Building the Foundation for HANDS: Nutrition Risk - PowerPoint Presentation

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2. Building the Foundation for HANDS: Nutrition RiskAnne Whitmire MPA IBCLC RLCWIC Breastfeeding and Training AdministratorArizona Department of Health Services

3. BackgroundFoundational SkillsTraining #1AssessmentNotesTraining #2Risk CodesHANDS Training#3 and BeyondPilot/Roll-outTentative: March/April

4. WICVENAPCSOARSABCDEE-O-ETGIF

5. BackgroundFoundational SkillsTraining #1AssessmentNotesTraining #2Risk CodesHANDS Training#3 and BeyondPilot/Roll-outTentative: March/April

6. Nutrition Risk RefreshAnne WhitmireWIC Breastfeeding and Training AdministratorBureau of Nutrition and Physical Activity

7. AgendaSelf AssessmentNutrition Risk OverviewHistoryRISC CommitteeFFY22 RisksDid You KnowNutrition Risk Bingo

8. Nutrition Risk Self AssessmentRefresh

9. 1. When evaluating a woman for underweight or overweight, for which category of woman is her pre-pregnancy weight not a consideration?PregnantPostpartum, non-breastfeedingBreastfeeding under 6 monthsBreastfeeding over 6 months or more

10. Risk 101 Underweight/111 OverweightD

11. 2. What amount of weight loss (minimally) is consistent with the definition of Risk Code 301 – Hyperemesis Gravidarium?3%5%8%10%

12. 2. Risk 301 Hyperemesis GravidarumB

13. 3. Risk Code 411.1 Routinely using a substitute for human milk or for FDA approved iron fortified formula as the primary nutrient source during the first year of life applies to all homemade concoctions no matter what the ingredients.TrueFalse

14. 3. Risk 411.1 Routinely using a substitute for human milk or for FDA approved iron fortified formula as the primary nutrient source during the first year of lifeTrue

15. 4. Infant and Children that have not had a Blood Lead test qualify for Risk 211 – Elevated Blood Lead Level.TrueFalse

16. 4. Risk 211 Elevated Blood Lead LevelsFalse

17. 5. At what age does Risk 141-Low Birth Weight and Very Low Birth Weight no longer apply?6 months1 year2 years4 years

18. 5. Risk 141 Low Birth Weight and Very Low Birth WeightC

19. 6. In order to qualify for Risk Code 302 – Gestational Diabetes, the woman must be on medication and pregnant.TrueFalse

20. 6. Risk 302 Gestational DiabetesFalse

21. 7. Risk Code 411.2 Routinely using nursing bottles or cups improperly applies to what practices:Using the bottle for fruit juicePutting an infant to bed with the bottlePropping the bottle during a feedingCereal in the bottleAll of the above

22. 7. Risk 411.2 Routinely using nursing bottles or cups improperlyE

23. 8. Preterm births account for approximately 70% of newborn deaths and 36% of infant deaths. At what week of pregnancy is delivery no longer considered early or preterm?38394041

24. 8. 142 Preterm or Early Term DeliveryB

25. 9. In order to assign Risk Code 335 – Multifetal Gestation, you need to have proof from a healthcare provider.TrueFalse

26. 9. Risk 335 Multi‐fetal GestationFalse

27. 10. At what age does a child on the bottle qualify for Risk 425.3 – Routinely using bottles, cups, or pacifiers improperly12 months14 months16 months18 months

28. 10. Risk 425.3 Routinely using nursing bottles, cups, or pacifiers improperlyC

29. 11. What is the range of weight gain that we look for when evaluating a woman who is pregnant with a BMI of 28  (Overweight) for Risk 131 Low Maternal Weight Gain or 133 High Maternal Weight Gain?28-4025-3515-2511-20

30. 11. Risk 131 Low Maternal Weight Gain/Risk 133 High Maternal Weight GainC

31. 12. A person who states they or their child are currently being treated for Protein Energy Malnutrition, Scurvy, Rickets, Beriberi, Hypocalcemia and Pellagra would be assigned which risk?Risk 341 Nutrition Deficiency or DiseaseRisk 344 Thyroid DiseaseRisk 349 Genetic and Congenital DisordersNone of the above

32. 12. Risk 341 Nutrition Deficiency or DiseaseA

33. 13. Risk 427.5 - Pregnant woman ingesting foods that could be contaminated with pathogenic microorganisms includes foods like raw fish, deli meat, feta, and cookie dough batter.TrueFalse

34. 13. Risk 427.5 Pregnant woman ingesting foods that could be contaminated with pathogenic microorganisms.True

35. 14. What is the range of weight gain that we look for when evaluating a woman who is pregnant with a BMI of 28  (Overweight) for Risk 131 Low Maternal Weight Gain or 133 High Maternal Weight Gain?37-5431-5025-42Same as for a singleton pregnancy

36. 14. Risk 131 Low Maternal Weight Gain/Risk 133 High Maternal Weight GainB

37. 15. If a pregnant woman says they have “High Sugar” then they should be assigned Risk 343 – Diabetes MellitusTrueFalse

38. 15. Risk 343 Diabetes MellitusFalse

39. 16. What nutrients are directly evaluated in order to qualify for Risk 427.4 – Inadequate vitamin/mineral supplementation recognized as essential by national public health policy. Prenatal VitaminVitamin DBothNone

40. 16. Risk 427.4 Inadequate vitamin/mineral supplementation recognized as essential by national public health policy.D

41. 17. Celiac Disease is an autoimmune disease precipitated by the ingestion of gluten that results in damage to the small intestine and malabsorption of nutrients from food. Gluten is a protein found in what food:WheatRyeBarleyAll of the Above

42. 17. Risk 354 - Celiac DiseaseD

43. 18. Breastfeeding two (2) siblings who are not twins qualifies a woman for Risk 602 Breastfeeding Complications or Potential Complications (Women).TrueFalse

44. 18. Risk 602 Breastfeeding Complications orPotential Complications (Women)True

45. 19. Which categories does Risk 382 – Fetal Alcohol Spectrum Disorders apply to:WomenInfantsChildrenAll of the above

46. 19. Risk 382 - Fetal Alcohol SyndromeD

47. 20. Which of these issues qualifies a women, children and/or infants for Risk Code – 902 Woman or Infant/Child of Primary Caregiver with Limited Ability to make Appropriate Feeding Decisions and/or Prepare Food?Use of a marijuanaDepressionIntellectual or physical disability≤ 17All of the aboveNone

48. 20. Risk 902 Woman or Infant/Child of Primary Caregiver with Limited Ability to Make Appropriate Feeding Decisions and/or Prepare FoodE

49. 21. Risk 381 – Oral Health Conditions applies to women and children over 2 and includes dental caries, periodontal disease, gingivitis, tooth loss, ineffective replacement teeth or oral infectionsTrueFalse

50. 21. Risk 381 Oral Health ConditionsTrue

51. History1974WIC Began; State – Nutrition Risk1989Child Nutrition and WIC Reauthorization ActMost Need1993National Academy of Sciences' Institute of Medicine 1996WIC Nutrition Risk Criteria: A Scientific Assessment RISC Identification And Selection Collaborative was established.

52. RISC CommitteeCollaborative PartnershipUSDA – Food and Nutrition ServiceNational WIC AssociationCriteriaSound SciencePractical for WIC ApplicationNutritionally linked or related to services provided by WICIndex of Allowable CriteriaVENA Implications to WIC Services

53. State Guiding DocumentImplementationOctober 1Add/Remove (Risk, Categories)ChangeNameDefinitionJustificationReferencesImplications for WIC Nutrition Services

54. FFY 2022 Risk Changes: 10/01/2021

55. Risk 134: Failure to ThriveJustificationAdded indicators for HCP diagnosisReferenceImplications for WIC Nutrition Services

56. Risk 331 Pregnancy at a Young AgeFFY 22Definition20 and underJustificationReferenceImplications to WIC Services

57. Risk 333 High Parity and Young Age

58. Risk 371 Nicotine and Tobacco UseFFY21: Maternal SmokingFFY22DefinitionJustificationReferenceImplications for WIC Nutrition Services

59. Risk 904 Exposure to Environmental Tobacco SmokeFFY21: Environmental Tobacco Smoke ExposureFFY22 DefinitionJustificationReferenceImplications for WIC Nutrition Services

60. Risk Codes CARES to HANDS

61. Risk Codes In HANDS

62. Risk Factor Auto-Assign vs Manual

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64. Risk Code: HistoryPregnancy/Breastfeeding/Postpartum: AnyRisk 303History of Gestational DiabetesRisk 304History of PreeclampsiaPregnancy: AnyBreastfeeding/Postpartum: Most RecentRisk 311History of Preterm or Early Term DeliveryRisk 312History of Low Birth WeightRisk 321History of Spontaneous Abortion, Fetal or Neonatal LossRisk 337History of Birth of a Large for Gestational Age InfantRisk 339History of Birth with Nutrition Related Congenital or Birth Defect

65. Risk Code: PairsRisk 601Breastfeeding Mother of Infant at Nutritional RiskRisk 701Infant Up to 6 Months Old of WIC Mother or of a Woman Who Would Have Been Eligible During PregnancyRisk 702Breastfeeding Infant of Woman at Nutritional Risk

66. Risk Code: FamilyRisk 502Tranfer of CertificationRisk 801HomelessnessRisk 802MigrancyRisk 901Recipient of Abuse

67. Risk : Nutritional Status347 – CancerA chronic disease whereby populations of cells have acquired the ability to multiply and spread without the usual biologic restraints. The current condition, or the treatment for the condition, must be severe enough to affect nutritional status. 348 - Central Nervous DisorderConditions which affect energy requirements, ability to feed self, or alter nutritional status metabolically, mechanically, or both. 359 - Recent Major Surgery, Physical Trauma, and BurnsAny occurrence: Within the past two (≤2) months may be self-reported. More than two (>2) months previous must have the continued need for nutritional support diagnosed by a physician or a health care provider working under the orders of a physician.360 -Other Medical ConditionsDiseases or conditions with nutritional implications that are not included in any of the other medical conditionsThe current condition, or treatment for the condition, must be severe enough to affect nutritional status.

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69. Risk 135 Slowed/Faltering Growth PatternInfants Birth to 2 Weeks Excessive weight loss after birth, defined as > 7% birth weight. Infants 2 weeks to 6 Months of Age Any weight loss. Use two separate weight measurements taken at least eight weeks apart.

70. Risk 332 Short Interpregnancy IntervalShort Interpregnancy Interval (IPI), formerly known as Closely Spaced Pregnancies, is defined as an interpregnancy interval of less than 18 months from the date of a live birth to the conception of the subsequent pregnancy

71. Risk 349 Genetic and Congenital DisordersMay include, but is not limited to, cleft lip or palate, Down’s syndrome, thalassemia major, sickle cell anemia (not sickle cell trait), and muscular dystrophy. Hereditary or congenital condition at birth that causes physical or metabolic abnormality. The current condition must alter nutrition status metabolically, mechanically, or both.

72. Risk 352a Infectious Diseases - AcuteA disease which is characterized by a single or repeated episode of relatively rapid onset and short duration. Infectious diseases come from bacteria, viruses, parasites, or fungi and spread directly or indirectly from person to person (1). Infectious diseases may also be zoonotic, which are transmitted from animals to humans, or vector-borne, which are transmitted from mosquitoes, ticks, and fleas to humansThe infectious disease must be present within the past six months

73. Risk 353 Food AllergiesAllergyDiagnosisFood allergies are adverse health effects arising from a specific immune response that occurs reproducibly on exposure to a given food. Food allergy reactions occur when the body’s immune system responds to a harmless food as if it were a threat IntoleranceFood intolerances are classified differently from food allergies based on the pathophysiological mechanism of the reactions. Unlike food allergies, food intolerances do not involve the immune system. Food intolerances are adverse reactions to food caused either by the properties of the food itself, such as a toxin, or the characteristics of the individual, such as a metabolic disorder

74. Risk 411.7 Routinely limiting the frequency of nursing of the exclusively breastfed infant when human milk is the sole source of nutrientsLess than 8 feedings in 24 hours if less than 2 months of age.Scheduled feedings instead of demand feedings

75. Risk 401 Failure to Meet Dietary Guidelines for AmericansWomen and children two years of age and older who meet the income, categorical, and residency eligibility requirements may be presumed to be at nutrition risk for failure to meet Dietary Guidelines for Americans The Failure to meet Dietary Guidelines for Americans risk criterion can only be used when a complete nutrition assessment has been completed and no other risk criteria have been identified. This includes assessing for risk #425, Inappropriate Nutrition Practices for Children or risk #427, Inappropriate Nutrition Practices for Women.

76. Nutrition Risk BingoWin: AcrossDown orDiagonal

77. To qualify for Risk 103 Underweight or At Risk of Underweight, a child that is between 2-5 years old would need to be below what percentile of BMI for Age using CDC age/gender specific growth charts?35810

78. 103: Underweight or At Risk of Underweight

79. How many times a day does a pregnant woman need to breastfeed in order to qualify for Risk 338 – Pregnant Woman Currently Breastfeeding?1248

80. 338 Pregnant Woman Currently BreastfeedingFederal Definition of Breastfeeding is one time per day

81. For hemoglobin/hematocrit, how many days old can the information be and still be used for risk determination?Today only10 days60 days90 days

82. 201 Low Hematocrit/Low Hemoglobin90 Days

83. Risk 151 – Small for Gestational Age can apply to which categoriesC2C3C4None of the above

84. 151 Small for Gestational Age

85. At what birth weight, does an infant qualify for Risk Code 153 – Large Gestational Age or a woman for Risk Code – 337 History of a Large for Gestational Age Infant?891011

86. 153 Large for Gestational Age/337 History of Birth of a Large for Gestational Age Infant

87. A person who states they or their child are currently being treated for Pancreatitis, Crohn’s Disease, Gastroesophageal Reflux Disease (Gerd) would be assigned which risk?341 Nutrition Deficiency or Disease342 Gastrointestinal Disorders353 Food AllergiesNone of the above

88. 342 Gastrointestinal Disorder

89. At what age, does Risk Code 153 – Large for Gestational Age no longer apply6 months1 year2 years3 years

90. 153 Large for Gestational Age

91. What categories does Risk 345 – Hypertension and Prehypertension apply to:WomanInfantChildAll of the above

92. 345 Hypertension and Prehypertension

93. At what age does Risk Code 135 – Slowed/Faltering Growth Pattern no longer apply7 months1 year2 years4 years

94. 135 – Slowed/Faltering Growth Pattern

95. Examples of conditions that qualify for Risk 348 – Central Nervous Disorder are:EpilepsySpina BifidaCerebral PalsyAll of the Above

96. 348 Central Nervous Disorder

97. In order to qualify for Risk Factor – 355 Lactose Intolerance, the participant must be sensitive to all lactose containing foods including milk, cheese, yogurt, etc.TrueFalse

98. 355 Lactose Intolerance

99. What nutrients are directly evaluated in order to qualify for Risk 425.8 – Routinely not providing dietary supplements recognized as essential by national public health policy when a child’s diet alone cannot meet nutrient requirements.FluorideVitamin DBothNone

100. 425.8 – Routinely not providing dietary supplements recognized as essential by national public health policy when a child’s diet alone cannot meet nutrient requirements

101. Risk 361 – Depression applies to:All women categoriesDiagnosed by psychologist or MDIncludes postpartum depressionAll of the above

102. 361 Depression

103. Risk Code 411.3 Routinely offering complementary foods or other substances that are inappropriate in type or timing to include offering baby food before 6 months.TrueFalse

104. 411.3 Routinely offering complementary foods or other substances that inappropriate in type or timing

105. At what age is High Weight for Length no longer an applicable risk?1 year2 Years3 Years4 Years

106. 115 High Weight for Length

107. Hypoglycemia is more common in newborns that are small for gestation than in newborns that are appropriate size for gestation.TrueFalse

108. 356 Hypoglycemia

109. Feeding donor milk from an individual or the internet makes the infant eligible for what risk code(s):Risk 411.5 Feeding foods to an infant that could be contaminated with harmful microorganismsRisk 411.9 Rountinely using inappropriate sanitation in the feeding, preparation, handling, and or storage of expressed human milk or formulaBothNone

110. 411.5 Feeding foods to an infant that could be contaminated with harmful microorganisms or toxins./411.9 Routinely using inappropriate sanitation in the feeding, preparation, handling, and/or storage of expressed human milk or formula.

111. Risk 372 – Alcohol and Substance Abuse defines High Risk Drinking as routine consumption of ≥8 drinks per week or ≥_____ drinks on any day. 3456

112. 372 Alcohol and Substance Abuse

113. For approximately how long do symptoms of Risk Code 383 – Neonatal Abstinence syndrome remain present:3 months6 months9 months12 months

114. 383 Neonatal Abstinence Syndrome

115. Having less that 6 wet diapers a day qualifies an infant for Risk 603 – Breastfeeding Complications or Potential Complications (Infant).TrueFalse

116. 603 Breastfeeding Complications orPotential Complications (Infants)

117. Pica is a Risk Code for what categories:Pregnant WomenBreastfeeding/Postpartum WomenChildrenAll of Above

118. 425.9/427.3 PICAChildren: All AgesWomen: All Categories

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120. To learn more:

121. Training #3: HANDS Basic FunctionalityGetting StartedClient/Family SearchClient/Family ScreenCert ActionMedical

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