VENA
(Value Enhanced Nutrition Assessment)
The First Step in Quality Nutrition Services
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VENA
(Value Enhanced Nutrition Assessment) was
developed jointly by the Food and Nutrition Service (FNS)
and the National WIC Association (NWA) and is part of the
larger Revitalizing Quality Nutrition Service (RQNS) in WIC
initiative. The VENA guidance provides a process for completing
a comprehensive WIC nutrition assessment,
including the content of such an assessment and an outline
of the necessary staff competencies.
For more information, see the following:
Executive Summary [PDF]
VENA Guidance Document
Frequently Asked Questions - Updated
June 2007
VENA Competency Training Materials
VENA Implementation
Materials - Updated March 2009
VENA Information for
WIC Program Managers Brochure [PDF]
VENA Information
for WIC Nutrition Staff Brochure [PDF]
WIC Learning Online (VENA modules) |
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What
is VENA? |
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Why
VENA? |
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In general,
how will VENA impact the WIC Program? |
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How
will VENA affect the WIC nutrition assessment process in my
State? |
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How
will VENA relate to WIC nutrition risks? |
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Will
VENA impact only dietary risk? |
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How
do you document dietary risk without a 24-hour Dietary Recall
or Food Frequency Questionnaire? |
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How will
VENA impact the way WIC staff explain eligibility determination
with respect to nutrition risk? |
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Does FNS
expect every WIC State Agency to implement the health outcome-based
approach to WIC nutrition assessment? |
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How
will VENA impact the way in which WIC staff document nutrition
services provided by participants? |
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What
kind of training will be needed to implement VENA? |
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My State
agency has varied levels of WIC staff expertise in each of the
VENA competency areas. What is the expectation or how should
my agency approach local program staff training? |
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How
will VENA impact nutrition education? |
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Are WIC
staff expected to counsel participants on every identified nutrition
risk at certification? |
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How
will we know if this new way is better? |
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What
is the timeline for VENA? |
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What
is VENA? |
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VENA
(Value Enhanced Nutrition Assessment) was developed
jointly by the Food and Nutrition Service (FNS) and the National
WIC Association (NWA) and is part of the larger Revitalizing
Quality Nutrition Service (RQNS) in WIC initiative. The VENA
guidance provides a process for completing a comprehensive
WIC nutrition assessment, including the content of
such an assessment and an outline of the necessary staff competencies.
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The focus of VENA is assessment;
it does not prescribe specific nutrition education messages
or interventions. |
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| VENA is not
a packet of new forms to be completed; it does
provide guidance for each State agency on how to review, develop
and enhance its current assessment protocols. |
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| VENA is not a new data
collection list; it is a framework for collecting
comprehensive assessment information with a participant-centered,
positive approach to better provide the most relevant nutrition
services for each WIC participant. |
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| VENA is not a script
of questions that must be asked of every participant at every
visit; it is a method for initiating and sustaining
conversations that allow the participant a greater sense of
ownership and involvement in her/his WIC experience. |
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| VENA is not a cookie-cutter
model to be used in all clinics; it does provide
flexibility for each State agency to use the guidance to develop
quality nutrition assessment protocols that best suit its unique
operations.
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Why
VENA? |
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The Value Enhanced Nutrition
Assessment (VENA) initiative was developed to address the Institute
of Medicine (IOM) report: Dietary Risk Assessment in the
WIC Program. In its report, the IOM recommended that all
women and children ages 2 to 5 years should be presumed to be
at dietary risk based on failure to meet the Dietary Guidelines
for Americans. The goal of VENA is to expand the purpose
of nutrition assessment from eligibility determination to improved
nutrition education. VENA will improve and enhance the risk
assessment process by ensuring that a medical-nutritional assessment
continues to be completed and streamlining dietary assessment
to collect more relevant information to be used to individualize
nutrition services.
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In
general, how will VENA impact the WIC Program? |
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VENA represents a paradigm
shift in that VENA will change the way that WIC interacts with
applicants, participants and program staff. Participant risks
and needs change over time, as do the scientific knowledge and
best practices for methods to improve the health of women, infants
and children. VENA allows and encourages the adaptation and
enhancement of the program to address new emerging health-related
risks and the changing needs of participants. VENA will be an
ongoing process so that WIC continues to be effective in its
mission and maintains its status as a premiere public health
nutrition program.
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How
will VENA affect the WIC nutrition assessment process in my
State? |
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Each State agency will review
its current assessment protocols and determine what nutrition
assessment enhancements are necessary. A State agency may enhance
existing quality nutrition assessment protocols or choose to
take this as an opportunity to significantly redesign their
nutrition assessment and documentation processess. FNS recognizes
that no one approach will fit all agencies.
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How
will VENA relate to WIC nutrition risks? |
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VENA and WIC nutrition risks
provide a cohesive framework for a comprehensive assessment
addressing all WIC risks - anthropometric, biochemical, clinical
and dietary. WIC nutrition risk criteria provide a foundation
by establishing program eligibility for each participant. The
VENA guidance outlines a process for achieving a consistent
and comprehensive WIC nutrition assessment.
FNS Policy Memorandum 98-9, Revision 8; WIC Nutrition Risk Criteria
(issued in March 2005), provides State agencies with the information
they need to revise the dietary risk criteria. The VENA guidance
complements Policy Memorandum 98-9, Revision 8, and provides
information to assist State agencies with the implementation
of the revised dietary risk criteria.
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Will
VENA impact only dietary risk? |
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No, the VENA guidance covers
all aspects of assessment, including non-dietary risks. The
joint FNS/NWA VENA workgroup was brought together to develop
guidance specifically in response to the IOM report that addressed
dietary risk. However, the workgroup strongly believed that
all WIC nutrition risks - anthropometric, biochemical, clinical
and dietary are interrelated and focused on developing a comprehensive
framework addressing the "A, B, C and D" of nutritional
risk.
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How
do you document dietary risk without a 24-hour Dietary Recall
or Food Frequency Questionnaire? |
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An important finding of
the IOM report states that commonly used dietary assessment
methods (e.g., 24-hour Dietary Recall, Food Frequency Questionnaire
[FFQ]) are not appropriate for determining nutrient deficiencies
in individuals and for WIC eligibility purposes. Twenty-four
hour Dietary Recalls and FFQs will no longer be used to quantify
diet in order to determine WIC eligibility. Now, with VENA,
information gathered through 24-hour Dietary Recalls and FFQs,
if used, should only be used to assist WIC staff in initiating
a dialogue with participants about diet, food intake and feeding
behaviors.
The revised dietary risk criteria clearly identify inappropriate
nutrition practices that can be used to develop assessment protocols
for the documentation and determination of WIC dietary risk.
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How
will VENA impact the way WIC staff explain eligibility determination
with respect to nutrition risk? |
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It is important to inform
participants that the WIC Program has various eligibility criteria,
one of which is determined through the nutrition assessment
process. WIC staff should clearly explain that nutrition assessment
questions and measurements are used not only to determine eligibility
but just as importantly, to guide the nutrition services that
are provided.
In keeping with VENA and the nutrition education guidance,
a participant must be informed of the risk factor(s) that
have been identified, in a constructive and sensitive
manner. It is important to communicate with participants in
such a way that describes nutrition risks as potential barriers
to positive health outcomes – and not in a way that
makes them feel like they are being judged or are bad parents.
In those cases where many risk factors have been identified,
professional judgment may be used to focus the explanation
of nutrition risk on one or two factors that are most relevant
and/or important at the time of certification.
FNS is in the process of revising WIC Policy Memorandum 92-5:
WIC Program Explanation, to better conform to the VENA philosophy
of participant-centered communication.
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Does
FNS expect every WIC State Agency to implement the health outcome-based
approach to WIC nutrition assessment? |
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Ideally, the health outcome
based approach is what we would like to see implemented. However,
we realize that this may not be reasonable or realistic for
every WIC State agency operation. It is our expectation that
all State Agencies will implement a positive approach to WIC
nutrition assessment. One that builds on an overarching health
outcome (e.g., delivery of a healthy baby) – rather than
deficiency findings - and that focuses on ways that WIC can
assist the participant in reaching their desired health outcome.
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How
will VENA impact the way in which WIC staff document nutrition
services provided to participants? |
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As part of VENA implementation,
State Agencies may find it necessary to establish more specific
requirements for documenting nutrition risks assigned, nutrition
risks addressed, and plans for follow-up or exploring nutrition
risks assigned.
To enable the Competent Professional Authority (CPA) to provide
tailored nutrition education and for monitoring purposes State
Agencies should ensure their policies for documentation include:
1) what risks were assigned and what was discussed 2) how
likely/receptive the participant was to changing behavior(s),
and 3) plans for follow-up on risks discussed or risks that
should be explored with participants at the next appointment.
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What
kind of training will be needed to implement VENA? |
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The VENA guidance outlines
key staff competencies necessary to conduct a comprehensive
assessment, e.g., knowledge of nutrition, communication skills,
and critical thinking. State agencies will need to evaluate
staff training needs and build upon existing training systems.
The training materials provided at the 2006 FNS Regional VENA
Competency Trainings are meant to be adapted by State Agencies
for use with their local agency staff.
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My
State agency has varied levels of WIC staff expertise in each
of the VENA competency areas. What is the expectation or how
should my agency approach local program staff training? |
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Training, one of the 5 priority
areas described in the VENA Implementation Guidance, may be
approached differently by State agencies - depending on local
agency staffing resources (professional vs. paraprofessional),
division of staff responsibilities, etc. However, the focus
for all State agencies should be to provide training that develops
the essential knowledge base and skills necessary (as identified
in the VENA Guidance) for staff to conduct value enhanced WIC
nutrition assessments. Training, followed by periodic staff
evaluation and continued education activities, assures that
WIC personnel maintain and refine their skills.
Federal rules, i.e., the definition of Competent Professional
Authority and the Nutrition Service Standards related to staffing,
remain unchanged. Nonetheless, the VENA Implementation process
does provide State agencies the opportunity to review and
strengthen their policies pertaining to staff qualifications,
roles and responsibilities.
In addition to varied skills of local staff, there may also
be a varied level of enthusiasm and/or buy-in to the VENA
initiative in general. FNS will facilitate opportunities for
State Agencies to brainstorm this issue as well as share successful
training strategies and materials via WIC Works, FNS Regional
and VENA Implementation Group conference calls.
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How
will VENA impact nutrition education? |
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While the focus of VENA
is to strengthen risk assessment, one of the outcomes will be
the collection of more relevant information to be used for individualized
nutrition services. VENA was developed to align the purpose
and scope of a multi-faceted WIC nutrition assessment with targeted
and relevant nutrition education to guide and support families
in making healthier eating and lifestyle choices. It is meant
to be a bridge to enhance and expand nutrition education and
other nutrition services provided by WIC. VENA complements the
participant-centered strategies that many State agenices have
incorporated into their delivery of nutrition education and
counseling.
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Are
WIC staff expected to counsel participants on every identified
nutrition risk at certification? |
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No. It is expected that
a complete nutrition assessment be conducted at each certification,
and that all nutrition risks are reported/documented. It is
not expected that all nutrition risks (especially if there are
many) will be covered at the initial certification. Covering
all messages at once could result in information overload –
which is not an effective education strategy. In keeping with
VENA and the nutrition education guidance, WIC staff should
prioritize, in conjunction with the participant, the nutrition
related topics to be covered at certification. Other identified
nutrition risks and nutrition related participant concerns can
be covered at subsequent nutrition education encounters. (For
more information about nutrition education and its relationship
to nutrition assessment, please see the WIC
Nutrition Education Frequently Asked Questions).
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How
will we know if this new way is better? |
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It may be difficult to measure
how VENA improves WIC as some areas are intangible. However,
improvements should be seen in staff competencies and morale;
consistent and comprehensive risk identification; and participant
outcomes and satisfaction. In addition, FNS plans to encourage
the use of WIC Special Project Grants to examine and evaluate
the effects of VENA on WIC nutrition assessment and services.
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What
is the timeline for VENA? |
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Implementation of VENA will
be a gradual process determined by each State agency's current
staffing and nutrition assessment procedures. In August 2007,
each State agency will submit a plan that outlines and projects
the implementation of VENA nutrition assessment protocols by
fiscal year 2010.
Below is a more detailed timeline: |
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| December 15, 2006 -
WIC State agencies submit to FNS Regional Offices findings from
their review and evaluation of existing assessment protocols. |
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| August 15, 2007 - WIC
State agencies, as part of the State Plan, submit VENA implementation
plans to FNS Regional Offices. |
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| Fiscal Year 2008-2009
- WIC State agencies revise nutrition assessment policy and
procedures and provide necessary staff training, etc., (as described
in their FNS approved plans) to implement VENA. |
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| October 1, 2009 - VENA
implemented in all WIC State agencies. |
