1. Value Enhanced Nutrition Assessment (VENA) Counseling Sessions: Providing Client-Centered Nutrition Services

2. This module, Value Enhanced Nutrition Assessment Counseling Sessions, is part of the WIC SPIRIT Readiness training series. The series is designed to be an overview of major changes in the Arkansas WIC Program and to prepare WIC staff for further training in regards to SPIRIT, the new Management Information System.

3. The series includes VENA, the Value Enhanced Nutrition Assessment initiative; the WIC food packages; and nutrition risk factors.

4. VENA Counseling Sessions Objectives By the end of this module the learner will be able to: 1. State the guiding principles of VENA. 2. List the seven elements of a VENA counseling session.

5. Objectives (continued) 3.Describe activities that are involved in each element of a VENA counseling session. 4.Demonstrate application of the elements of a VENA counseling session.

6. Guiding Principles of VENA 1. VENA is a joint exploration of health goals by WIC staff and client. 2. VENA allows the WIC family to express their concerns.

7. Guiding Principles of VENA 3. VENA supports and promotes a personalized care plan. 4. VENA provides a positive approach based on desired health outcomes.

8. Elements of a VENA Counseling Session: Welcome and introduction Establish rapport with client Gather and assess information Identify and explore client’s needs & concerns

9. Elements of a VENA Counseling Session: (continued) Provide information Discuss and set behavior change goal(s) Close session

10. Welcome Introduction Welcome and Introduction Greet the client -Smile -Greet client by name -Introduce yourself & your role -Explain purpose of visit -Acknowledge wait time if appropriate -State the (approximate) appointment length -Ask a general open-ended question(s) -Examples: “How’s your pregnancy going?” What questions or concerns do you have today?

11. Establish Rapport Ensure privacy -Keep voice low -Close door -Move to private location Demonstrate caring -Be patient -Use nonjudgmental language -Display respect & understanding for other cultures -Offer help -Show concern for the client’s feelings

12. Establish Rapport (continued) Promote positive communication -Handle distractions politely -Use appropriate non-verbal communication -Examples: spatial proximity; body posture -Use body language that encourages client to talk -Examples: nodding ; pleasant facial expressions

13. Establish Rapport (continued) Promote positive communication (continued) - Maintain eye contact -Focus on the client when using translators -Use active listening skills -Examples:(demonstrates support/indicates sympathy): “I see”, “uh, huh”, “sure”, “tell me more”, “I understand”

14. Gather and Assess Information Seek relevant information without dwelling on irrelevant issues (using VENA questions in SPIRIT) -Review client’s past history -Collect missing information

15. Gather and Assess Information Use probing questions to clarify response -Ask for clarification: In what ways? How much? When? -Ask for a specific example -Ask : What else?

16. Gather and Assess Information Share findings with client in a nonjudgmental manner Extend gratitude for honesty and willingness to answer questions

17. Identify and Explore Client’s Needs/Concerns Involve client in determining the main health concern Use open-ended questions to explore client’s -current concerns -current questions -current knowledge -stages of change Use active listening skills

18. Identify and Explore Client’s Needs/Concerns Help client to explore feelings and attitudes about main health concern Validate client concerns - Example: “I appreciate your willingness to talk about this difficult issue.

19. Identify and Explore Client’s Needs/Concerns Identify and acknowledge client’s positive behaviors (strengths) Maintain focus on desired health outcome Assess client’s readiness to change

20. Provide Information Ask permission Limit number of nutrition messages given during one session - Tailor nutrition message -Keep message simple and concise

21. Provide Information Speak directly to client in friendly manner Speak according to client’s education, culture, interest, language, learning ability and stage of change

22. Provide Information Provide nonjudgmental responses Cover topic’s main points Use visual aids that fit client’s education, culture and interest

23. Provide Information Correct misinformation gracefully Assess client’s understanding of nutrition message Encourage questions

24. Discuss and Set Behavior Change Goals Summarize the conversation Ask client what issue he/she is willing to work on

25. Discuss and Set Behavior Change Goals Assist client in setting goal(s) that is specific and realistic for family lifestyle - Remember: client is the best judge of what will work Document goal(s) in SPIRIT with client’s stage of change. Click here to access the Change Process module to refresh your knowledge and skills. Important Note: To return to the PowerPoint module, click on the back arrow at the upper left hand side of the screen.here

26. Close Session Close on a positive note Summarize what was discussed Restate goal(s) and check for understanding - Review any agreements, plans, referrals

27. Close Session Offer client chance to ask any final questions Express appreciation for client’s time Exhibit enthusiasm for follow-up.

28. Throughout the Session E ncouragement -Identify and praise the client on his/her personal strengths -Provide a positive outlook and encouragement Collaboration -View client as the expert on his or her problems

29. Throughout the Session Critical Thinking -Use your professional judgment -Use relevant information Active Listening -Validate -Allow for silence -Don’t interrupt

30. View video “Making a Difference with Nutrition Education” found in your Local Health Unit Click here to access and print the Video Outline. Important Note: To return to the PowerPoint module, click on the back arrow at the upper left hand side of the screen.here Use the Video Outline document to follow along while viewing the video.

31. Making a Difference With Nutrition Education Video Summary  Setting the Stage - Client must be relaxed enough to hear what you are saying, think about it, and be able to respond.  Listening - It’s important to really listen to people.

32. Making a Difference With Nutrition Education Video Summary  Address Nutrition Concerns - People are much more interested in nutrition if it relates directly to them or their family.  Using Pamphlets - Information alone is dull, boring, and lifeless. Help the client use the information in a personal way.

33. Making a Difference With Nutrition Education Video Summary  Setting Nutrition Goals - Setting goals helps people think through what they can do at home.  Follow Up at the Next Appointment - Follow up gives us the chance to reinforce what we talked about but also lets the client know we are interested in them and what they have been doing.

34. VENA Counseling Sessions Recap The VENA Counseling session should include the following: 1. Welcome and introduction 2. Establish rapport with client 3. Gather and assess information 4. Identify and explore client’s needs and concerns 5. Provide information 6. Discuss and set behavior change goal(s) 7. Close session

35. VENA Counseling Sessions WIC works because WIC helps people make the important connection between health and nutrition. Our VENA counseling session is a way we can make this connection. Through our counseling sessions, we have the chance to help people learn what good nutrition really is and how to fit good nutrition into their everyday life.

36. VENA Counseling Sessions Thank you for your efforts to improve your education and counseling skills! You deserve to feel good about your efforts at the end of every clinic day. You deserve to know you’ve made a real contribution – because you have! Your efforts continue to make the Arkansas WIC Program one of the most successful public health programs ever!