value enhanced nutrition assessment vena story web cast

1. Value Enhanced Nutrition Assessment (VENA) Story Web Cast Presented by Tony Zech State of Wisconsin WIC Program Nutritionist December 15, 2008 Welcome to the VENA Story Web Cast. I am Tony Zech, State WIC Program Nutritionist. I will be your host and guide for this presentation which is designed to help you learn more about VENA or Value Enhanced Nutrition Assessment and see it in action! This is our second VENA webcast. The first was the VENA Overview, which was taped on November 14th. The VENA Overview was designed to help you learn about the general principles and practices of VENA. The VENA Overview and the VENA Story webcasts will be linked so you can easily view both of them. We hope you enjoy this VENA Story webcast and find it helpful on your journey to implement VENA! Welcome to the VENA Story Web Cast. I am Tony Zech, State WIC Program Nutritionist. I will be your host and guide for this presentation which is designed to help you learn more about VENA or Value Enhanced Nutrition Assessment and see it in action! This is our second VENA webcast. The first was the VENA Overview, which was taped on November 14th. The VENA Overview was designed to help you learn about the general principles and practices of VENA. The VENA Overview and the VENA Story webcasts will be linked so you can easily view both of them. We hope you enjoy this VENA Story webcast and find it helpful on your journey to implement VENA!

2. The agenda for our VENA Story Web Cast is as follows: What is VENA? Introduction to the VENA Story Demonstrations and Activities Key VENA Practices and Resources The agenda for our VENA Story Web Cast is as follows: What is VENA? Introduction to the VENA Story Demonstrations and Activities Key VENA Practices and Resources

3. VENA is � the accurate and enhanced collection and interpretation of assessment information that serves as the basis for counseling, nutrition education, food prescriptions, and referrals. VENA is (read definition above). VENA is (read definition above).

4. VENA Guiding Principle: Strengthen and re-align the primary purpose of WIC nutrition assessment from determining eligibility to using the nutrition assessment as the bridge to providing the most appropriate and effective counseling, nutrition education, food prescriptions, and referrals. (Read this slowly): The guiding principle of 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 my hands from my right to my left to illustrate the bridge) to providing the most appropriate and effective counseling, nutrition education, food prescriptions, and referrals in order to maximize WIC�s impact. (Read this slowly): The guiding principle of 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 my hands from my right to my left to illustrate the bridge) to providing the most appropriate and effective counseling, nutrition education, food prescriptions, and referrals in order to maximize WIC�s impact.

5. VENA Guiding Principle � WIC Nutrition Assessment Here is a visual to illustrate the Guiding Principle of VENA. Here is a visual to illustrate the Guiding Principle of VENA.

6. Health Outcomes Approach Pregnant woman ? Healthy full � term infant, optimal health Breastfeeding woman ? Optimal health, reduced risk of chronic disease Non � Breastfeeding ? Optimal health, reduced Postpartum woman risk of chronic disease To achieve this guiding principle and have maximum impact, VENA uses a Health Outcomes Approach: the goal is a desired health outcome for each participant category. Each health outcome is dependant on health determinants--a set of factors influenced by individual behaviors, past and current health conditions, and family and social environment�that increase the likelihood of the desired outcome. To achieve this guiding principle and have maximum impact, VENA uses a Health Outcomes Approach: the goal is a desired health outcome for each participant category. Each health outcome is dependant on health determinants--a set of factors influenced by individual behaviors, past and current health conditions, and family and social environment�that increase the likelihood of the desired outcome.

7. Health Outcomes Approach Infant & Child ? Optimal growth and (12 � 60 months) development in nurturing environment, healthy eating practices More information on the Health Outcomes Approach is in the VENA toolkit, which we will provide a link to in a few minutes. More information on the Health Outcomes Approach is in the VENA toolkit, which we will provide a link to in a few minutes.

8. VENA Process Build rapport Review past care plan, risks, secondary education Review results of anthropometric, blood screening and health history Ask open-ended questions Determine client concerns Review risks and problems � determine interrelationship(s) and root cause(s). The next two slides list the VENA process. More information about each of these steps and how they relate to other VENA skills and competencies is in the VENA Overview webcast. 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. Most of the steps on this slide are part of the nutrition assessment. All of these steps help build that strong bridge to counseling and healthier outcomes! The next two slides list the VENA process. More information about each of these steps and how they relate to other VENA skills and competencies is in the VENA Overview webcast. 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. Most of the steps on this slide are part of the nutrition assessment. All of these steps help build that strong bridge to counseling and healthier outcomes!

9. VENA Process (cont.) Use assessment information and health outcomes for the participant�s category to: a) provide counseling/referrals b) develop behavioral objective for next contact c) prescribe food package d) schedule appropriate secondary nutrition education. Complete documentation. The slide describes the transition from the assessment to the counseling and documentation steps. You will notice that the scheduling of appropriate secondary nutrition education is included. Remember that the nutrition education scheduled needs to be linked to the nutritional needs identified during the nutrition assessment. Lastly, the documentation is completed. The slide describes the transition from the assessment to the counseling and documentation steps. You will notice that the scheduling of appropriate secondary nutrition education is included. Remember that the nutrition education scheduled needs to be linked to the nutritional needs identified during the nutrition assessment. Lastly, the documentation is completed.

10. 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 five main VENA Process Skill Areas for Effective Assessment and Counseling. These skill areas are broken down into even more detail in the VENA Skills Checklist of the VENA Toolkit, and in the VENA Observation Forms. I will give you the links to these resources in a few minutes. By using these VENA skills and competencies, you will save time and be more effective. For example, you could save time by completing your assessment before counseling. Or, you could be more effective by identifying and exploring concerns depending on the participant�s responses to the italicized potential CSHCN-related questions. These skills and related competencies, such as critical thinking, are covered in more detail in the VENA Overview webcast. There are many skills that are needed and will be improved as you implement VENA. This slide identifies five main VENA Process Skill Areas for Effective Assessment and Counseling. These skill areas are broken down into even more detail in the VENA Skills Checklist of the VENA Toolkit, and in the VENA Observation Forms. I will give you the links to these resources in a few minutes. By using these VENA skills and competencies, you will save time and be more effective. For example, you could save time by completing your assessment before counseling. Or, you could be more effective by identifying and exploring concerns depending on the participant�s responses to the italicized potential CSHCN-related questions. These skills and related competencies, such as critical thinking, are covered in more detail in the VENA Overview webcast.

11. Demonstrations by local staff Based on participant stories Interact with web cast - VENA observation forms Now that we have defined VENA, let�s move on to the VENA Story. The VENA Story Web Cast was developed using demonstrations by local WIC staff of real participant stories. To make the webcast more helpful to you, we encourage you to use or download the VENA resources on our Training Connection website and the VENA observation forms. I will provide you with the link to these resources and observation forms in a few moments. Now that we have defined VENA, let�s move on to the VENA Story. The VENA Story Web Cast was developed using demonstrations by local WIC staff of real participant stories. To make the webcast more helpful to you, we encourage you to use or download the VENA resources on our Training Connection website and the VENA observation forms. I will provide you with the link to these resources and observation forms in a few moments.

12. Appreciations� Carol Birkeland Washington/Ozaukee Emily Filiatreaux 16th Street Janice Landisch Seeds of Health Valerie Peterson 16th Street Angie Wilks-Tate MLK Heritage Center Chassidy Zakowski MLK Heritage Center At this time, we would like to provide a special thank you to the local WIC staff that are the actors in these demonstrations. Also, thank you to the many others that were involved in this project. At this time, we would like to provide a special thank you to the local WIC staff that are the actors in these demonstrations. Also, thank you to the many others that were involved in this project.

13. VENA Story Demonstrations Pregnant woman Postpartum woman and infant Two boys Let�s move now into preparing to watch the demos. Here is a list of the participant types that will be featured in the demonstrations (read off) Let�s move now into preparing to watch the demos. Here is a list of the participant types that will be featured in the demonstrations (read off)

14. Activities - Observation Forms Download and print observation forms in advance: http://dhs.wisconsin.gov/wic/WICPRO/training/vena.htm Review Observation Form right now (pause webcast) Ready? At this time, if you haven�t already done so, download and print the VENA Story Observation Forms that are tailored to go along with each demo. As you watch each demo, check off each VENA-related item as you see it. Also, at the bottom of the form, there is a direction for you to THINK about certain things as you watch the demo. Pause the webcast now to review the observation forms. When you are finished reviewing the observation forms, I will provide you with some background information on the first demo. At this time, if you haven�t already done so, download and print the VENA Story Observation Forms that are tailored to go along with each demo. As you watch each demo, check off each VENA-related item as you see it. Also, at the bottom of the form, there is a direction for you to THINK about certain things as you watch the demo. Pause the webcast now to review the observation forms. When you are finished reviewing the observation forms, I will provide you with some background information on the first demo.

15. Pregnant Woman Background Information 23-year old pregnant woman Nutritionist has already reviewed information on other tabs Agency has both WIC & PNCC programs Here is the background information for the Pregnant Women demonstration. (Read through it). Here is the background information for the Pregnant Women demonstration. (Read through it).

16. Pregnant Woman Follow the directions on Observation Form #1 Watch demonstration Observation Form #1 has directions for you to follow and is tailored to the Pregnant Women demonstration. Our actors for this demonstration are both from Sixteenth Street WIC in Milwaukee. Valerie Peterson will play the role of the WIC Nutritionist and Emily Filiatreaux will be the Pregnant Woman (Audra). After the demonstration, I will provide some examples of VENA skills that were demonstrated. Go ahead Valerie and Emily. Observation Form #1 has directions for you to follow and is tailored to the Pregnant Women demonstration. Our actors for this demonstration are both from Sixteenth Street WIC in Milwaukee. Valerie Peterson will play the role of the WIC Nutritionist and Emily Filiatreaux will be the Pregnant Woman (Audra). After the demonstration, I will provide some examples of VENA skills that were demonstrated. Go ahead Valerie and Emily.

17. Pregnant Woman What did you see? What are you thinking? Examples from form (Look at Valerie and Emily). Thank you Valerie and Emily. (Look at camera): If you haven�t already, spend some time thinking about what is different and the same from what the Nutritionist did from what you normally do. You may stop the tape now and do this. When you are ready, I will provide you with examples that demonstrated from the role play that demonstrated the VENA process. Let�s start by looking at the first step on the Observation Form: Establishing Rapport. You may recall that in the very beginning of interview, the nutritionist stated: �I have several questions to ask you that will help you develop goals for having a healthy pregnancy and baby. Then, we�ll talk about your interests and concerns. OK?� To �develop goals for having a healthy PG and baby� is very �Health Outcome� oriented. The nutritionist then followed-through with this a couple of times: - During diet questions, the mom said �I eat everything!...don�t know what I�m going to look like when the baby comes.� The nutritionist responded: �I can tell that you�re worried about gaining weight with this pregnancy. We can talk about that later if you want.� - Later, when they talked about breastfeeding, the nutritionist asked some questions and then stated �We can talk about this today or at your next visit.� Another VENA process they demonstrated was the use of open-ended and �Umbrella� questions. For example, the nutritionist stated: �Tell me about your day to day eating habits and what kinds of foods and beverages you enjoy.� Another VENA process I want to highlight is �Works with client to identify problem behaviors and ideas for change.� Here is an example of that: The nutritionist asked if she could share information that could help her health during pregnancy. This led into PNCC (transportation, finding a dentist). Another example: The nutritionist asked Audra which topics she�d like to talk about, using pictures of topics that came up in the discussion. The nutritionist narrowed the focus to particular topics and then Audra identified what she wanted to talk about (Audra selected iron). This concludes the highlighting of examples from the first demonstration. We will now provide you with some background information for our second demonstration. (Look at Valerie and Emily). Thank you Valerie and Emily. (Look at camera): If you haven�t already, spend some time thinking about what is different and the same from what the Nutritionist did from what you normally do. You may stop the tape now and do this. When you are ready, I will provide you with examples that demonstrated from the role play that demonstrated the VENA process. Let�s start by looking at the first step on the Observation Form: Establishing Rapport. You may recall that in the very beginning of interview, the nutritionist stated: �I have several questions to ask you that will help you develop goals for having a healthy pregnancy and baby. Then, we�ll talk about your interests and concerns. OK?� To �develop goals for having a healthy PG and baby� is very �Health Outcome� oriented. The nutritionist then followed-through with this a couple of times: - During diet questions, the mom said �I eat everything!...don�t know what I�m going to look like when the baby comes.� The nutritionist responded: �I can tell that you�re worried about gaining weight with this pregnancy. We can talk about that later if you want.� - Later, when they talked about breastfeeding, the nutritionist asked some questions and then stated �We can talk about this today or at your next visit.� Another VENA process they demonstrated was the use of open-ended and �Umbrella� questions. For example, the nutritionist stated: �Tell me about your day to day eating habits and what kinds of foods and beverages you enjoy.� Another VENA process I want to highlight is �Works with client to identify problem behaviors and ideas for change.� Here is an example of that: The nutritionist asked if she could share information that could help her health during pregnancy. This led into PNCC (transportation, finding a dentist). Another example: The nutritionist asked Audra which topics she�d like to talk about, using pictures of topics that came up in the discussion. The nutritionist narrowed the focus to particular topics and then Audra identified what she wanted to talk about (Audra selected iron). This concludes the highlighting of examples from the first demonstration. We will now provide you with some background information for our second demonstration.

18. Postpartum woman & infant Background Information Mom and baby - certified together. Mom - on WIC prenatally. Nutritionist - already reviewed other tabs. Baby - not breastfed. This WIC project is involved in the Infant Mortality reduction initiative. Our second demonstration will be of the certification of a postpartum women and infant. (Read through background information). Our second demonstration will be of the certification of a postpartum women and infant. (Read through background information).

19. Postpartum woman & infant Follow the directions on Observation Form #2 Watch demonstration At this time, please take out Observation Form #2. You will be following the same process you went through for the first demo. Some of the items have changed and the THINK question is different. Pause the webcast now to review the form so you know what you are looking for during the demonstration. Return to the webcast for more information. When you are ready, watch the demonstration. We will have a debriefing after the demonstration. The three items that I will highlight during this debriefing will be: Open-ended and �umbrella questions� Probing Questions Interrelationships and root causes or risks or problems Our actors for this demonstration are both from MLK Heritage Center in Milwaukee. Angie Wilks-Tate will play the nutritionist role, and Chassidy Zakowski will play the role of the postpartum woman (Juanita). Take it away Angie and Chassidy. At this time, please take out Observation Form #2. You will be following the same process you went through for the first demo. Some of the items have changed and the THINK question is different. Pause the webcast now to review the form so you know what you are looking for during the demonstration. Return to the webcast for more information. When you are ready, watch the demonstration. We will have a debriefing after the demonstration. The three items that I will highlight during this debriefing will be: Open-ended and �umbrella questions� Probing Questions Interrelationships and root causes or risks or problems Our actors for this demonstration are both from MLK Heritage Center in Milwaukee. Angie Wilks-Tate will play the nutritionist role, and Chassidy Zakowski will play the role of the postpartum woman (Juanita). Take it away Angie and Chassidy.

20. Postpartum woman & infant What did you see? What are you thinking? Examples from form (Look at Angie and Chassidy): Thank you Angie and Chassidy. (Turn back to camera): If you haven�t already, please spend some time processing the demonstration using the Observation Form. This slide has a few questions to help you do that. To help you gain additional understanding of the VENA process, I will now highlight examples of three steps of the VENA process that were demonstrated in this demonstration: Open-ended questions and �umbrella� questions. Probing questions Interrelationships and root causes of risks or problems. Here are some examples of open-ended questions or �umbrella questions� from the demo: -Tell me about any medication use and medical conditions -Tell me about your appetite and how often you eat meals and snacks The nutritionist used probing questions to find out more information: -Juanita said her baby has diarrhea. The nutritionist probed further about that and showed her a picture guide of stools. -When Juanita said she can�t really eat fruit or vegetables every day, the nutritionist asked why. Did you notice an example of how the nutritionist identified the interrelationship of risks and root cause? -It occurred when Juanita said she really couldn�t each F&V every day. The nutritionist asked why, and Juanita replied because they�re so expensive. The nutritionist referred to SHARE and gave her the 211#. Talking to her about favorite F&V or recipes wouldn�t have been effective � that wasn�t the root cause of the problem. That concludes our debriefing of demonstration #2. I will now provide you with some background on demonstration #3. (Look at Angie and Chassidy): Thank you Angie and Chassidy. (Turn back to camera): If you haven�t already, please spend some time processing the demonstration using the Observation Form. This slide has a few questions to help you do that. To help you gain additional understanding of the VENA process, I will now highlight examples of three steps of the VENA process that were demonstrated in this demonstration: Open-ended questions and �umbrella� questions. Probing questions Interrelationships and root causes of risks or problems. Here are some examples of open-ended questions or �umbrella questions� from the demo: -Tell me about any medication use and medical conditions -Tell me about your appetite and how often you eat meals and snacks The nutritionist used probing questions to find out more information: -Juanita said her baby has diarrhea. The nutritionist probed further about that and showed her a picture guide of stools. -When Juanita said she can�t really eat fruit or vegetables every day, the nutritionist asked why. Did you notice an example of how the nutritionist identified the interrelationship of risks and root cause? -It occurred when Juanita said she really couldn�t each F&V every day. The nutritionist asked why, and Juanita replied because they�re so expensive. The nutritionist referred to SHARE and gave her the 211#. Talking to her about favorite F&V or recipes wouldn�t have been effective � that wasn�t the root cause of the problem. That concludes our debriefing of demonstration #2. I will now provide you with some background on demonstration #3.

21. Two Boys Background Information: Eli -18 months old Ezra - 3 years old Both on WIC since birth Nutritionist reviewed other tabs, including care plans. (Read through background information) (Read through background information)

22. Two Boys Follow the directions on Observation Form #3 Watch demonstration As before, the Observation Form will help you watch for key VENA items demonstrated. Pause the webcast now to review the form and return for more information. After this demo, I will talk about the second #1 on the form (Reviews Care Plan and risks), and the third #3 re: Secondary Education, and a surprise one that�s not on the list. Our actors are Carol Birkeland, from Washington/Ozaukee County WIC who will play the role of nutritionist, and Janice Landisch, Seeds of Health, who will be the mom (Liza) of the two boys. Go ahead Carol and Janice. As before, the Observation Form will help you watch for key VENA items demonstrated. Pause the webcast now to review the form and return for more information. After this demo, I will talk about the second #1 on the form (Reviews Care Plan and risks), and the third #3 re: Secondary Education, and a surprise one that�s not on the list. Our actors are Carol Birkeland, from Washington/Ozaukee County WIC who will play the role of nutritionist, and Janice Landisch, Seeds of Health, who will be the mom (Liza) of the two boys. Go ahead Carol and Janice.

23. Two Boys What did you see? What are you thinking? Examples from form Thank you Carol and Janice. Question: What do you think were the indicators that the nutritionist reviewed the past Care Plan and risks? Answer: After Liza stated Eli was weaned off the bottle, the nutritionist stated �Looks like that was your goal from last time we met-looks like you�ve reached it!� What did the nutritionist do to schedule secondary nutrition education that will help the participant meet their goals? Since the nutrition display on the mom�s next pick-up day didn�t pertain, the nutritionist explored the mom�s access to and interest in an internet activity, and then identified 2 pertinent topics, and the mom picked the one she was most interested in (picky eater). Last, here�s one not on the Observation list since the actresses decided to ad lib and did a great job: How did the nutritionist avoids spending a lot of time on irrelevant information? ANSWER: When the nutritionist asked Liza what foods the boys eat and which they�re lacking, Liza starts going on and on. The nutritionist brought her back to the topic. This concludes the debrief for this demo. I will now highlight a few key VENA practices that were in all of the demos. Thank you Carol and Janice. Question: What do you think were the indicators that the nutritionist reviewed the past Care Plan and risks? Answer: After Liza stated Eli was weaned off the bottle, the nutritionist stated �Looks like that was your goal from last time we met-looks like you�ve reached it!� What did the nutritionist do to schedule secondary nutrition education that will help the participant meet their goals? Since the nutrition display on the mom�s next pick-up day didn�t pertain, the nutritionist explored the mom�s access to and interest in an internet activity, and then identified 2 pertinent topics, and the mom picked the one she was most interested in (picky eater). Last, here�s one not on the Observation list since the actresses decided to ad lib and did a great job: How did the nutritionist avoids spending a lot of time on irrelevant information? ANSWER: When the nutritionist asked Liza what foods the boys eat and which they�re lacking, Liza starts going on and on. The nutritionist brought her back to the topic. This concludes the debrief for this demo. I will now highlight a few key VENA practices that were in all of the demos.

24. VENA Story � Key Practices Use open�ended & umbrella questions Counsel after completing the assessment Use active listening; reflect concerns Summarize key concerns Be participant � centered; help the participant identify realistic goals The first key practice listed here is the use of open-ended and umbrella questions. These are questions that can not be answered with a yes or no and may provide you with answers to multiple questions. The second bullet, counsel after completing the assessment can be challenging, but can also save you time. Thirdly, use active listening techniques, such as eye contact and reflective statements. Fourthly, summarize key concerns, so you can more easily transition into counseling. Lastly, remember to be participant-centered and to help the participant set realistic goals. The first key practice listed here is the use of open-ended and umbrella questions. These are questions that can not be answered with a yes or no and may provide you with answers to multiple questions. The second bullet, counsel after completing the assessment can be challenging, but can also save you time. Thirdly, use active listening techniques, such as eye contact and reflective statements. Fourthly, summarize key concerns, so you can more easily transition into counseling. Lastly, remember to be participant-centered and to help the participant set realistic goals.

25. VENA Story � Resources Wisconsin WIC Training Connection website: (http://dhs.wisconsin.gov/WIC/WICPRO/training/index.htm USDA WIC Works: (http://www.nal.usda.gov/wicworks/Learning_Center/Assessment_VENA.html To conclude: Here are the links to resources available in Wisconsin and from USDA related to VENA. The VENA toolkit I mentioned earlier is located with all of the other VENA information on our Wisconsin WIC Training Connection website. The USDA WIC Works website has links to USDA VENA resources, materials from other states, and on-line learning modules. To conclude: Here are the links to resources available in Wisconsin and from USDA related to VENA. The VENA toolkit I mentioned earlier is located with all of the other VENA information on our Wisconsin WIC Training Connection website. The USDA WIC Works website has links to USDA VENA resources, materials from other states, and on-line learning modules.

26. VENA Story � Contact Tony Zech, RD, MBA 1 W. Wilson Street Madison, WI 53702 Ph. 608-266-3742 Email: anthony.zech@wisconsin.gov Here is my contact information. Let me know if you have any questions or how I can help you. Here is my contact information. Let me know if you have any questions or how I can help you.

27. VENA Story THANKS FOR WATCHING AND PARTICIPATING. WE WISH YOU THE BEST ON YOUR VENA JOURNEY! In closing, (Read slide) In closing, (Read slide)