CT: 7 Nutrition Assessment and Risk Determination (New)

Effective Date: 03/01 Downloads: PDF Version    Revised Date: 01/17
   

Policy

WIC CPA’s and Nutritionists / RD’s will perform a comprehensive nutrition assessment at each certification appointment using Value Enhanced Nutrition Assessment (VENA) principles to provide quality nutrition services in a participant-centered framework. Nutrition assessment links collected health and diet information to risk assessment and the delivery of appropriate and personalized nutrition interventions that lead to improved health outcomes. Nutrition assessment should be completed prior to nutrition education.

Procedure

To be certified as eligible for the WIC program applicants who have met the program eligibility standards (refer to CT: 01) must be determined to be at nutritional risk. Only a WIC Competent Professional Authority (CPA), Nutritionist / RD, through a medical and/or nutritional assessment, may determine what the nutritional risk factors are, certify for eligibility, and prescribe WIC food packages. (Refer to GP:9 for staff qualifications, roles and responsibilities)

Nutritional Assessment

The nutrition assessment obtains and synthesizes relevant and accurate information in order to:

  • Assess an applicant’s nutrition status, risk(s), capacities, strengths, needs and/or concerns.
  • Design appropriate nutrition education and breastfeeding promotion and support that address a participant’s needs and concerns.
  • Tailor the food package to address nutrition needs.
  • Make appropriate referrals.

A participant must be physically present for his/or her certification appointment for adequate nutrition assessment data collection unless an exception in granted and documented. See CT: 3. Nutritional risk will be documented in the participant’s file.

A nutritional assessment is considered complete when the following indicators of nutritional status have been evaluated;

    1. Current weight and height/length (or data provided by a health care provider no more than 60 days prior to certification, excluding infants birth measurements)- All applicants
    2. Head Circumference (or data provided by a health care provider no more than 60 days prior to certification, excludes infants birth measurements)-Per RD discretion only     
    3. Hemoglobin or hematocrit- All applicants age 9 months of age or older (Refer to Policy CT: 12).
    4. Medical/Nutritional Questionnaire-All applicants (Note: Code Sheet/Training Tool must be utilized to evaluate and score questionnaires.)

 

***The full nutrition assessment must be completed before nutrition education is provided***

 

Nutrition Risk Conditions

Once a nutrition assessment has been completed, compile all data from the participant’s health history, diet assessment, and hemoglobin and anthropometric results. Nutrition risk criteria are categorized in five overarching groups:

  1. Anthropometric
  2. Biochemical
  3. Clinical / Health / Mental
  4. Dietary
  5. Other

If new nutrition risk conditions are identified at subsequent appointments, then the new risk code(s), nutrition intervention/education and relevant referrals need to be provided and documented based on these newly identified nutrition risks.

Nutrition Risk Documentation:

Every condition of nutritional risk will be identified and justified on the participant’s health questionnaire. In addition, all participants’ files will have supporting documentation for every risk code (e.g., growth charts, diet and health questionnaires).

 

Example:

Sponsor reports on Health Questionnaire that child participant is being given sugar-sweetened beverages most day (e.g. Kool-Aid or Soda). CPA assign, document and justify Risk Code “425 – routinely feeding sugar-containing fluids” next to dietary recall on participant Health Questionnaire.

 

State of Nevada Allowable Risk Criteria

See CT: 8 and Developed nutrition risk code cheat sheets. For full definition and justification, refer to full Nutrition Risk manual.

Imputing Risk Codes and Assigning Priority

Enter nutrition risk codes from the applicant’s questionnaire into the participant’s record into the WIC computer program. Usually the priority will automatically appear in the computer, if not, enter the priority. Each risk code is listed under its priority category. If the participant has more than one risk, enter the highest priority that applies. General categories of nutritional risk codes are listed below with priority levels.

Priority

A priority of I-VI must be assigned to each applicant, based on the applicant’s nutritional risk and category, as follows:

  • Priority I – Pregnant and breastfeeding women and infants with nutritionally-related medical risks. Breastfeeding women of Priority I infants and infants of Priority I breastfeeding women.
  • Priority II – Infants under 6 months of age who were born to women who were either on the WIC Program during pregnancy or who were not on the program but would have qualified as Priority I had they been on the program. Breastfeeding women of Priority II infants.
  • Priority III – Children with nutritionally-related medical risks.
  • Priority IV – Pregnant and breastfeeding women and infants with dietary risks. Breastfeeding women of Priority IV infants and infants of Priority IV breastfeeding women. Postpartum women with nutritionally-related medical risks.
  • Priority V – Children with dietary risks.
  • Priority VI – Postpartum women with dietary and medical/nutritional risks.

Nutrition Education:

See NE: 1 Nutrition education should be based upon the participant’s highest priority needs and interests. Intervention and education are not required on all identified nutrition risk factors in one clinic visit