WPM #2006-5: Value Enhanced Nutrition Assessment-WIC Nutrition Assessment Policy

Background and Overview

For over a decade, the Food and Nutrition Service (FNS) has utilized the expertise of the Institute of Medicine (IOM) to provide science-based information to guide WIC program policy decisions. The 2002 IOM report, Dietary Risk Assessment in the WIC program, found that traditional diet assessment methods are not sufficiently accurate or precise enough to determine an individual's dietary risk and recommended the inclusion of a presumed WIC dietary risk criterion. As a result, FNS identified the need for comprehensive nutrition assessment policy and guidance. To accomplish this task, FNS, in collaboration with the National WIC Association (NWA), convened a joint workgroup to develop the Value Enhanced Nutrition Assessment (VENA) Policy and Guidance. This memorandum defines and describes WIC nutrition assessment policy under the VENA initiative. The VENA Guidance will be disseminated to all state agencies in a separate mailing.

The purpose of WIC, as an adjunct to health care, is to improve the health status of and prevent the occurrence of health problems in program participants. This is accomplished in large part through the delivery of WIC nutrition services. A complete WIC nutrition assessment is the first vital step in this process. In an effort to maintain WIC as a premier public health program, the FNS/NWA VENA workgroup collectively identified the process, content, and staff competencies necessary for a WIC nutrition assessment. The VENA Policy and Guidance presents a change in philosophy from conducting nutrition assessment primarily for the purpose of determining WIC eligibility, to using assessment as a means to enhance the interaction between WIC provider and participant as well as to link collected health and diet information to the delivery of relevant nutrition education, referrals and food package tailoring. VENA is part of the larger FNS process known as Revitalizing Quality Nutrition Services in WIC.

WIC Nutrition Assessment Policy

The WIC nutrition assessment serves as the foundation on which other nutrition services are planned and provided. Therefore, each WIC state agency must ensure that each applicant receives a complete WIC nutrition assessment at each certification.

A complete WIC nutrition assessment consists of a process ( described in the Process of a Value Enhanced WIC Nutrition Assessment section of the VENA Guidance) to obtain and synthesize relevant and accurate information (described in Appendix A of the VENA Guidance) in order to:

• Assess an applicant's nutritional status and risk(s);
• Tailor the food package to address nutritional needs;
• Design appropriate nutrition education; and,
• Make referrals to health and social services for follow-up as necessary and appropriate.

The VENA Guidance

The VENA Guidance is intended to guide WIC state agencies in developing policies and procedures related to all aspects of nutrition assessment. It is comprehensive and includes information about all aspects of nutrition assessment. It promotes a positive participant-centered approach and a dietary assessment process that is not dependent upon traditional food frequency or diet recall collection tools. In addition, it includes information about critical thinking skills and links assessment with the current FNS allowed nutrition risk criteria. As stated previously, the VENA Guidance will be mailed separately by FNS headquarters directly to all WIC state agencies. Each WIC state agency will receive two hard copies and one CD of the VENA Guidance.

We applaud the efforts of those state and local agencies that have already begun to adopt the VENA approach by engaging WIC participants as active partners in determining their nutritional care. It is intended that the VENA guidance will be used by WIC state agencies to identify gaps that may exist in current assessment practices and to enhance the quality of existing nutrition assessment policies and procedures.

VENA and Policy Memorandum 98-9: WIC Nutrition Risk Criteria

The VENA Guidance and Policy Memorandum 98-9: WIC Nutrition Risk Criteria, are intended to be used as companion documents. The VENA Guidance (Appendix A: Relevant WIC Nutrition Assessment Information Tables) includes a detailed description of the information to be collected during an assessment. Policy Memorandum 98-9, served as the resource document for developing Appendix A: Relevant WIC Nutrition Assessment Information Tables.

The revised dietary risk criteria included in Policy Memorandum 98-9, Revision 8 (issued March 2005) define inappropriate nutrition practices for each category of WIC participant. These dietary risk criteria screen for dietary practices ( e.g., exclusion of entire food groups, prolonged used of nursing bottle) that could lead to impaired nutrition status, disease or health problems. As a result of the revision, the assessment for dietary risk criteria will be more qualitative in nature rather than quantitative (i.e., serving sizes and serving per day of food groups will not be tabulated). For more information about WIC dietary risk assessment, please read Dietary Risk Assessment in WIC in the VENA Guidance.

Policy Memorandum 98-9, Revision 8, also incorporated the recommendation of the 2002 IOM report, Dietary Risk Assessment in the WIC program, to allow for a presumed dietary risk criterion. It is important to note that Risks 401, Failure to Meet Dietary Guidelines ( a presumed dietary risk criterion), and 428, Dietary Risk Associated with Complementary Feeding Practices (a predisposing dietary risk criterion), may be assigned only after a complete assessment has been performed.

VENA Implementation Date and Projected Timeline

State agencies are required to submit a VENA Implementation Plan (to include a timeline) on or before Aug. 15, 2007, with their fiscal year 2008 state plan submission. It is also required that state agencies complete a VENA Self-Evaluation to review and compare their current nutrition assessment practices and policies to the VENA Policy and Guidance to identify gaps and potential areas for enhancement. Summary findings of the VENA Self-Evaluation must be submitted to FNS Regional Offices on or before Dec. 15, 2006. The VENA Implementation Plan should address the gaps discovered through the self-evaluation process. FNS regional offices will use the VENA Self-Evaluation findings to evaluate the appropriateness of the VENA Implementation Plan. FNS will provide VENA Implementation Guidance regarding the VENA Self-Evaluation and Implementation Plan in a separate letter in April 2006.

During fiscal years (FY) 2008 and 2009 it is expected that state agencies will revise nutrition assessment policy and procedures, provide necessary staff training, etc. in preparation for VENA implementation (as described in their FNS-approved VENA Implementation Plan). We acknowledge that a VENA implementation timeline will be state specific, depending on staffing, resources and degree of change required however, it is expected that all state agencies will begin VENA implementation by Oct. 1, 2009 (FY 2010).

FNS recognizes the need and importance of staff training for VENA implementation. To assist state agencies with training local agency staff, FNS has contracted with the Rochester Institute of Technology to develop a curriculum for 3 modules determined to be essential in successfully implementing VENA: 1) Rapport Building; 2) Critical Thinking; and 3) Health Outcome-Based WIC Nutrition Assessment. Regional trainings in a "Train-the-Trainer" format will occur in the latter part of FY 2006. Each state agency will be expected to send appropriate staff to the Regional training. FNS regional offices will inform their respective state agencies of the training schedule.

The projected VENA timeline is as follows:

Early 2006

• Final VENA Policy Memorandum issued.
• Final VENA Guidance issued.
• VENA Implementation Guidance issued (to include a self-evaluation guide).

July-September 2006

• Regional (for state agency attendance) VENA Competency Training (rapport building, critical thinking and health outcome-based assessment).

On or Before Dec. 15, 2006

• WIC state agencies submit results from their self-evaluation of existing nutrition assessment protocols and identify potential areas for enhancement, to FNS regional offices.

Spring 2007

• FY 2008 state plan guidance issued with instructions for state agencies to include a VENA implementation plan and amendments as necessary to implement Policy Memorandum 98-9: WIC Nutrition Risk Criteria; Revision 8, in their state plan submissions.

On or Before Aug. 15, 2007

• WIC state agencies submit FY 2008 state plans to include:
  1. VENA Implementation Plan.
  2. Amendment(s) as necessary to implement WIC Policy Memorandum, 98-9, Revision 8.

Fiscal Year 2008 - 2009

• WIC state agencies revise nutrition assessment policy and procedures, provide necessary staff training, etc., (as described in their FNS-approved plans) to implement VENA.

Fiscal Year 2010 (Oct. 1, 2009)

• VENA implemented in all WIC state agencies.

We appreciate your continued commitment to improving WIC nutrition services and believe the VENA initiative will have many positive and long-term benefits to WIC program operations and to the participants we serve.

PATRICIA N. DANIELS
Director
Supplemental Food Programs Division