summary of baseline WIC nutrition assessment practices, including identification of strengths and areas for enhancements in the 5 priority areas: WIC policies, WIC nutrition assessment practices and processes, staff competencies/training, Management Information System (MIS), and quality assurance and monitoring.
Uses


  • The Self-Evaluation will be used by the State agency to develop the VENA Implementation Plan.

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  • The Self-Evaluation will be used by the FNS Regional Office to evaluate the appropriateness of the State agency VENA Implementation Plan.


Due Date
The due date for the submission of the VENA Self-Evaluation to the FNS Regional office is on or before December 15, 2006.
Local Agency Input for the Self-Evaluation
It is crucial to the success of VENA for the State agency to solicit local agency input in order to translate VENA principles into local agency operations and staff practices. As such, FNS expects that State agencies will obtain local agency input as part of the self-evaluation process. Many State agencies have local agency task forces, committees or other established mechanisms to facilitate local agency input. In addition, there are other ways – surveys, observational visits, etc. - to facilitate this input. State agencies may choose the manner or means by which to collect local agency input, as long as the local agency perspective is included in the self-evaluation process.

The Self-Evaluation Process
VENA is envisioned to be a continual process in which the 5 priority areas (see diagram below) build upon each other. Using this circular concept, State agencies can choose to begin the VENA Self-Evaluation at any point in the cycle to best meet their needs.


A State agency may choose to begin their self-evaluation with a broad look at operations, and subsequently narrow the focus down to specific components of the assessment process and the competencies needed to carry them out. Alternatively, they can start with specifics and consider


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how they contribute to overall operations. Whichever method is chosen, the self-evaluation must cover the five priority areas.


With regard to the staff competencies/training priority area, a State agency may want to wait until they attend their Regional VENA Competency Training (rapport building, critical thinking and health outcome-based WIC nutrition assessment) before completing this section of the self-evaluation. The other focus areas of the self-evaluation may be started prior to the regional trainings.
State agencies should refer to the following guidance and policy memorandums to conduct the VENA Self-Evaluation:

  • FNS WIC Policy Memorandum #2006-5, Value Enhanced Nutrition Assessment - WIC Nutrition Assessment Policy;

  • The VENA Guidance;

  • WIC Program Regulations, Section 246.7;

  • Nutrition Services Standards, Standard 7 Nutrition Assessment, sections A, C and D and;

  • FNS WIC Policy Memorandum 98-9, Revision 8, WIC Nutrition Risk Criteria.

Two appendices in the VENA Guidance are particularly helpful in the self-evaluation process. Appendix D, Essential Staff Competency Tables for WIC Nutrition Assessment, identifies the six staff competency areas necessary to conduct a value enhanced WIC nutrition assessment. Appendix A, Relevant WIC Nutrition Assessment Information Tables, identifies category specific information to be collected during a comprehensive WIC nutrition assessment in order to:




  • Identify WIC nutrition risk criteria used by the State agency;

  • Meet existing Program requirements, such as immunization and lead screening status; and

  • Address issues that affect the overall health of the participant, such as access to health care, physical activity, and food security.


Self-Evaluation Results
State agencies may use the attached Phase I: VENA Self-Evaluation Form, or another format, to submit a summary of their self-evaluation results. The Phase I: VENA Self-Evaluation Form includes questions for each of the five priority areas to help focus the review process. The focused questions are not intended to be answered individually, but should be used as a framework for completing the self-evaluation. Whatever format a State agency chooses, the self-evaluation summary must address the information requested for each of the five priority areas. WIC State agencies are encouraged to contact their FNS Regional Office if they have questions or would like technical assistance with completing the self-evaluation.
This self-evaluation of the nutrition assessment process creates the pre-VENA “picture”. Once State agencies have created a detailed picture of their current process and identified their strengths and areas for enhancements, State agencies should begin to develop their implementation plan.

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VENA IMPLEMENATION



PHASE I: VENA SELF-EVALUATION FORM*

Due On or Before December 15, 2006
This form was developed to assist State agencies in completing Phase I: VENA Self-Evaluation. State agencies have the option to complete this form or use another format that summarizes their finding from the self-evaluation. Whatever format is used, the report must include the information requested (see “Self Evaluation Results” column) for each activity (see “Activity” column below) on this form.





Activity

Self-Evaluation Results

Comments/Additional Information

1

Evaluate the current nutrition assessment process in the 5 priority areas (items a-e) identified below, in the context of a value enhanced nutrition assessment, to establish a baseline of WIC nutrition assessment practices. The questions posed below are provided to give focus to the review process and are to be used as a framework for completing the self-evaluation. It is not intended that each question be answered individually.


Please provide a brief summary of existing resources and processes from your State agency’s review of each priority area.




a

WIC Policies


  • How do your existing State nutrition assessment policies support and/or enhance VENA implementation?

  • How do your existing State nutrition assessment policies inhibit VENA implementation?

  • Are there State policies (e.g., certification, breastfeeding promotion and support) that impact VENA implementation?

  • Have staff competencies been identified for conducting specific parts of the nutrition assessment process? (Refer to Appendix D, Essential Staff Competency Tables for WIC Nutrition Assessment, of the VENA Guidance.)

  • What State policy changes/revisions are needed to implement WIC Policy Memorandum 98-9, Revision 8?



In considering the WIC policy questions: Please note that policy citations are not the desired responses for the self-evaluation results.  Rather, a brief narrative summary of current policies that support VENA and a brief description of potential areas for policy enhancements are expected for the VENA Self-Evaluation results submission.





* May be reported in another format. 4

VENA IMPLEMENATION

PHASE I: VENA SELF-EVALUATION FORM*

Due On or Before December 15, 2006

(Continued)






Activity

Self-Evaluation Results

Comments/Additional Information

b

WIC Nutrition Assessment Processes and Practices


  • How is all relevant nutrition risk information collected and how is priority assigned? (Refer to Appendix A, Relevant WIC Nutrition Assessment Information Tables, of the VENA Guidance)

  • How are interrelationships between risks considered?

  • How is dietary intake assessed?

  • How does the assessment process provide a positive experience for the applicant?

  • How does the documentation facilitate follow-up at subsequent participant appointments?

  • What is the process for follow-up of goals established on a prior visit?

  • What barriers currently exist to prevent local WIC staff from doing value enhanced nutrition assessment?

  • How will these barriers be addressed?

  • How does clinic flow affect the nutrition assessment process?









* May be reported in another format.

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VENA IMPLEMENATION



PHASE I: VENA SELF-EVALUATION FORM*

Due On or Before December 15, 2006

(Continued)






Activity

Self-Evaluation Results

Comments/Additional Information

c

Staff Competencies/Training


  • What training is provided to WIC staff responsible for each part of the nutrition assessment process?

  • How does the State agency ensure that the training is competency-based?

  • What nutrition knowledge components are included in the training?

  • How does the State agency ensure that the training prepares staff to perform a nutrition assessment?

  • How does the State agency ensure that the training addresses communication and counseling skills?

  • How does the State agency ensure that the training includes critical thinking skills (refer to the VENA Guidance for more details)?

  • What competencies are reassessed routinely?

  • Who is required to receive training on the nutrition assessment process (all Competent Professional authorities, paraprofessionals) and at what intervals?










* May be reported in another format.

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VENA IMPLEMENATION



PHASE I: VENA SELF-EVALUATION FORM*

Due On or Before December 15, 2006

(Continued)






Activity

Self-Evaluation Results

Comments/Additional Information

d

Management Information System (MIS)


  • How does the MIS facilitate/inhibit the nutrition assessment process?

  • What features/changes to the MIS are critical to the assessment process?

  • What changes to the MIS would enhance the nutrition assessment process?

  • What resources will be needed to make changes to the MIS as a result of VENA?

  • How will staff be trained on MIS changes?




It is important to note that a sophisticated data system is not a necessity for implementing

VENA. The State agency should consider the current system it has in place as the implementation plan is developed, and bear in mind that a data system’s main function is to collect and house information in an organized and efficient manner. Increased automation is not the targeted end-point for successful implementation of VENA. Rather, the goal should be to find the balance between a well-designed and highly functional MIS and a value enhanced nutrition assessment performed by well-trained staff. The MIS should serve as an adjunct that enhances the WIC nutrition assessment process.








e

Quality Assurance/ Monitoring


  • How and how often are all aspects of the nutrition assessment process monitored and evaluated by the State and the local agencies?

  • How does the State agency monitor the effectiveness of the training provided?










* May be reported in another format.

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VENA IMPLEMENATION



PHASE I: VENA SELF-EVALUATION FORM*

Due On or Before December 15, 2006

(Continued)






Activity

Self-Evaluation Results

Comments/Additional Information

2

Identify enhancements needed to implement VENA.

Please provide a brief summary of identified enhancements needed in each priority area. This summary should provide a preliminary overview of your State agency’s intentions. Detailed action steps and timelines will be requested as part of Phase II - VENA Implementation Plan in the Fiscal Year 2008 State Plan.





a

  • WIC Policies









b










c

  • Staff Competencies/Training









d

  • Management Information Systems (MIS)










e

  • Quality Assurance/ Monitoring









f

  • Other









3

Local Agency input



Please summarize how local agency input was incorporated into the VENA Self-Evaluation. Describe how local agency input will be solicited for the VENA Implementation Plan.





* May be reported in another format 8

Phase II: VENA Implementation Plan
Purpose
The purpose of the VENA Implementation Plan is to assist WIC State agencies in determining the necessary action steps and related timeframes to ensure VENA implementation by October 1, 2009.
Use
The VENA Implementation Plan will be used by State agencies and Regional Offices to evaluate progress towards achieving VENA during monitoring evaluations, State Plan review, etc.
Due Date
The due date for the submission of the VENA Implementation Plan is on or before

August 15, 2007 (to be submitted with the FY 2008 State Plan).
The VENA Implementation Plan
The VENA Implementation Plan should include information about the State agency’s plans to:


  • Identify and prioritize work activities and expenditures related to VENA implementation.




  • Develop or revise current policies and procedures to enhance the quality of WIC nutrition assessment (to include polices and procedures that will enhance the use of assessment information for personalizing nutrition interventions).




  • Identify VENA training needs and develop training plans for all staff related to WIC nutrition assessment, to include but not limited to the 3 areas covered in the VENA Competency Training (critical thinking, rapport building and Health Outcome-Based WIC Nutrition Assessment).




  • Develop a plan for shifting WIC nutrition assessment from a deficiency findings process to a more positive process that focuses on desired health outcomes. (May include development of new questionnaires or nutrition assessment methods e.g., use of the Health Outcome-Based WIC Nutrition Assessment model.)




  • Identify changes to the Management Information System (MIS) that support the value enhanced WIC nutrition assessment process.




  • Incorporate VENA into the State and local agency management evaluation review process.

State agencies have the option to complete the attached Phase II: VENA Implementation Plan Form, or submit in another format, their VENA Implementation Plan. Whichever format the State agency chooses the VENA Implementation Plan must have sufficient detail in each of the areas identified above. The FNS Regional Office will request additional information, if the plan submitted does not provide adequate information for the implementation of VENA. WIC State agencies are encouraged to contact their FNS Regional Office if they have questions or would like technical assistance with completing the implementation plan. Approval of the FY 2008 WIC State Plan will be dependent on the approval of the VENA Implementation Plan. 9



VENA IMPLEMENATION

PHASE II: VENA IMPLEMENATION PLAN FORM*

Due On or Before August 15, 2007
This form was developed to assist State agencies in completing Phase II: VENA Implementation Plan. State agencies may use this form or another format, such as the one used for State Plans, to develop their VENA Implementation Plans. Whatever format is used, the VENA Implementation Plan must have sufficient detail for each of the areas indicated below and must be appended to the Fiscal Year 2008 State Plan.





Activity

Action(s) Needed

Priority

Target Dates

Anticipated Costs

Policies and Procedures

Develop or revise current policies and procedures to enhance the quality of WIC nutrition assessment (to include policies and procedures that enhance the use of assessment information for personalizing nutrition interventions).

Please identify actions needed for each activity.


Please prioritize actions needed for each activity.

Please identify target dates for completion of actions needed for each activity.

Please identify anticipated costs (if any) for actions needed for each activity.

Training

Identify VENA training needs and develop training plans for all staff related to WIC nutrition assessment, to include but not limited to the 3 areas covered in the Regional VENA Competency Trainings (critical thinking; rapport building and; Health Outcome-Based WIC Nutrition Assessment).













*May be reported in another format.

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VENA IMPLEMENATION



PHASE II: VENA IMPLEMENATION PLAN FORM*

Due On or Before August 15, 2007

(Continued)






Activity

Action(s) Needed

Priority

Target Dates

Anticipated Costs

Positive Assessment Approaches

Develop plan for shifting WIC nutrition assessment from a deficiency finding process to a more positive process that focuses on desired health outcomes. (May include development of new assessment methods e.g., use of the Health Outcome-Based WIC Nutrition Assessment model.)













Management Information System (MIS) Support for Assessment

Identify changes to the MIS that support the value enhanced WIC nutrition assessment

process.














Local Agency Review Process

Incorporate VENA into the State and local agency review process.














*May be reported in another format.

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