Effective October 1 2021 Purpose of Nutrition Risk Criteria With the flexibility allowed by risks such as 401 and 428 we dont usually think of nutrition risk as a determining factor for eligibility ID: 932499
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Slide1
FFY22 Revised Nutrition Risk Criteria
Effective October 1, 2021
Slide2Purpose of Nutrition Risk Criteria
With the flexibility allowed by risks such as 401 and 428 we don’t usually think of nutrition risk as a determining factor for eligibility. It’s important to remember that in addition to eligibility requirements for
WIC category, income, and residency - federal regulations require the determination of a
nutrition risk based a medical or nutritional assessment.
OPTIONAL BACKGROUND INFORMATION
https://www.fns.usda.gov/wic/nutrition-risk-criteria
Slide3Risk Identification and Selection Collaborative
If decreased funding required the program to limit participation, priorities based on category and nutrition risk are implemented to serve those with the greatest needs. So, it’s very important to keep nutrition risks up-to-date and assign them accurately.
OPTIONAL BACKGROUND INFORMATION
Slide4Risk Identification and Selection Collaborative
To make sure WIC staff are equipped with the best, up-to-date information to identify nutrition risks the Risk Identification and Selection Collaborative (RISC) was formed.
RISC includes members from federal, state and local-agency staff who periodically review criteria to ensure they are:Based on sound sciencePractical for WIC application, and
Nutritionally linked or related to the nutrition services provided by WIC
OPTIONAL BACKGROUND INFORMATION
Slide5Revised Risk Criteria
Currently, RISC has identified 4 risk criteria impacted by the latest research and evidence-based recommendations from:The Centers for Disease Control (CDC)
The American Academy of Pediatrics (AAP)The National Academies of Sciences (NAS)Peer-reviewed academic literature
OPTIONAL BACKGROUND INFORMATION
Slide6FFY2022 Risk Revisions – Arizona WIC Program
Beginning October 2021, changes to the following nutrition risk criteria will be implemented in Arizona WIC:
1. 134 Failure to Thrive2. 331 Pregnancy at a Young Age3. 371 Nicotine and Tobacco Use4. 904 Exposure to Environmental Tobacco Smoke
[DISCONTINUED: 333 High Parity and Young Age]
Slide7HANDS and Existing Resources
On October 1, relevant changes will be made to HANDS and other resources:
HANDS criteria for auto-assigned WIC Codes (331 Pregnancy at a Young Age)Arizona WIC Nutrition Risk Manual (WIC Manuals)
WIC Code Cheat Sheets (WIC Manuals)Nutrition Care Guidelines (WIC Manuals)
Arizona WIC Risk Table FFY2022 (WIC Manuals)No change needed: When to Refer to a High Risk Dietitian
Slide8DISCONTINUED:
Risk 333 High Parity and Young AgeDefinition: Women under age 20 at date of conception who have had 3 or more previous pregnancies of at least 20 weeks duration.
This criterion is being discontinued because it is redundant to the revised code 331 Pregnancy at Young Age.
Risk Code
BF&PP
WIC Code Cheat Sheet
Pregnant
WIC Code Cheat Sheet
Child
WIC Code Cheat Sheet
Infant
WIC Code Cheat Sheet
333
Removed
Removed
n/a
n/a
Slide9DISCONTINUED:
Risk 333 High Parity and Young AgeCode 333 is no longer needed since the revision to code 331 Pregnancy at a Young Age can be assigned for women who conceive at 20 years or younger (instead of 17 years or younger).
WIC staff will continue to assign code 332 Closely Spaced Pregnancies as appropriate to address increased needs due to a recent previous pregnancy.
Impact on Current PracticeFor any situations 333 High Parity and Young Age would have applied, WIC staff shall assign 331 Pregnancy at a Young Age.
Risk Code
BF&PP
WIC Code Cheat Sheet
Pregnant
WIC Code Cheat Sheet
Child
WIC Code Cheat Sheet
Infant
WIC Code Cheat Sheet
333
Removed
Removed
n/a
n/a
Slide10Revised: 331 Pregnancy at a Young Age
(Auto-assigned by HANDS)
Changes:1. REVISED: Definition. 2. EXPANDED: Justification and Reference sections.
3. ADDED: The Implications for WIC Nutrition Services. (Food pkg, breastfeeding support, referrals)
Risk Code
BF&PP
WIC Code Cheat Sheet
Pregnant
WIC Code Cheat Sheet
Child
WIC Code Cheat Sheet
Infant
WIC Code Cheat Sheet
331
Pregnancy
<
20 years
Pregnancy
<
20 years
n/a
n/a
Slide11Revised: 331 Pregnancy at a Young Age
(Auto-assigned by HANDS)
Risk Code
BF&PP
WIC Code Cheat Sheet
Pregnant
WIC Code Cheat Sheet
Child
WIC Code Cheat Sheet
Infant
WIC Code Cheat Sheet
331
Pregnancy
<
20 years
Pregnancy
<
20 years
n/a
n/a
Revised definition:
Pregnancy at a young age is defined as conception at or less than 20 years of age.
Previous definition:
Pregnancy at a young age is defined as conception at or less than 17 years of age.
Slide12Justification
Pregnancy in women under the age of 20 is associated with:
AnemiaEclampsiaPostpartum depressionMaternal death
Low birth weightPreterm deliveryStillbirthLower socioeconomic and education statusIncreased health care costs
Competition for nutrients between the still growing adolescent mother and developing fetus.
Slide13References
A study in the state of Delaware documented the higher costs of care associated with pregnancies for young women in the following age categories: 17 years and under, 18-20 years, and 21-24 years of age. (1)
A study by the World Health Organization compared 124,446 mothers in 29 countries in Africa, Latin America, Asia, and the Middle East. Compared to mothers aged 20-24 years, mothers aged 10-19 years had higher risks of eclampsia, puerperal endometritis (uterine infection), systemic infections, low birthweight, preterm delivery and severe neonatal conditions. (2)
Maiden K, Gunter WD, Martin SS, et al. Teen mothers, unintended pregnancies, and costs across Delaware. Del Med J. 2014 April (cited 2020 May 28); 86(4):109-16. Available from: https://pubmed.ncbi.nlm.nih.gov/25000643/2.
Ganchimeg T, Ota E, Morisaki N, et al. Pregnancy and child birth outcomes among adolescent mothers: a World Health Organization multicountry
study. BJOG. 2014 Mar (cited 2020 May 28); 121:40-48. Available from: https://pubmed.ncbi.nlm.nih.gov/24641534/
Slide14Impact on Current Practice
Impact on Current Practice:
HANDS will auto-assign code
331 for
any woman age 20 years or younger on the date of conception (instead of 17 years or younger). WIC staff shall determine appropriate referrals, nutrition education, and resources to support prenatal health for women who conceive at 20 years of age or younger.
Slide15Revised:
371 Nicotine and Tobacco UseChanges:
1. REVISED: Definition.2. EXPANDED: Justification and Reference sections. 3. ADDED: The Implications for WIC Nutrition Services. (Supportive environment, education, referrals)
Risk Code
BF&PP
WIC Code Cheat Sheet
Pregnant
WIC Code Cheat Sheet
Child
WIC Code Cheat Sheet
Infant
WIC Code Cheat Sheet
371
Includes nicotine products
Includes nicotine products
n/a
n/a
Slide16Revised: 371 Nicotine and Tobacco Use
Previously titled Maternal Smoking
Revised Definition: Any use of products that contains nicotine and/or tobacco to include but not limited to cigarettes, pipes, cigars, electronic nicotine delivery systems (e.g. e-cigarettes, vaping devices), hookahs, smokeless tobacco (e.g. chewing tobacco, snuff,
dissolvables), or nicotine replacement therapies (e.g. gums, patches). Previous definition: Any smoking of tobacco products, i.e., cigarettes, pipes, or cigars.
Slide17Justification
Nicotine can be found in breastmilk, therefore, the use of nicotine products may directly impact breastfed infants.Exhaled vapors from Electronic Nicotine Delivery Systems (ENDS) have been shown to contain chemicals that can cause cancer, can harm the fetus, and are a source of indoor air pollution.
The CDC has stated that ENDS use is not safe for pregnant women.
Slide18Updated Research
Multiple studies by CDC, USDA, AAP and peer-reviewed journals published between 2016 and 2020 provide more information about the consequences of exposure to nicotine though tobacco products and non-tobacco products containing nicotine.
Credit for images:
(left) https://www.cdc.gov/tobacco/basic_information/secondhand_smoke/index.htm
(right) https://www.cdc.gov/tobacco/basic_information/e-cigarettes/index.htm
Slide19Impact on Current Practice
Impact on Current Practice
WIC staff shall ask open-ended questions about the use of any products containing nicotine, including tobacco and non-tobacco products. As appropriate, staff shall assign 371 for women who use tobacco products, as well as non-tobacco products that contain nicotine such as e-cigarettes, vaping devices, gums, and patches.
Note: Open ended questions appropriate for assigning 371 are included with “Environmental” questions on the ABCDE guide.
Slide20Revised: 904 Environmental Tobacco Smoke Exposure
Previously titled Exposure to Environmental Tobacco Smoke
Changes: 1. REVISED: Definition.
2. EXPANDED: Justification and Reference sections. 3. ADDED: The Implications for WIC Nutrition Services. (Supportive environment, education, referrals)
Risk Code
BF&PP
WIC Code Cheat Sheet
Pregnant
WIC Code Cheat Sheet
Child
WIC Code Cheat Sheet
Infant
WIC Code Cheat Sheet
904
Includes vaping aerosols and “enclosed spaces”
Includes vaping aerosols and “enclosed spaces”
Includes vaping aerosols and “enclosed spaces”
Includes vaping aerosols and “enclosed spaces”
Slide21Revised Definition
Environmental tobacco smoke (ETS) exposure is defined (for WIC eligibility purposes) as exposure to smoke from tobacco products inside enclosed areas, like the home, place of child care, etc. ETS is also known as secondhand, passive, or involuntary smoke. The ETS definition also includes the exposure to the aerosol from electronic nicotine delivery systems.Previous definition:
Environmental tobacco smoke (ETS) exposure is defined (for WIC eligibility purposes) as exposure to smoke from tobacco products inside the home. ETS is also known as passive, secondhand, or involuntary smoke.
Exposure to aerosol from nicotine-containing products (vapes, e-cigarettes, e-pipes, etc.) in addition to smoke exposure from tobacco products.
It also includes enclosed areas like the place of child care, etc. in addition to inside the home.
Slide22Justification
The vapor produced by electronic nicotine delivery systems has been shown to be hazardous.
Second-hand exposure:
A few studies have demonstrated that passive exposure to ENDS among healthy adults causes an increase in nicotine in the bloodstream that is similar to that from passive exposure to cigarette smoke.
Third-hand exposure:Nicotine exposure can be caused by residual tobacco smoke pollutants which adhere to the clothing and hair of smokers, to pet fur, and to surfaces, furnishings, and dust in indoor environments. Infants and children are the most at risk of THS exposure because they spend more time indoors and are closer to or on the ground where the nicotine-contaminated dust accumulates.
Slide23Impact on Current Practice
CDC:
Updated report on e-cigarette use from the Surgeon General
National Cancer Institute:
Updated guidance in 2019 about the consequences of environmental tobacco smoke exposure.
Impact on Current Practice:
WIC staff shall ask open-ended questions about exposure to smoke from tobacco products as well as exposure to aerosol from Electronic Nicotine Delivery Systems (ENDS).
WIC staff shall assign code 904 when clients confirm such exposure occurs inside the home or enclosed areas outside the home such as the place of child care, etc.
Slide24Revised:
134 Failure to Thrive
Changes:
1. REVISED: Recommended cutoff values for HCP diagnosis.2. UPDATED: Justification and Reference sections.
3. ADDED: The Implications for WIC Nutrition Services. (Coord. care w/ HCPs, food pkg, referrals)
Risk Code
BF&PP
WIC Code Cheat Sheet
Pregnant
WIC Code Cheat Sheet
Child
WIC Code Cheat Sheet
Infant
WIC Code Cheat Sheet
134
n/a
n/a
No change (HCP diagnosis)
No change (HCP diagnosis)
Slide25Definition (no change)
Definition:
Presence of failure to thrive (FTT) diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Clarification for more information about self-reporting a diagnosis.
The Justification, Clarification and Reference sections were revised with the most up-to-date guidelines for HCP diagnosis of Failure to Thrive.
The Implications for WIC Nutrition Services section was added to provide program-specific guidance for providing support to WIC families.
Risk Code
BF&PP
WIC Code Cheat Sheet
Pregnant
WIC Code Cheat Sheet
Child
WIC Code Cheat Sheet
Infant
WIC Code Cheat Sheet
134
n/a
n/a
No change (HCP diagnosis)
No change (HCP diagnosis)
Slide26Justification
Updated details about indicators for an HCP diagnosis:Weight-for-age:
< 2 years: repeatedly below the 2.3rd percentile > 2 years: repeatedly below the 5th percentile Weight-for-length:
< 2 years: repeatedly below the 2.3rd percentile > 2 years: BMI repeatedly below the 5th percentile Stature-for-age:
< 2 years: repeatedly below the 2.3rd percentile > 2 years: repeatedly below the 5th percentile Weight:< 2 years: less than 75% of median (“typical”) weight-for-age
> 2 years: less than 80% of median weight-for-stature Progressive fall-off that crosses down two major percentile lines (includes any measurement above).
Rate of weight gain less than the 5th percentile based on World Health Organization velocity standards.
Slide27Impact on Current Practice
AAP published updated diagnostic guidelines for Failure to Thrive in 2019, in addition to supporting evidence published by several peer-reviewed journals between 2016 and 2019.
Impact on Current Practice:
WIC staff shall continue to assign code 134 based on a Health Care Provider diagnosis.
Slide28QUESTIONS?
THANK YOU FOR REVIEWING THE CHANGES GOING INTO EFFECT ON OCTOBER 1, 2021.