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Texas WIC News November December 2009

Volume 18, Number 6


Looking Ahead for Texas WIC


Texas WIC Looks to the Future
WIC Embraces a Client-Centered Approach to Nutrition Education
Collaboration Provides New WIC Certification Training to Local Agencies
Texas WIC Works Toward Greater Clinic Efficiency
WIN Evolution Allows for Improved Communications
Local Agency Spotlight: Transitioning From Classroom to Living Room Is a Good Fit for Client-Centered Education
WIC Wellness Works
IDL “Lunch with Linda” Celebrates Accomplishments
News 2 Use
2009 Texas WIC Dietetic Interns Share Their Experiences and Goals
Top Ten Ways WIC Makes Texas a Better Place to Live
Test Your Nutrition IQ



Texas WIC Looks to the Future

From the Texas WIC Director
— Mike Montgomery

A s I write this, WIC participants throughout Texas are purchasing fresh and frozen fruits and vegetables, whole grain products, baby food, low-fat milk and maybe even tofu and soymilk. More than that, they are using these healthy additions to the new food packages to nourish their children. You put so much time and effort toward educating our participants about these changes and now, they are reaping the benefits. This is something you should all be very proud of. I know I am.

One thing you can always count on with WIC, we never rest too long on our accomplishments. We are always looking to the future and embracing new possibilities. This issue is a preview of what’s next!

Client-Centered Nutrition Education
Find out how client-centered nutrition education can make your classroom education efforts more relevant and meaningful for WIC participants. Quality nutrition education is a longterm benefit of the WIC program that has the potential to improve lives for years to come. Texas WIC will continue to set the highest standards for nutrition education. See the article titled WIC Embraces a Client-Centered Approach to Nutrition Education on page 4.

Clinic Efficiency
When we put our heads together, great things happen. Be sure to read the article titled Texas WIC Works Toward Greater Clinic Efficiency on page 8. It is about strategies local and state agency staff have proposed to increase efficiency and facilitate clinic flow.

WIC Certification Specialist Training Program
The Clinic Services Branch and The University of Texas have produced a comprehensive WCS training curriculum. Read about how this training can help local agencies maximize their staff potential in the article titled Collaboration Provides New WIC Certification Training to Local Agencies on page 6.

WIN Evolution
This is the next BIG step in modernizing the clinic-side computer system. Read about what the future holds in the article on page 9 titled WIN Evolution Allows for Improved Communications.

As we look to the future and the challenges and opportunities that are to come, keep in mind that the ultimate measure of our success is the health and success of our participants.

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WIC Embraces a Client-Centered Approach to Nutrition Education

by Erica Harris, M.S., R.D., L.D.
Nutrition Education Consultant

WIC nutrition education continually evolves to stay up with the times. In October 2007, Texas WIC implemented Value Enhanced Nutrition Education (VENA), launching a paradigm shift toward participant centered counseling. Since adopting VENA principles, WIC counselors are better able to provide individualized care, support participants in making long-term behavior changes, and promote positive health outcomes. In an effort to apply a participant-centered approach to all nutrition education at WIC, a subtle shift has also begun to take shape in the WIC classroom.

What is Client-Centered Education?
Embracing a client-centered approach to nutrition education means providing more choices and opportunities for active learning, and may involve a variety of learning experiences. From allowing clients to complete their nutrition education online to creating new opportunities in group education, WIC is evolving to meet the needs of our diverse client population. Many agencies are already offering client-centered education, and it’s time to make this the norm.

Key elements of client-centered learning include:
• Acknowledging and respecting clients as adults who have expertise about their own families.
• Involving clients as active participants in their own learning.
• Including an element of choice such as choice of lesson topic or format.

Overall, adopting participant-centered principles in the classroom means shifting from a traditional, didactic model to a learner-centered approach, and some staff has begun to call it “VENA of the classroom.” From group discussions to nutrition fairs to action-oriented classes involving games, skits, food demonstrations, or role-plays, client-centered classes can incorporate many different approaches in order to meet learners’ needs. WIC instructors may find themselves shifting from “teacher” to “guide” in order to connect moms and facilitate peer-to-peer learning. One of the biggest benefits of a client-centered approach is the opportunity for WIC participants to share experiences and provide social support to each other in making healthy changes.

Piloting the Concept at Texas WIC
In 2007, eight WIC local agencies participated in a pilot program to experiment with making nutrition education classes more client-centered. During the pilot, 27 WIC staff across the state taught over 95 client-centered classes, reaching over 600 participants. Responses from staff and participants were extremely positive.

WIC staff comment:
“…really enjoyed this format… particularly for our clients who have been on the program for several years. It not only gives them an opportunity to talk about something different, but it also allows them the chance to share their expertise with our newer parents.”

Client comments:
• “The class was fun.”
• “This class gives you the opportunity to express your concerns and ideas.”
• “They are more entertaining and I learned new things when exchanging opinions with other people.”
• “You actually had class participation instead of watching a video (boring).”

Enthusiastic feedback from the pilot program spurred development of training on client-centered approaches in order to provide more support to local agencies moving forward.

Training Development
In 2008, as interest in client-centered education grew, state staff began to develop training materials and offer basic training upon request to local agencies. Usually consisting of a full-day hands-on workshop, early trainings focused on adult learning principles, classroom management and facilitation skills, creating and maintaining a positive environment, and incorporating client-centered principles into classes. Several new lessons embracing client-centered principles were also developed, as well as a lesson development template to help local agencies put their own creative ideas onto paper.

Resource Toolkit
As training materials evolved, state staff enlisted the help of The University of Texas Nutrition Education Team to consolidate and reformat the training materials into a resource toolkit for local agencies. Just as client-centered education is not a cookie-cutter method of education for our clients, staff training on the concepts is likely to be most effective if local agency leadership has the capability to tailor it to meet staff needs. When complete, the resource toolkit will hopefully give local agency directors and nutrition education/training coordinators more resources and flexibility to train staff moving forward.

In September 2009, local agencies were invited to send agency leaders to a full-day training workshop in Austin. During this workshop, staff learned about client-centered nutrition education, participated in hands-on activities and discussions, and provided feedback on an early draft of the resource toolkit. Collaboration with and feedback from local agencies has been crucial to this project, and many thanks go out to those who provided input. More details will follow in coming months once the toolkit is ready for release.

Learning from Others
Local agencies who have received state-sponsored training on client-centered nutrition education—either through participation in the pilot program or subsequent trainings—should communicate with their state nutrition education liaison to implement changes slowly, in ways that make sense for them. Interviews with agencies, after client-centered trainings, have shown subtle shifts occurring, such as WIC instructors making an effort to simply listen more and talk less during group classes or arranging seating to create a more client-friendly classroom.

Bigger steps that some local agencies have taken to adopt a spirit of client-centered learning include:

  • Incorporating emotion-based materials from Pam McCarthy’s Touching Hearts Touching Minds project into nutrition education classes.
  • Building an herb garden on-site at a clinic and exploring it during NE classes to inspire clients about healthy cooking.
  • Creating new classes surrounding “hot topics” so participants can discuss timely nutrition topics during classes.
  • Adding taste tests and grab bags of props to existing lessons.

While some agencies have used funds from the obesity project mini-grant program to try new things, others have been able to make meaningful changes without additional funding.

On the Horizon
Adopting a client-centered spirit is something we can all do. Be sure to look out for training opportunities as they become available to find out what’s new and to identify next steps for your agency. You can also communicate with your local agency’s nutrition education coordinator and state agency nutrition education liaison to explore ways to move forward. By blending a more client-centered approach into what we’re already doing and sharing best practices we can continue to bring the best nutrition education to the table at WIC.

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Collaboration Provides New WIC Certification Training to Local Agencies

by Tonia Swartz, R.D., L.D.,
WIC Clinical Nutrition Specialist

Tara Ray, M.A., Lorna Reutner, M.A., and Carol Spaulding, Ph.D.,
University of Texas at Austin, WCS Team

Is there a WIC certification specialist in your future?

Does your local agency need the services of a WIC certification specialist (WCS)? Have you put off training a specialist due to the work and resources involved in developing your own training and materials? It will be easier now, thanks to a new training program.

In collaboration with The University of Texas at Austin, the WIC Clinical Services Branch is currently developing a competency-based training certification program that may be used by local agencies interested in implementing a WCS program.

Why is the certification training being developed?

Currently, there is no official training curriculum available for local agencies to use as a model for developing their own training program for WCS candidates. This new program provides standardized training to help ensure that all candidates go through the same consistent and reliable training program. Local agencies no longer have to devote valuable time and resources to developing their own programs. The new training program will replace existing WCS programs currently in use by local agencies and will be utilized by any agency approved for starting this program. New candidates starting the training program at an already approved WIC certification specialist local agency will be required to use this new program.

In addition, if a certified WIC certification specialist moves from one agency to another, the hiring agency will be reassured to know that the specialist has been thoroughly trained by a standardized, competency-based program.

What does the training cover?

The new certification program is a self-paced manual that consists of eleven modules covering the following competency areas:

VENA skills: rapport building, communication and critical thinking.
Professional skills: program delivery, ethics and professionalism, customer service and group education.
Clinical skills: anthropometric and biochemical data collection, health assessment and individual counseling.
Training must be guided by a preceptor. A preceptor is a registered dietitian who provides guidance and support through the four phases of the course. Course materials include a set of preceptor guidelines that provide guidance for the preceptor to prepare, support, and evaluate the candidate to successful completion of the course. The preceptor guidelines include answers to all the activities and pacing guidelines. Observation checklists allow the preceptor to observe the candidate successfully perform all the course competencies at the end of each phase of training.

What does the candidate do to complete the course?

The candidate works through the self-paced manual by reading the content and completing the course activities. The training aims to simulate on-the-job training by using case study scenarios to teach how to provide services to a variety of WIC clients and real-life situations common to WIC. Effective video segments supplement the course content and the case studies. The candidate has frequent opportunities to check their own understanding with self-checks and reviews. There will be an exam and observation period at the end of each phase. The candidate is expected to observe other WIC staff identified by the preceptor, and work with clients in a variety of situations.

Why should my agency use this course?

The WIC certification specialist course allows candidates to complete the training at their own pace with supervision from a preceptor. The course provides standardized content, learning activities, and evaluation to help ensure success and provide the same depth of required training for the position to all candidates.

What is the current status of this new training?

The modules have been written and reviewed for consistency with WIC policies and guidelines. The videos have been shot and are in the editing process. Field testing of the modules is ongoing with several agencies. Local agency directors have reviewed and commented on modules. A final draft of the course manual and preceptor guidelines should be completed fall 2009.

How soon can my staff use this training?

Beta-testing of the course began this fall. Participating agencies have the opportunity to complete the course in its entirety. Candidates will complete all modules and exams in sequential order under the supervision of their preceptor. Throughout beta-testing, candidates and their preceptors have the opportunity to provide feedback about their experience. This feedback will be used to improve the course before it is made available statewide.

Certification as a WIC certification specialist will be awarded for staff that successfully complete the modules, exams, and observations during beta-testing.

How can I find out more?

For more information about the WCS training program, including beta-testing, contact Tonia Swartz by email or by phone at 1-512-341-4586.

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Texas WIC Works Toward Greater Clinic Efficiency

by Ellen Larkin
Local Agency Operations Coordinator

Texas WIC is now serving over 1 million participants! The state agency realizes that WIC clinics across Texas are working diligently to serve the record breaking number of participants. Therefore, the state agency, in coordination with the Texas Association of WIC Directors, is working to create efficiencies in the current WIC processes.

In June 2009, the state agency, in an effort to hear your ideas and suggestions on how you would improve clinic procedures, conducted a survey on what your job is and what would assist you to do your job better and more efficiently. Thanks to everyone who took the survey.

We found clear themes emerged from your responses:

Additional workstations
Many staff said that additional workstations would allow them to schedule appointments and enter information more efficiently. This in turn would allow clinics to see more participants during the day. State staff is working with local WIC directors to add computers to clinics when possible and where necessary to enhance clinic flow.

Scheduling software
A number of staff said they would benefit from the use of appointment software that makes appointments outside of the WIN system, tracks date of first visit, and maintains appointment history. Such software could be especially helpful for agencies with call centers. Currently a local agency is piloting the use of such software. If successful, other local agencies may utilize appointment software with the same specifications.

Plotting software
Another suggestion was to have plotting software on computers in the clinic. The software would allow staff to enter the height and weight which will be plotted electronically on the correct CDC growth grid and printed. This can decrease the time and error rate in many areas such as noncontract formulas, certifications and midpoint screenings. The state agency is exploring different software choices and hopes that an option can be found soon that meets WIC criteria.

Formula approval process
Staff is concerned that the formula approval process increases time spent during an appointment for both staff and participant. The state agency has created an online form, which physicians can complete electronically, print out, and give to the participant. The state agency is investigating the feasibility of allowing doctors to electronically submit the form as well.

In addition, there are a couple of state agency projects that, while not mentioned as suggestions in the efficiency survey, will hopefully help with clinic efficiency as well.

Laptop connectivity
The goal is to no longer require laptop sites to dock daily. Data will be transferred using wireless technology, eliminating the need for laptops to dock. So travel clinics will no longer be required to go to a VSAT site to transmit information. Once the details have been determined, laptops across the state will be equipped with wireless devices.

Zip code locator
The Texas WIC Program has created a zip code locator on the WIC Web site. When a person types in their zip code the website will provide the closest clinic, the address, directions on how to get there and a picture of the clinic itself. Hopefully, this will cut down on the number of calls clinics get with people asking for directions.

Clinic staff work extremely hard and hopefully together, we can find ways to improve the experience for both staff and participants.

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WIN Evolution Allows for Improved Communications

by Anita Ramos, R.D.
Training Specialist

Congratulations on the successful implementation of the new food package! With the new food package underway, it’s time to begin discussing the next big project for the Texas WIC Program. If you thought EBT and the new food package rules were exciting, let me introduce you to “WIN evolution” (WINe).

WINe is a complete replacement of the current Texas WIN computer system. The current Texas WIN is written in Fox Pro for DOS. WIN evolution will be Windows driven, in addition to being a web-based system accessed through the Internet. All data will reside on a server at the state WIC office. All clinics, including laptops, will connect directly to the database. State information will be sent to every WIC computer in the clinics. The system will offer endless possibilities for the Texas WIC program, including:

  • Automatically calculating household income.
  • Determining income eligibility.
  • Easily handling the appointment schedules for one clinic or many clinics while capturing date of first visit.
  • Calculating body mass index (BMI) and plotting growth.
  • Assigning risk codes for program eligibility.
  • Keeping a history of appointments and certification data.
  • Saving partial certification data without entering all certification information.
  • Enhancing state agency reporting to create custom reports as needed.
  • Automating financial reports.
  • Gathering statistical data on demand.

The web-based computer system is targeted to be implemented statewide during 2013. Texas State agency staff has observed system demonstrations from three vendors. Currently none of the three systems observed serve more than 300,000 participants. Modification will have to be done to accommodate the size of the Texas WIC caseload. Much work has been done up to this point, including several meetings which were held at the state office with local agency directors and vendors.
The documentation requirements for the computer system are currently being written and reviewed. Recently a contractor was hired to assist the state office in selecting the best web-based computer system for the Texas WIC program.

Although final implementation decisions have yet to be made, the implementation process may duplicate the implementation of EBT. This means piloting the system and rolling out one section of the state at a time, instead of a complete statewide rollout all at once like we did with the new food rules.

We look forward to another exciting project that will improve the efficiency of staff and provide excellent customer service to our 1,000,000 plus participants.

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Transitioning From Classroom to Living Room Is a Good Fit for Client-Centered Education

by Kay Jarrett
BVCAA WIC Director, Project 32

The transformation of our classroom is a work in progress. It began September 2007 with money from the Obesity Prevention Mini-Grant. The original idea was to purchase a portable kitchen so we could offer cooking classes to WIC participants through our Healthy Living Classes. It turned out that the kitchen is only portable if you have enough electrical circuits to handle the load, as well as a strong back. Although not as easy to transport as we expected, the kitchen is a wonderful addition to our classroom. Once the decision was made to set the kitchen up as a permanent part of the classroom, ideas started flowing as to how to make the room both more inviting and more functional. Space was an issue. An under-utilized built-in document holder was removed and the space turned into a grocery store. Without taking up extra space, this allows the clients a hands-on approach to reading labels and making informed decisions about the fat and sugar content of foods. The participants get to actually read labels and compare ingredients. Posters are attached to the walls with Velcro allowing us to easily change the posters during the class depending on the questions asked by the participants.

A small segment of the room containing a play kitchen serves as a play area for the children. It is easily seen by everyone in the room. Student volunteers from Texas A&M and staff provide educational activities for the children while moms attend the healthy living class.

Last summer, the process of beautifying the classroom began. Drapes, lamps and an area rug were added to make the room more inviting. It still looked like a classroom. Next we purchased a couch, chair and loveseat to take the place of tables and chairs. Clipboards are used to make writing easier. The next purchases were end tables and a credenza for the TV. This added to the home-like atmosphere. With the furniture change, the class atmosphere has improved. It is now more like visiting a neighbor for a friendly visit. This is a good fit for the move to client-centered education. Future planned additions include a couple of bean bag chairs for the children and possibly some art for the walls.

This year’s classes are in a series of three, with each series spanning three consecutive months. Concerns the staff had about whether or not moms would commit for three months have proved to be unfounded. Last year’s classes had an attendance rate in excess of 90 percent. Each individual class contains a segment on exercise, on shopping and label reading, as well as a cooking demo. The cooking demos are as hands on as possible. The focus of the cooking segment is on quick, easy recipes that use common ingredients. Our summer classes emphasized using foods from the new food packages.

The changes have been met with enthusiasm by the staff and the participants alike. Staff report that clients are more relaxed and participate more in group discussions, frequently commenting on the comfort of the classroom. The breastfeeding moms in particular seem very comfortable and relaxed. The room, which promotes family and conversation, is warm and welcoming. As a result, staff is able to transition from the role of lecturer or teacher to facilitator. Because this change has been so beneficial, the clinics in our outer counties are planning similar transformations. 

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WIC Wellness Works

WIC Wellness DOES Work!

It’s hard to believe that WIC Wellness Works (WWW) is only seven years old. In 2003 the Texas Department of State Health Services (DSHS) contracted with The University of Texas at Austin to develop, implement, and evaluate a worksite wellness program for WIC employees in Texas. The WIC Wellness Works program began with just a few selected sites and has grown in leaps and bounds ever since. The numbers speak for themselves:


WIC Wellness Works!
WWW Then (2003)
WWW Now (2009)
413 participants
2200 participants
5 local agencies
52 local agencies
28 clinics
324 clinics

A 2003 needs assessment highlighted healthy eating, physical activity, and stress management as the key wellness topics of interest to Texas WIC employees. Social support, program flexibility, and incentive items were determined to be critical for success. A contest among WIC staff to rename the program resulted in the new name: WIC Wellness Works in 2005.

Statewide participation in the WWW program has increased 500 percent since 2003, along with the services and products featured in the program. The WWW program has offered physical activity challenges over the years, such as Highway to Health, Walk Circles around Your Scale, and Take a Hike on the Texas Trails, and one challenge on managing stress and improving resilience titled Keys to Kindness. Weekly wellness tips are sent out electronically. Coordinator training is conducted over IDL. Additionally, all WIC clinics received two full length DVDs featuring short wellness breaks on topics like fast food choices, stretching, stress eating, quick and healthy meals for use during staff meetings.

Most recently, all WIC staff had an opportunity to participate in Smart Choices, Healthy Staff!, the employee program featuring the new WIC food package. This statewide distribution allowed employees to take part in fun activities such as Raid Your Pantry, Whole Grain Exchange, Basket Full of Goodies, Build a Salad, Licuados Drinks and more. Through this initiative, employees shared their experiences of changing their eating habits and became great role models for the WIC participants they serve.

We know that WIC staff faces many challenges every day. Increased participant numbers, the rollout of EBT, and the introduction of the new food package are only a few of the many challenges staff have faced. It is not easy to juggle daily tasks, participants, family commitments, personal motivation, staff and time shortages, as well as minor or major clinic changes. Our hope is that the WWW program reaches out to as many employees and clinics as possible, while providing each individual with healthy ideas to approach positive lifestyle changes.

Statewide, clinics are making this program their own and taking it to new heights. The WWW participants are the true backbone behind this unique program. We truly appreciate the feedback, personal stories, and ideas that have been shared with us during this remarkable journey. The 2200 WWW participants are living proof that clinic by clinic- WIC Wellness really does Work. Our UT-Austin wellness team would like to thank all of the WWW participants for giving wellness a whirl and changing their own lives and ours in the process.

It’s on to 2010 and another fun-filled, informative year of wellness for WIC staff. Be on the lookout for another innovative year filled with the latest and greatest ways to improve your health brought to you by WIC Wellness Works.

Through the years, we have been inspired by the many role model stories about how this program has changed people’s lives. During the first year, more than one third of participants told us that the program not only affected their own lives, but also positively impacted their friends’ and families’ lives too. The success of the wellness program is told best through the many inspiring stories shared from the field. We love to hear from you — please keep those stories coming.

Take a peek at what participants have said about the program over the years.

“The WIC Wellness Works program makes work not the only common thread that we have because we are working together to meet our healthy living goals.”

“I had a lot of stress – everything from moving, to losing a family member, to getting into a car accident – but the [WWW Highway to Health walking challenge] program kept me moving and gave my mind something positive to focus on.”

“Seeing your co-workers exercise and actually enjoy it motivates other staff to join in. There’s increased awareness amongst staff about fitness and health and more conversation about who is losing weight and how they are eating better and exercising more!”

“Everyone’s lost a few inches. Two have had pretty dramatic results. They’re feeling a lot better, shopping for new clothes, and it’s motivating them to continue. We do the walking video, people have been bringing their own lunch instead of eating out, and we cut our lunch a little bit short so that we have time to exercise. It’s definitely helped with our stress too! We’re all feeling better!”

“Once a month, we get together to come up with different ways of cooking vegetables. And one month we did a smoothie happy hour every week. We get these ideas from the WIC Wellness Works packets. They are full of good information!”

“Our agency is loving this (Go with the Grain)! We had our quarterly staff training that included a display table with grain products that Admin Staff were consuming. Then, we demonstrated what foods were the ‘good’  grains vs. the “bad” grain choices. Door prizes consisted of whole grain products they could use (whole grain pasta, tortillas, pita bread, etc) .They are so excited and the clinics are doing creative activities at their sites.”

“Even though not everyone made it around the [Take a Hike] trail, significant progress was made by all staff. It was nice to see staff walk together during lunch and encourage one another. One staff member shared that her neighbors saw her walking and got motivated to start walking themselves.”

“What I like most about being in the wellness program is trying new foods together, taking turns making smoothies and exercising during our lunch hour. Best of all I got a certificate of achievement for best role model for healthy eating.”

“I think that this challenge (Keys to Kindness) has helped everyone in my clinic including myself become aware of the things that we say on a daily basis and how some of these things can affect our clients, co-workers etc. I feel that we are all thinking about the things we say before we say them and also thinking about new ways in complimenting each other and everyone else. This has taught all of us some good things. Thank You So Very Much!”

“My blood sugar went up over 200. I made excuses and figured it was just something I ate. But after the wellness program started, I realized that I needed to do something. I needed to start walking again. My blood sugar was up 40 points more than usual. Once I started walking again, it fell back within the normal range, and it has stayed there.”

“We use each other as motivation." “When you see your coworkers moving ahead on the [Highway to Health] map you think, ‘Hey, if they can do it with seven kids at home, I can do it too!’”

“I like that the WIC program cares about its employees.”

“It is truly amazing to have witnessed the evolution of WIC Wellness Works from a select pilot group in a few clinics to a complete program encompassing all of Texas. The information and helpful tips set the stage for success in achieving individual wellness goals.”

“Receiving support from clinic coordinators and the buddy system, they made the healthy choices of walking during lunchtime at the park, replacing the donuts and soft drinks with fresh fruit and water, and increasing their daily consumption of vegetables and water. Their example has motivated family and friends and they acquired the reputation as the ‘nice WIC ladies.’ Our WIC staff has taken this program and made it their own.”

“What I like most about being in the wellness program is trying new foods together, taking turns making smoothies and exercising during our lunch hour.”

“The key to a successful wellness program is to be accountable to each other and to motivate each other.It is also important to keep wellness alive by talking about it, making it part of your staff meetings, and part of your daily routine.”

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IDL “Lunch with Linda” Celebrates Accomplishments

By Linda Brumble, M.A., B.S.
Unit Manager, NECS

Texas WIC grew from serving 200,000 participants in 1990 to over 1,000,000 in 2009. Statewide participation for the month of May in 2009 was 1,000,652.

To celebrate our reaching and exceeding 1,000,000 clients, the June IDL “Lunch with Linda” session was dedicated to recognizing and cheering on local agency staff for their accomplishment. Using data from May 2008 to May 2009, acknowledgment was given to the local agencies with the most overall growth in four different categories based on agency size, as seen in the chart below.

The local agency with the largest increase in the number of participants was Local Agency #77, UTMB with an increase of 11,339. They were followed by Local Agency #07, City of Dallas with 10,994 and Local Agency #01, City of Austin with 6,616.

The clinic site with the largest amount of growth was Tarrant County’s SE Green Oaks clinic site #054-39 in Fort Worth with an increase of 1,393 clients in the past year. The SE Dallas site 07-05 had the second largest increase with 1,215 participants. The UT Health Science Center North Channel Clinic site #17-15 was third with an increase of 1,212.

The breakdown of client growth based on agency size is as follows:


The breakdown of client growth based on agency size
0-2,000 Participants LA #67 Corsicana-Navarro County 176
LA #64 Medina County 164
LA #106 St. Josephs Hospital (Caldwell) 153
2,001-5,000 Participants LA #89 Santa Rosa (San Antonio) 847
LA #102 ETMC (Quitman) 537
LA #40 Beaumont 453
5,001-10,000 Participants LA #22 City of Waco 1,505
LA #73 Centro Med (San Antonio) 1,279
LA #32 Brazos Valley (Bryan) 1,217
10,001-25,000 Participants LA #77 UTMB (Galveston) 11,339
LA #17 UT Health Science (Houston) 4,201
LA #35 Denton County (Denton) 1,946
25,001-above Participants LA #07 City of Dallas 10,994
LA #01 City of Austin 6,616
LA #03 Cameron County (Harlingen) 6,349

Statewide almost every agency experienced growth. Many staff have been serving WIC clients for 20, 25 and 30 plus years. All clinic employees are truly to be congratulated for their part in reaching and helping an even bigger part of Texas’ most vulnerable population receive WIC benefits. 

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news 2 use

by Cristina Garcia, R.D., L.D.
Nutrition Education Consultant

Assessing VENA (Value Enhanced Nutrition Assessment):

To assist local agencies in assessing their staff’s ability to provide VENA, an IDL class, Assessing VENA, has been created to highlight existing counseling tools, introduce staff to a self-audit counseling checklist, and provide guidance for both counselors and trainers. These tools will help ensure your agency is VENA ready.   

Assessing VENA will be provided once a month, towards the end of the month. The main focus is highlighting tools and resources to assess counselors’ implementation of VENA.  It is intended to help counselors identify strengths and areas of improvement in order to provide participant-centered counseling and continuity of care. This training will also be beneficial for staff that perform local agency quality assurance self audits. 

During the IDL training the following tools will be reviewed:

  • VENA Counseling Framework Desk Reference: a desk reference highlighting a five-step framework to provide guidance for structuring VENA counseling sessions.
  • VENA Family Documentation Tool Desk Reference: a desk reference on how to properly complete the VENA Family Documentation Tool.
  • VENA Self-audit Counseling Checklist: a training or self-audit tool to identify counselor’s strengths and areas for improvement.
  • VENA Tips for Counselors and Trainers: a two-sided handout to assist trainers and counselors on how to utilize VENA trainings and tools.

These tools can be used individually or together to support your local agency training and assessment of VENA.

For more information, check the IDL website for these tools and the monthly schedule to join the training.

High Risk Counselors:

In a survey conducted in 2008, Texas WIC high risk dietitians communicated their need for more peer networking throughout the state. As a result, the state office is holding bi-annual conference calls for high risk counselors and WIC directors to network and share best practices and ideas. In an effort to open the lines of communication even further, a Texas WIC Dietitians Yahoo group was formed to enable high risk counselors and WIC directors to openly “chat” about best practices. For more information about joining the Yahoo group, check under the High Risk section of the Texas WIC webpage at www.dshs.state.tx.us/wichd/ or contact Lauren Christian, nutrition education consultant, at 1-512-341-4590 or e-mail Lauren Christian.

Texas Ten Step Program:

The Texas Ten Step Program was developed by the Texas Hospital Association and the Texas Department of State Health Services (DSHS) in an effort to recognize facilities that are providing optimal care to improve breastfeeding outcomes.
In August 2009, hospitals in the state of Texas that provided excellent care for breastfeeding mothers were announced. These hospitals are considered Texas Ten Step hospitals for the 2010 year based on their performance in 2009.

This program has been endorsed by the Texas Medical Association to encourage more birth facilities to improve maternity care practices surrounding breastfeeding. Please join the Department of State Health Services, the Texas Hospital Association and the Texas Medical Association in recognizing these facilities. Find the recognized facilities at www.dshs.state.tx.us/wichd/lactate/txfact_facilities.shtm.

Encourage hospitals in your area that have not received the designation to become a Texas Ten Step facility. Your clinic has applications and information about the program available to them through DSHS materials. Encourage your clients to choose a hospital that will support them in their decision to breastfeed.

If you would like more information about the program or have any questions, please contact Kristina Arrieta, Nutrition Education/Clinic Services Unit, at 1-512-341-4592 or e-mail Kristina Arrieta.

Qwest Hot Topics:

In August 2009, the first of a quarterly series of Qwest Hot Topics sessions for continuing education credits (CEUs) was facilitated by the state. The purpose of the series is to keep WIC nutrition professionals informed about up-to-date nutrition topics in the news.  The presentations address relevant topics that are popping up in current nutrition publications and also provide opportunities for RDs to earn CEUs.  Topics previously covered include infant feeding, food allergies, and the connection between sleep and obesity. Subsequent Qwest Hot Topics sessions are scheduled for November, February and May and so on. Please check the IDL/Qwest schedule in these months for specific dates and times.

Motivational Interviewing IDL:

Motivational Interviewing IDL training is designed for counselors who are familiar with the VENA counseling style and want to improve their counseling skills and learn practical techniques to facilitate change within their clients. In addition to reviewing tried and tested Motivational Interviewing (MI) techniques, a live example will help the audience see the techniques in action. Please check the IDL schedule for upcoming classes.

New Nutrition Education Lessons:

Six new lessons have been created incorporating a new lesson format and client-centered learning principles. These lessons combine discussions with hands-on activities and games to actively engage participants in their learning. 

Lesson topics include:  introducing vegetables, role modeling, physical activity, media, feeding your family on a budget, and anemia.

These new lessons allow for each activity or discussion to flow in a unique way that is fun for both the participants and the facilitators.

The lessons are available to local agencies that have been trained in client centered nutrition education, either through involvement in the CCNE pilot program or subsequent trainings/workshops.  If your agency is interested in incorporating any of these lessons or creating new lessons using the lesson template, please contact your nutrition education liaison.

For more information see the article, WIC Embraces a Client-Centered Approach to Nutrition Education, also printed in this issue of the Texas WIC News on page 4. 

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2009 Texas WIC Dietetic Interns Share Their Experiences and Goals

by Mary Van Eck, M.S., R.D., L.D.
Texas WIC Dietetic Internship Director

Lindsay Berryman
A 2005 graduate of Texas A&M University, Lindsay Berryman is originally from Breckenridge, Texas, but has lived in the Dallas area since 2007. She enjoys going to church, reading, being silly with family and friends, and spending time outdoors. She and her husband of a little over a year enjoy the company of their very spoiled dog named Ellie.

Berryman loves working with children. With pediatric nutrition as her passion, WIC has been a great home for her. She feels the internship has been challenging at times, but worth every minute.

“I have worked with wonderful preceptors and have gotten to see a wide variety of the opportunities that are out there for a Registered Dietitian,” said Berryman. “After the internship I plan to continue working at WIC.”

Aditi Patel
Having worked for Dallas WIC Site 24 as a nutritionist for two years, Aditi Patel wanted to further her training and expertise by completing the Texas WIC Dietetic Internship. She says her experience during the internship was outstanding. She feels the superb teaching in addition to the variety of on-site rotational programs provided a broad and rewarding experience.

“The support by the internship coordinators was particularly outstanding,” said Aditi. She is thankful to her family for being so supportive during this busy year. She hopes to complete the RD exam this fall and use her new fund of knowledge to advance client care within the WIC clinics.

Christy Waldrop
Christy Waldrop enjoyed her internship experience. “The time flew by so quickly,” said Waldrop. “I didn’t have a favorite rotation because each rotation was wonderful for different reasons. I loved all of the dietitians and preceptors that I worked with and learned so much from them.”

She plans to keep in touch with all of them.  She looks forward to returning to the WIC clinic and being able to provide high risk counseling. After observing first-hand some of the various experiences that the WIC clients go through on a daily basis, Waldrop has a new understanding of their lives. She looks forward to a future in community nutrition and teaching WIC clients how to live a healthy lifestyle.

Tejal Patel Pathak
Nutrition has been Tejal Patel Pathak’s passion. She feels the WIC Internship has been a great tool for enhancing and growing her career.

“I believe that the Texas WIC dietetic internship is one of the top internship programs available,” said Pathak. “It definitely helps to strengthen and recognize one’s own skills. It challenges you through out the training and teaches you to manage your own time, build relationships, and networking.”

After completing the internship, her first goal will be to obtain the RD license. She plans to utilize the internship training to provide high-risk counseling to special needs children and families. She is thankful for the encouragement and support of her husband.

Kelley Roop
The DSHS Dietetic Internship has enabled Kelley Roop to grow both personally and professionally more than she ever dreamed possible.

“Completion of such an internship has reminded me that I can do anything I put my mind to, that my dreams come true if I just reach for them,” said Roop. “Throughout the internship, my time management, organization, communication, and networking skills have greatly improved.”

Roop feels blessed to have had the opportunity to make so many connections with dietitians within the community that serve as teachers for dietitians in training. She hopes to someday follow in their footsteps and is looking forward to returning to the WIC community with the necessary skills to counsel high risk participants.

Amy Schenck
Amy Schenck became interested in nutrition as a child when her mother signed her up for a nutrition and exercise program. She was interested in the link between food and health. She renewed this interest her junior year in college when she was deciding on a career field that she would really enjoy.

Within a month after graduating from college Schenck began working as a nutritionist with WIC.

“I felt compelled to apply for the internship as a way to better serve the WIC clientele and further my career with WIC,” said Schenck. “I have enjoyed every aspect of the experience and look forward to returning to Dallas WIC as a dietitian providing high risk counseling services.”

Ashley Simpson
Ashley Simpson has enjoyed her experiences while in the WIC Dietetic Internship.

“I have been able to learn a lot of new information and challenge myself in many new ways.” said Simpson. “I have been able to push myself and grow as a person through the internship. I am glad to be back in the clinics and serving the Tarrant County participants.”

Jesus Rivera
After several years in the United States Air Force, Jesus Rivera moved to El Paso, Texas, and received a bachelor’s degree in human nutrition at New Mexico State University. In 2005, he was hired as a nutritionist for the El Paso WIC Program and was accepted into the WIC Dietetic Internship Program in 2009.

Rivera feels the internship program has been a great learning experience because it brings exposure to various areas of the nutrition field. He also feels, the internship is quite challenging and has taught him good organization skills.

“After completion of the internship, I will continue to provide services to WIC clients and perhaps someday, I would like to work in either clinical nutrition or foodservice,” said Rivera.

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Top 10 Ways WIC Makes Texas a Better Place to Live

by Renee Mims
Contributing Editor

Texas WIC director Mike Montgomery recently presented WIC’s accomplishments to fellow directors at a summer retreat sponsored by Family and Community Health. We decided to reprint so you could join in our celebration of the following accomplishments:

Number 10: By producing award winning videos.

Our videos “WIC: EBT in the Fast Lane” and “Pumping Breast Milk for your Premature Infant,” both won awards of Excellence from the International Communicator Awards.

“Collecting Blood Samples: Do It Right the First Time,” won a Bronze from the Telly Awards and a Merit from the National Health Information Awards.

“Fetal Alcohol Spectrum Disorders: The Effects are Irreversible, “ also won a Bronze from the National Health Information Awards.

Number 9: By creating outstanding in-house print materials.

The northeast region of USDA has adopted a number of our outstanding print materials to use throughout New York, Massachusetts, Maine, Connecticut, Vermont, Rhode Island, and New Hampshire. (Brochures were: The Hospital Experience and the WIC Food Packages for Moms & Infants brochure)

Number 8: By developing web-based lessons for clients and staff.

Our TexasWIC.org website provides:
(1) web-based WIC classes
(2) Breastfeeding information
(3) Nutrition information and recipes
(4) WIC EBT information
(5) Health-care provider’s information

Number 7: By helping employers become Mother Friendly Worksites to support breastfeeding at work.

This workplace initiative helps encourage moms to continue breastfeeding after returning to work by providing a place to pump and store breastmilk. Texas WIC in collaboration with the U.S. Department of Health and Human Services Health Resources and Services Administration has established guidelines for Mother-Friendly Worksites to create best practices for breastfeeding supportive employers.

Number 6: By training hospital staff and other caregivers to support and increase breastfeeding rates.

Hospitals and caregivers receive the Texas Ten Step certification for training staff to support and encourage breastfeeding. Our program supports the health of our newest Texans!

Number 5: By conducting an infant feeding practices survey.

Our survey provides statistics to help target breastfeeding promotion and support activities in local agencies, communities, and hospitals. The most comprehensive survey of its kind in the United States reveals common reasons for not initiating or discontinuing breastfeeding. The results will help guide WIC to produce promotional material to encourage moms to try breastfeeding and to breastfeed longer.

Number 4: By Collaborating with Texas A&M in developing a new food package pre and post survey.

We are conducting a pre and post implementation survey of participants and WIC staff on the New WIC Food Packages through a contract with Texas A&M University.  Through the survey, we’ll be able to learn what effect the new WIC food packages have on food preferences and eating behaviors. Over 35 other states and territories are participating in the national version of the survey. 

We are doing a survey for WIC staff related to the foods in the New WIC Food Packages to see how staff food preferences and eating behaviors compare with participants and if staff behaviors change based on the new WIC food packages.

Number 3: By introducing healthier food packages to include fresh fruits and vegetables, whole grains and lower fat milk.

In October, we’ll offer the WIC food packages which include fresh and frozen fruits and vegetables, as well as whole grains in whole-wheat bread, brown rice, oatmeal, whole-wheat tortillas, and soft corn tortillas. Soy milk and tofu may be substituted for milk, and whole milk will no longer be available except for children younger than 2.

Changes to the infant food package include eliminating juice during the first year and adding baby-food fruits and vegetables.

The revisions align the WIC food packages with the 2005 Dietary Guidelines for Americans and the infant feeding practice guidelines of the American Academy of Pediatrics. The interim final rule revisions largely reflect recommendations made by the Institute of Medicine of the National Academies.

Number 2: By successfully replacing paper vouchers with the Electronic Benefits Transfer Card.

Statewide transfer to the EBT system
Our new system is a faster, more efficient way for WIC participants to get their WIC foods at participating grocery stores. Previously, WIC participants would bring hand-signed paper vouchers to a store to exchange for WIC-approved foods. Now, with the new EBT system, the participant simply uses a plastic WIC-only “Lone Star” card. For shopper and cashier alike, it’s as easy to use as a credit card.

And the number one way WIC Makes Texas a Better Place to Live is by successfully serving 1,021,733 Texans!

In June, WIC in Texas served 1,021,733 women, infants and children. To commemorate the milestone, simultaneous celebrations were held at the state office in Austin and at WIC contractors’ clinics throughout Texas. The event was shared via an interactive videoconferencing system used regularly for trainings and communications. Read the article titled IDL “Lunch with Linda” Celebrates Accomplishments on page 11.

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test your nutrition IQ

by Eaton Wright, B.S., NUT
Nutrition Expert

Hello everybody!

Eaton Wright here to talk about the new additions to WIC. And, there’s no better time to talk about new additions than now since Eaton and the ever lovely Ms. Always B. have welcomed their first addition. So…let’s take a quiz.


1. True or False. CCNE stands for Clown College of New England.

2. The new food package contains

a. Fresh blueberries
b. Whole wheat tortillas
c. 1% milk
d. Frozen broccoli
e. Stage 2 baby carrots
f. All of the above

3. Which of the following is not a new nutrition education lesson?

a. Sesame Street’s The Get Healthy Now Show
b. MyBasic4 Quadrilateral
c. Moove to Low Fat Milk
d. Zobey’s Jungle Jive

4. True or False. WCS stands for WIC Choral Society.


1. The answer is false. CCNE stands for client-centered nutrition education. CCNE is a style of nutrition education that engages clients as active participants in the learning process and offers them more choices and more opportunities for active learning. It can involve methods such as group discussion, cooking demonstrations, hands-on activities, and take-home options. Overall, CCNE allows WIC educators more freedom to explore issues that are relevant to clients. CCNE can be as simple as modifying an existing lesson to encourage client interaction or as complex as designing a series of lessons from scratch. The state WIC office is eager to provide CCNE training to local agencies in order to maximize their resources and skills to develop and deliver CCNE.

The Clown College of New England is where Eaton received his nutrition degree. No wonder he’s always talking about the MyBasic4 Quadrilateral – cotton candy, popcorn, peanuts and hot dogs.

2. The answer is f – all of the above. In addition to wonderful blueberries, the new food package may contain all kinds of fresh and frozen fruits and vegetables; whole grains like whole wheat tortillas and whole wheat bread; lower fat milk and baby foods. The WIC food package is changing in wonderful ways. Blueberries, tomatoes, fat-free milk, whole wheat tortillas… it’s all on the table.

3. The correct answer is b. By now the Big Tomato and Carlos and Clarice have arrived in the clinics. And it won’t be long before Zobey’s new friends from The Jungle swing by, but one lesson local agencies shouldn’t expect too soon is the MyBasic 4 Quadrilateral.

4. Nope. WCS stands for WIC Certification Specialist. The WCS Program was developed by the state to allow local agencies a way for training paraprofessionals to function as certifying authorities. Texas’ rural areas often have difficulties staffing dietitians and nutritionists. WCSs allow an agency to free up their dietitians and nutritionists to focus more on the higher risk participants. Currently, the state is collaborating with The University of Texas to develop a uniform WCS training program that will be utilized to certify interested staff as a WCS.

The WIC Choral Society is a singing group consisting of Shellie Shores, Tonia Swartz, Carlos Galvan, Amanda Hovis, Shirley Ellis, Mary VanEck, and Ponna Sambasivan. You might have heard some of their songs like, Sing So Low That I Can’t Hear You or Sing by the Window and I’ll Help You Out.

About the author: Eaton Wright is a certified NUT based in Austin, Texas.

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Last updated May 26, 2017