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WIC ME CHANGES 2015 April 13, 2015

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MPR MPR/Indicator/Criteria Text Change Documentation

required How to verify 2.3a The WIC Program keeps the names and addresses of

clients and other members of the public confidential, except to the extent necessary to carry out the purposes of conducting an investigation, hearing or judicial proceeding, or for referral and outreach to other public health and welfare programs, where authorized in the WIC Client Agreement. (7 CFR 246.21(b), 246.26(d), FNS Instruction 800-1, MI-WIC Policy 1.03, 1.06, 9.02)

Documentation review Review signed annual Michigan WIC Employee Confidentiality And Compliance Agreement Signature Form 9.02a. (a)

Signed Michigan WIC Employee Confidentiality And Compliance Agreement Signature Form on file

4.2a The WIC Program verifies the residency, presence, proof of pregnancy and income of applicants and clients at the time of each certification (annual income verification for migrant farm workers and their families) and verifies identity at the initial certification according to policy. (7 CFR 246.7(d), MI-WIC Policy 2.01, 2.02, 2.03, 2.04, 2.05, 2.06, 2.07, 2.08, 2.09, 2.10, 2.11, 2.12, 2.18, 2.19)

Included Auth. Person ID verification.

Observe certification process to determine if identity (client, initial certification only, Authorized Person ID must be verified (ID check or recognition) at each visit), residency, presence, proof of pregnancy and income verification was correctly completed. (a)

Check ID or recognize Authorized Person.

4.3a Health and Diet Assessment: The WIC Program screens health and diet information at each certification and recertification, including elements on the Client Assessment (CAR) Tool for manual risk assignment and referrals. Infants and children shall also be screened during infant/child evaluations. (7 CFR 246.7(e)(1), 246.7(g)(1)(iv), MI-WIC Policy 2.13, 2.14)

...including elements on the CAR tool for manual risk assignment and referrals

Demonstrate use of CAR Tool elements during certification.

Verify that CAR Tool Elements are reviewed during the certifications reviewed.




required How to verify 4.3d Assignment of Risk: The WIC Program’s Competent

Professional Authority (CPA) determines an individual’s nutritional risk by considering dietary, anthropometric, hematological, and health history assessments and assigns all applicable risks. (7 CFR 246.7(e)(2), MI-WIC Policy 2.13, 2.14, 2.15, 2.16)

Evaluation includes… All applicable risks are assessed and accurately assigned, with required documentation. Non- applicable risks are not removed from the Nutrition and Health Summary screen. CPAs may document why the risk is not applicable in the Client Note. (d) Observe that current Medical Documentation forms are used to document known diagnosis as risk. (d)

“Non-applicable” risks identified must be assigned. If not applicable, document in client notes why not applicable. Medical Doc forms are used to assign known diagnosis as risk

Review client notes for documentation of non-applicable risks. If client has MDF, verify the diagnosis is documented as a risk?

5.1b The WIC Program advises and refers each client, parent or caregiver of the types of health and community services that may benefit the client, including Maternal Infant Health Program (MIHP)/Healthy Start/Nurse Family Partnership, or similar program., referrals for all pregnant women and infants. (7 CFR 246.7(b)(2), MI-WIC Policy 6.02, 6.05)

Included similar home visiting programs along with MIHP, etc. for PG women and Infants

Referral documentation of offer of MIHP or other home visiting services.

Review referral documentation for PG and Infant clients.




required How to verify 5.1c The WIC Program makes available a list of local

resources for drug and other harmful substance abuse counseling, prevention and treatment, where they are located, how they may be obtained, and why they may be useful at the first WIC visit and thereafter as appropriate. (Public Law 101-147, MI-WIC Policy 6.02)

Written information is available in clinic regarding local substance abuse counseling, prevention, treatment and referral programs.

Written listing of Local Substance Abuse Referral and Treatment Agencies available.

Observe written listing of Local Substance Abuse Referral and Treatment Agencies available.

6.2 The WIC Program provides and documents client centered nutrition education that assists the client to achieve a positive change in health habits, improve nutritional status and prevent nutrition-related problems through use of the WIC supplemental foods and other nutritious foods. (7 CFR 246.11(b)(2), MI-WIC Policy 5.01)

Includes client centered…

Observation of client centered nutrition education. Evaluation questions have been updated to reflect client centered services.

Observation




required How to verify 6.5 The WIC Program creates a positive clinic environment,

which endorses breastfeeding as the preferred method of infant feeding. (7 CFR 246.11(c)(8)(i), MI-WIC Policy 4.01, 4.02, 4.03)

NWA Breastfeeding Six Steps checklist is now available in the ME Tools.

Observe that the facility provides an area conducive to breastfeeding that includes comfortable chairs with arms, and is away from the entrance. (a) Observe that the clinic is a breastfeeding positive environment (i.e., Breastfeeding friendly signage, breastfeeding posters in all client areas, no formula displayed). (a)

Use NWA checklist to verify facility Breastfeeding Friendly.

6.6a The WIC Program identifies and offers high risk and Class III formula clients opportunity to meet with the Registered Dietitian (RD) for assessment and for development of an individualized care plan at each certification/evaluation. If the client refuses the opportunity to meet with the RD, this action must be documented in the client record at each offer. (MI-WIC Policy 2.13, 5.06)

Clarifies that high risk services need to be offered at each certification/evaluation.

Observation Verify that NCRD services were offered to High Risk clients at the certifications observed.




required How to verify 6.6b WIC Program ensures that a Registered Dietitian is

accessible to see high-risk clients. At counseling, the RD reviews the client nutrition assessment and either develops and implements an individual care plan (ICP) based on client concerns. Or, the RD may document that a care plan is not needed. (USDA WIC Nutrition Services Standards (2013), MI-WIC Policy 5.06)

Updated with ICP and current policy.

Observation that NCRD appointments are available on the schedule within 30 days of the date reviewed.

RD appointments available on the schedule within the next 30 days.

6.6c CPA documents the nutrition high risk condition and additional important information for subsequent counseling with R.D. in the Problem List tab. (MI-WIC Policy 2.13, 5.06)

Updated with current policy.

Notes in Problem List.

Review Problem List Tab for notes.

6.6e Appropriate follow-up is documented, preferably in the MI-WIC Care Plan follow-up tab. The RD closes the Individual Care Plan per policy 5.06.

New criteria based on policy.

Follow-up tab in the ICP.

Review high risk client records for documentation of Care Plan follow up and closure. (e)

7.1 The WIC Program notifies clients about authorized foods and provides clients the authorized WIC Food Guide and current Inserts. (7 CFR 246.10, MI-WIC Policy 7.02, 8.06)

Wording change, including Food Guide Inserts.

Observe that clients are provided with a WIC Food Guide and current Food Guide Inserts.

7.2b The WIC CPA makes available to the client at least one food from each group based on client category and type of food package allowed. Foods are excluded or lessened if the client declines any of the foods offered in the package, or if the CPA determines the food is contraindicated for the client due to the amount of breastfeeding/supplementation or a special medical problem. (7 CFR 246.10(b)(2), 246.10(c), MI-WIC Policy 7.03, 7.04, 7.05)

Includes breastfeeding/ supplementation related to new policies 7.03 and 7.04.

Food Package, Special Formula/Food Request Form, amount of Breastfeeding/formula feeding documented.

Food Package is customized based on clients’ needs.




required How to verify 7.3 The WIC Program provides special formula and food

packages to clients based on medical documentation (7 CFR 246.10, MI-WIC Policy 1.07, 7.02, 7.03).

Wording change to incorporate Policy changes in 7.02 with Soy beverage and 2% milk.

Food Package, Special Formula/Food Request Form

Review record

7.3a The WIC Program CPA/RD approves and provides special formula and food packages as indicated for clients with special dietary needs, based on required documentation for: -Standard infant (Class I) formulas after 1 year of age. -Soy beverage food package for children. Risk, qualifying condition or reason needed in record. -2% milk food packages. Risk, qualifying condition or reason needed in record, when applicable. Medical documentation needed if Class II or III formula included in food package. -Hypoallergenic infant (Class II) formulas. -Specialty formulas (Class III). -Other special food packages as indicated per policy. (7 CFR 246.10(c)(1), MI-WIC Policy 1.07, 7.02, 7.03)

Wording changes from Policy 7.02.

Same as above Qualifying condition documented in record for 2% beverage food package assignment for children and women and soy beverage food package for children.

Same as Above

12 The local agency shall assure that all WIC infants and children are assessed for immunization status at each certification using a documented record, and all WIC clients, when indicated, are referred for immunization.

Included All WIC clients are referred for immunization update.

See 12.1 See 12.1




required How to verify 12.1 All infant and child clients will be assessed for

immunization status using a documented record during certification, recertification and infant/child health/nutrition evaluation. Pregnant woman clients will be provided information regarding recommended immunizations. (MI-WIC Policy 6.03)

Added pregnant women to be provided with information regarding recommended immunizations.

Referral to Immunizations clinic or Doctor

Documentation in client record

12.1e Pregnant women will be provided information on recommended immunizations during pregnancy. (DRAFT MI-WIC Policy 6.03)

Pending Policy approval. Recommend Pertussis in 3rd trimester for protection of infant during first 3 months of life.

Referral to Immunization/MCP for PG women.

Observe staff reviewing immunization recommendations for pregnant women during certification. Document referral to immunization, if needed.

Certification: Quality Assurance-Lab Procedures 4.2a Is family income calculated using past 30 days of pay

documentation? (exception: adjunct eligibility, migrant, homeless, works for cash, variable or no income) (MI-WIC Policy 2.04)

Stated income review of 30 days of documentation.

30 days of income for verification.

Observe use of 30 days of income for verification.

Lab Work: Does all staff wear gloves when collecting blood? (optional: appropriate personal protective equipment -lab coat, gown, scrubs apron)

Updated per Lab Manual

Observe use of gloves/personal protective equipment for lab procedures.

Lab Work: Does staff prepare testing supplies on a fresh drape/tissue for each client?

Updated per Lab Manual

Does staff cover work surface




required How to verify

If referral data is used, was it obtained within the last 6 months for a child or during their pregnancy or post-partum period?

Clarified question to state lab data interval.

Referral data for child not more than 6 months old or obtained while PG or B/NPP.

Observe that data meets timeframe requirements.

12.1a Are all infants and children assessed and assessment documented for current immunization status using MI-WIC or other records? Circle what records are used to assess: MI-WIC MCIR Imms. Card Medical Record

Included “other” in list of options for review of immunization status.

Review of immunization documentation or MIWIC assessment

Utilize MIWIC/MCIR interface or other source to evaluate imms. Status.

12.1c Does the LA provide the recommended immunization schedule to clients who are not up-to-date or don’t have a documented record? Includes MCIR record, verbal or written information. (MI-WIC Policy 6.03) Is the CDC Immunization website on the desktop to provide current recommendations and detailed information? If not, suggest they do?

Clarified that schedule does not need to be in written form, can give copy of MCIR record, CDC brochure or verbal imms. Schedule to client who is not up to date.

Recommended schedule provide to client who is not up to date with child’s immunization schedule.

Observe provision of imms. schedule to Auth. Person.

12.1e Are pregnant women informed of the need for third trimester pertussis vaccine for each pregnancy (Tdap)? DRAFT POLICY

DRAFT Policy. Incorporates CDC recommendation for Tdap in 3rd trimester for all PG women.

Imms referral if referred for Tdap. May review woman’s MCIR from screen to see if UTD with other immunizations.

Observe PG women informed of recommendation for Tdap during 3rd trimester of each pregnancy.




required How to verify 4.1b Are clients who are asked to pay for immunization or

lead testing during their WIC visit told that refusal will not affect their WIC eligibility?

Clarified statement. Observe that clients who must pay for lead testing or immunization administration are informed they can refuse these services and still be on WIC.

6.5d At Cert and Infant Evaluation, does the CPA assess BF support and progress (PG & for both baby and mother) and provide education and support? (MI-WIC Policy 4.01)

Revised citation

6.5d Does the staff refer the breastfeeding mother to the CPA when she is changing food packages?

Revised citation

6.5d Does the staff record or update the Breastfeeding statistics at initial certification and when the BF status changes or at the Infant/Child Evaluation? See Medical Information /Breastfeeding Statistics Screen.

Revised citation

Does the CPA establish rapport with the client? (Welcome and engagement)

Updated language based on CCS model.

Observe CPA engaging client to establish rapport.




required How to verify 6.2c Does the CPA summarize the relevant information from

the assessment and concerns identified and ask client what they’d like to work on? For current education, do the CPA and client discuss (a) topics and (b) client behavior changes based on client concerns?


Observe CPA summarizing the assessment gathered along with client’s concerns, to focus client education.

6.2c Are clients without concerns offered anticipatory guidance appropriate for category/age?


Observe CPA offering anticipatory guidance if mom has no concerns.

6.2c Does the CPA encourage the client to participate in nutrition education and highlight how the nutrition education meets the client’s needs? (MI-WIC Policy 5.01, 5.03)


Observe CPA offering NE options to meet client needs and concerns.

5.1b Are all pregnant women and infants referred to MIHP/Great Start, Nurse Family Partnership, or comparable program, if available in the community? (MI-WIC Policy 6.05)

Noted changes in home visiting programs for women and infants.

Discussed/Referral to home visiting program for PG and infants.

Observe CPA offering program to PG women and infants.

6.5d Are pregnant and breastfeeding clients referred to a peer counselor or other breastfeeding support person (BF Peer, IBCLC or LLL)? (MI-WIC Policy 4.01)

Clarified that all PG and BF clients should be offered BF support services.

Discussed/Referral to BF support service documented for all PG, BE/BP moms.

Observe CPA offering BF support services to all PG/BE/BP client.




required How to verify 7.1b Does the local agency notify clients of changes in the

authorized Food Guide/Infant Food Insert in a timely fashion and provide materials as indicated? Staff should only issue Infant Food Insert to clients

who are receiving formula or are older infants consuming solid foods. If not, suggest they do.

Clarified that Insert means Infant Food and Food Guide Changes Inserts to Food Guide.

Observe clients receiving Food Guide, Food Guide Changes and Infant Food Inserts

6.2d

Is the NE Plan printed and given at each cert/recert/infant or child evaluation? (required) Best Practice: CPA reviews plan with client, noting plan and expiration of certification (on screen or printed).

Updated citation, Included Best Practice- to review NE Plan with client.

Client must be given printed copy of NE Plan at cert, recert, Infant/Child Evaluation.

Best Practice: Observe staff reviewing NE Plan with Client.

6.2a During assessment, does the CPA identify and explore client concerns? Are clarification questions asked in a caring/collaborative manner? Does CPA note questions and acknowledge that education will follow the completed assessment? Does the CPA review the assessment forms/ HHx questions/screens/CAR Tool elements with the client and if warranted, explores further?

Clarified that CPA staff must review elements on CAR tool for manually assigned risks or appropriate referrals. They don’t have to READ the questions to the client. The questions can be paraphrased or included as part of the assessment conversation.

Identify and assign all applicable risks, through use of screens and CAR tool elements.

Observe CPA including CAR tool elements in the assessment to determine manually assigned risks or appropriate referrals.

Record Review

Compliance: Client Compliance Log for past 24 months to determine if agency is adequately monitoring compliance.

Instructions change to review 2 years of log.

Use 24 months of report when performing compliance review.




required How to verify

6.2d NE Plan printed? F: No Communications file avail. 12/11/14-1/7/15, 2/26-4/3/14

Noted citation change and Communication file limitations

Review documentation of the NE Plan printed in the Family level Communications file, if outside date parameters noted.

Verify (if outside dates identified), the NE Plan was printed at cert/recert/eval.

6.2c NE content documented on NE pop up screen? Citation change noted.

5.1b Other referrals documented, if applicable? (MIHP/Healthy Start, NFP/home visit program for I/PG, BE/BP, if available)

Included other Home visitation programs.

Documentation of discussed or referral to MIHP, etc.

Documentation of discussed or referral to MIHP, etc.

10.1 Did the agency complete the investigation and document resolution as required?

Compliance Report Review

4 records to determine if completed in timely manner

Review Compliance Reports from Log

7.3a Food Package/ Formula Approval Record Review 7.3 a- Review at least 8-client records total (including some of each group designated below) and verify that the agency is following WIC Policy for formula approval and documentation. Use the & Formula Usage Report to identify clients on Class I, II or III formulas, and 2% Milk/Soy Beverage Ad Hoc Report clients on 2% milk or soy beverage food packages for review 119. C1 Child: Client meets risk criteria of provider recommends 2%, overweight/obesity concern, family hx dyslipidemia, cardiovascular disease. 120. C2-C4 Child: Client meets risk criteria for at-risk of underweight, high-risk underweight, or inadequate growth. Woman: Client meets risk criteria for pre-pregnancy underweight, postpartum underweight, low maternal weight gain or maternal weight loss during pregnancy. (WIC Policy 7.02)

Updating Review to incorporate 2% milk and soy beverage records.

Soy beverage and 2% milk ad hoc report

Review client records from reports to determine compliance.

Included risk criteria in review to compare with client records for clients assigned 2% milk food packages.

Using 2%, soy beverage Ad hoc reports, verify that allowed risk or documentation is found in client record.

Review client record for risk or required documentation for assignment of food package.




required How to verify High Risk Individual Care Plan (ICP) (MI-WIC 5.06)

1. 6.6 c-Problem list/purpose of session 2. 6.6 b-Individual care plan (ICP) in record or RD documents that no care plan is needed 3.ICP includes: (6.6b)

a. Subjective/Data review –summary of relevant data (growth, diet, meds, diagnosis, treatment, diet prescription, lab values) b. Assessment- Major problem/topic(s) of client concerns, interests, actions. Document using Assessment Select checkboxes and/or Subjective/Assessment area of care plan. c. Intervention Plan – Client Centered Counseling provided including the following:

1. Client’s desired outcomes 2. One to three simple, attainable behavior changes 3. Practical interventions, including future nutrition education 4. Indicators to monitor and evaluate the client progress in follow-up

e. Intervention Plan for follow-up or that follow-up is not needed. (6.6 e)

4. Plan saved by R.D. (R.D. electronic name and date). 6.6 b

Care Plan frozen? If not, suggest they do shortly after ICP creation.

Follow-up Documentation for Individual Care Plan 5. 6.6e-Documented in record, preferably in Care Plan Follow-up area. Closure of Individual Care Plan

Updated High Risk Care plan checklists to reflect revised policy CCS and Advanced CPA trainings.

Review 5 client records identified as high risk with care plan.

Verify that care plan includes required documentation and follow up.




required How to verify 5. NE documented (NE pop-up screen): Date, Method,

Topic, Provider, Initials, Stage (opt), Evaluation, Behavior Change, Notes (if applicable). 6.6b Were Stage movement (opt), date achieved and other notes on previous NE follow up documented? 6.6b

Follow-up Documentation for Individual Care Plan 6. 6.6e-Documented in record, preferably in Care Plan Follow-up area. Closure of Individual Care Plan 7. 6.6b-R.D. signature (electronic initials) and rationale if closing case (5.06)

Updated High Risk Care plan checklists to reflect revised policy CCS and Advanced CPA trainings.

Review 5 client records identified as high risk with care plan.

Verify that care plan includes required documentation and follow up.

Referrals/Civil Rights 5.1c Observe or ask how staff provides all newly enrolled clients a listing

on local resources for drug and other harmful substance abuse counseling, prevention and treatment, where they are located and how they may be obtained, and why they may be useful.

Removed “and documents” provision of list. Clarified that staff are NOT to document on referral grid “Substance Abuse Services” for providing list.

Observe new clients being provided listing of local Substance Abuse Services.

5.6b Does the agency document outreach activities in the MI-WIC system? (MI-WIC Policy 6.01)

Removed “Outreach Log”.

Outreach activities documented in MI-WIC.

Verify outreach activities are documented in MI-WIC.

2.2a Is there documentation in the MI-WIC System (Admin/User Setup/Staff Information/training) of completion of the WIC Civil Rights training module LMS for new staff during orientation and for existing staff, at least annually? (MI-WIC Policy 1.09) Review all records with MI-WIC access.

Clarified requirement that ALL staff complete annual Civil Rights Training using the LMS module. New staff must also complete the

LMS training certificate or score.

Current LMS training certificate of completion for each staff member.




required How to verify 2.2a Was Online Civil Rights Training completed by all WIC Staff during

the past year? (MI-WIC Policy 1.09) LMS-Michigan WIC Civil Rights Training (M0500-15) https://courses.mihealth.org/PUBLIC/cm0682/home.html?orgid=Public Review Staff Training Documentation (MI-WIC) Did all new and experienced staff complete the required Civil Rights training in the past year?

Civil Rights Training in the LMS during orientation and annually thereafter.

Updated date on USDA Non-discrimination statement (2/25/14)

Updated date on USDA non-discrimination statement.

Use of updated non-discrimination statement on outreach materials, WIC website per Policy 1.09.




required How to verify Administration 12.1d Immunization Policy (MI-WIC Policy 6.03) Only

required if within a local health department. 1. Local agency immunization collaboration policies

may include the following: a. Immunization promotion methodologies b. Coordination of services that addresses:

i. Assessment of children who are not up-to-date

ii. Provision of information to Pregnant women regarding needed vaccines during pregnancy

iii. Provision of information on recommended vaccination schedules

iv. Referral for services v. Administration of vaccines.

c. Provision of immunization training for WIC staff

2. Non-health department WIC agencies are encouraged to collaborate with local health departments within their jurisdiction to increase immunization rates.

Updated to reflect current Immunization Policy requirements, defining what LA collaboration policies may include.

Review LA immunization collaboration policy.

8.1d Is the food package prorated if issuing “returned formula” instead of EBT benefits?

Updated citation. Clarified that proration occurs regardless of food or EBT benefit issuance.

Formula issuance log reflects benefits issued to clients.

Review client record and formula issuance log to determine if prorated amount of formula was given.




required How to verify 7.4c Does the LA issue (some) EBT benefits instead of

issuing all returned formula to ensure participation is counted? If not, suggest they do.

Suggested action.

6.5a Does the agency evaluate educational materials to determine whether they present breastfeeding in a positive tone, are accurate, and are free of product names or images? (MI-WIC Policy 4.03)

Updated citation 5.01c review forms for all BF materials not supplied by USDA or MDCH/WIC.

Review 5.01c for BF materials

6.5a Does the agency have a positive clinic environment – supporting breastfeeding as the preferred method of infant feeding?

Positive BF posters prominently displayed in each clinic room and area visible to clients

No formula/bottles displayed (MI-WIC Policy 4.03)

Updated citation NWA “6 steps” checklist used to assess clinic environment.

Use NWA “Six Steps” checklist to assess clinic environment.

6.5b Does the agency orient and train all staff to be supportive of breastfeeding? (MI-WIC Policy 4.02)

Clinic environment policies Program goals and philosophy regarding BF Task appropriate info about BF Ways to promote, protect & support BF to WIC

Clients

Updated citation Orientation and training logs

Review logs/orientation checklists to ensure staff are offered/provided BF support training.




required How to verify 6.5c Does the agency provide on-going breastfeeding training

and staff activities at least quarterly? (MI-WIC Policy 4.02) How is this done? In-Service? Conferences? Including (but not limited to):

Initiation and maintenance of BF Cultural diversity: sensitizing staff to their own

attitudes and beliefs about BF, ways to promote, protect & support BF

Information on State and national activities that promote, protect & support BF

Is training documented on staff training log/screen or meeting minutes?

Updated citation. Quarterly training logs, meeting minutes.

Review training logs and supporting documentation to verify provision of quarterly BF training.

6.5b What breastfeeding promotion and support activities are available to clients prenatally and during the post-partum period? BF classes BF Group BF peer (WIC or MSUE) Other: (MI-WIC Policy 4.01, 4.03)

Renamed to BF peer (WIC or MSUE)

Class outline, BF staff and peer documentation of BF support activities

Review evidence of BF promotion and support activities provided in clinic.

3.1a Is staff training (i.e., Civil Rights, Breastfeeding, Policy, etc.) ongoing and documented in the MI-WIC User Staff Information Screen/Staff Training pop-up?

Documentation of staff training in MI-WIC training pop-up screen.

Documentation of staff training in MI-WIC training pop-up screen.

Review staff training documented on MIWIC training pop-up screens.

10.1a Does the agency record all client fraud/compliance allegations on the Add Complaint Screen? (MI-WIC Policy 9.01, 9.02, 9.03)

Documentation of client compliance in MI-WIC using Complaint Screen.

Document client compliance allegations in MI-WIC using Complaint Screen.

Verify documentation of client compliance allegations in MI-WIC using Complaint Screen.




required How to verify 6.6d Does the agency review high risk records to ensure that

clients are referred for counseling as required? How often? Review monitoring data

Restating policy that High Risk records need to be reviewed to ensure services are being offered/provided according to Policy 5.06.

At least annual review of High Risk and Class III clients for evaluation of High Risk services.

Record review of ICP, referrals for High Risk services, Class III records for referral to RD.

Nutrition Education Does the agency maintain lesson plans/modules for

group education and self-directed activities? (MI-WIC 5.01e)

Updated to reflect current NE policies.

Lesson plans for group or self-directed nutrition education.

Review lesson plans to determine if they include required elements.

Does the agency offer internet education to clients who don’t need face-to-face EDU/NCRD? (i.e., low risk, established breastfeeding)

Observe that low risk clients are offered NE options including wichealth.org

How does the agency assist client access to wichealth.org? (circle) Brochure Posters NE Plan Word of mouth Demo Other:

Observe that wichealth.org outreach and support is offered to low risk clients who are interested.




required How to verify Does the agency follow up with clients who complete

their wichealth.org? Y N 6.2b If yes, when? (circle) 1. Use Online Ed Report-Contact the client 2. At the time on-site education occurs 3 Ask client to call 4. At next cert/eval/face to face visit (Observe during certification) Was the client with questions provided answers from qualified staff? 6.2b

When Internet education is reviewed with the client following the lesson, the initials and evaluation of the staff answering the questions must be entered. MIWIC Policy 5.07

Updated to reflect current NE policies.

On NE pop-up grid, document follow up from previous NE provided. If follow up is immediate, verify that staff document follow up in client records.

Observe, perform record reviews to determine if follow up of previous topics is done and documented.

Education Mall/Self Directed Modules 6.2c Does the agency offer a variety of NE options for clients

with no internet or low literacy? Circle options: Individual NE Group NE Ed Mall MIHP BF Peer Self Directed Other:_______________

Observe and interview staff to determine options available.

6.2a Are the examples and suggestions used appropriate for the target population (socioeconomic status, food preferences and cultural values)? (MI-WIC Policy 5.01)

Updated reference and policy language

6.4b Does nutrition education material stress positive relationship between nutrition, physical activity and health for nutritional needs of pregnant, postpartum and breastfeeding women, infants and children less than five years of age? (5.01)




required How to verify 6.5d Pregnant client – Is Breastfeeding education offered

detailing the benefits of breastfeeding and the risks of not breastfeeding? PROVIDER: Was the contact documented? Y N

BF support screen NE grid

Citation corrected

6.5d Breastfeeding client – Was the client provided support for breastfeeding questions or problems? PROVIDER: Was the contact documented? Y N


Citation corrected

6.5d Pregnant client –Breastfeeding education offered detailing the benefits of breastfeeding and the risks of not breastfeeding? Peer: Was the contact documented? Y N


Citation corrected

6.5d Breastfeeding client –Was the client provided support for breastfeeding questions or problems? Peer: Was the contact documented? Y N


Citation corrected

6.4b Are nutrition education materials, that are locally developed or obtained, evaluated for appropriateness using Exhibit 5.01C or equivalent local agency form? (State developed or provided materials exempt.)

Updated according to current policies.

Exhibit 5.01c checklists completed for materials used.

Review material evaluations.




required How to verify 6.2e Are nutrition education materials available that address

the danger of using drugs or other harmful substances? (5.01) (i.e., Intro to WIC Program, materials that discuss avoiding drugs, alcohol abuse during pregnancy and while parenting)

More information regarding acceptable materials.

3.1 Is the presenter qualified to provide nutrition education? (MI-WIC Policy 1.07 or 1.09)

Updated for current Policy 1.07.

Credentials for NE providers.

Review credentials of NE providers.

6.6b Was a nutrition assessment completed? (i.e. review of all pertinent data – Health history, growth/prenatal weight gain chart, lab, diet, medical status, client’s concerns and readiness for behavior change) Other: ______________________) Were the client’s MI-WIC Assessment statements checked if applicable (if not, suggest they do)?

Updated for current High Risk policy and Advanced CPA training.

ICP meets requirements for high risk counseling and documentation in Policy 5.06.

Observe that Counseling and ICP meets requirements for high risk counseling and documentation in Policy 5.06 6.6b Did the RD identify and summarize the client’s

problems, concerns, needs and readiness for change? 6.6b Does the Subjective/Assessment include summary of

client’s primary nutrition problems/concerns/needs, key information and motivation for change?

6.6b Was the client’s input central to the plan development? 6.6b Does the counseling provided build on or reinforce what

the client already knows, with time for discussion/question and answers?

6.6b Was the counseling tailored to client’s cultural values, reading level, situation, etc.?




required How to verify 6.6b Does the Intervention Plan developed with the client

include the following? a) Client’s desired outcomes b) One to three simple, attainable behavior changes c) Practical interventions, including future nutrition education d) Indicators to monitor and evaluate the client progress in follow-up

6.6b Was the client’s understanding of the plan/steps evaluated? (How do I know when I am doing it right?)

6.6e Were follow-up activities planned and future needs discussed and documented?

Were additional referrals offered, if applicable? 6.6b Did the RD provide and document appropriate nutrition

services in the care plan and on NE screens? (MI-WIC Policy 5.07)

Is the client provided a copy of the Nutrition Education Plan? If not, suggest they do. (MI-WIC Policy 2.20)

Does the RD “freeze” the Care Plan after completed? 6.6b From observations or discussions, does the counseling

meet high risk guidelines? Comments:

Recordkeeping and Accountability Does agency replace lost or stolen Michigan WIC Bridge

cards in the clinic when the MIWIC record is “stop access “or within 5 days of expiration of benefits? (MI-WIC Policy 8.01 Benefit Issuance) Always replace in clinic Only replace if inactive/5 days of expire Do not replace cards in clinic

Took out citation. Clarified card replacement of inactive EBT accounts. Identify if agency allows clinic card replacement.

LA policy/procedure (written or verbal) for EBT card replacement.

Observe, ask what procedure is for clients who request EBT card replacement in the clinic.

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