UCONN DAHS Coordinated Program in Dietetics

Diet 3235 Winter/Spring 2023

WIC site reflection template

Name: _Courtney LeDuc___ WIC Site visited: __East Hartford__

Approximate number of clients served at this site on this day: ___3_____

A. Discuss the counseling sessions you were invited to sit in on with the WIC nutritionist.
How many sessions were you able to sit in on? Discuss the nutrition topics the WIC
counselor reviewed with the mom/dad. Discuss the process of nutrition assessment at this
WIC? What were the nutrition messages that were repeated client to client? Were most of
the messages about children’s nutritional health, or adult’s nutrition health or a balanced
combination of both? Were there any language issues/barriers you noted? If so, how were
they handled?
WIC is still primarily operating remotely, with staff calling participants for appointments
over the phone. At the time of our visit, the office was beginning to have more in person visits
from families. Certain appointments, like new or re-certifications, were being scheduled as in
person, however if the participant forgot or preferred remotely, it was allowed to be done over the
phone no problem. The offices were also accepting in-person walk-in appointments for missed
appointments, for people to drop off required documents, or for nutritionists to obtain required
anthropometrics or blood work. During our visit there were no language barriers but the staff
had access to a language line they use to conference call with the participant.
During our visit, the nutritionist I was shadowing explained that mornings for them can
often be slow because of “no-shows” or people just not answering their phone. This was also a
common occurrence for my WIC office in MA while doing phone appointments. I observed
about 3 full phone appointments with the nutritionist I was shadowing: 1 brief child follow up, 1
formula change, and 1 postpartum recertification. As a bonus, a parent came into the office to
have her son's hemoglobin checked, so we were able to observe the child sitting with the
non-invasive Pronto machine. It was nice to see the in-person interaction between the family and
nutritionist.
While the nutritionist was conducting the follow-up appointment, she used
documentation from the previous consult to come up with follow-up questions about the child.
This particular appointment was simple since the child was generally healthy so the nutritionist
asked questions about diet recall, juice intake changes, and using sippy cups less. The education
provided included decreasing juice to about 4 oz per day and to switch to using cups to protect
their teeth. A dental referral was also provided verbally since the child had not seen any dental
care yet. This was all familiar to me from my experience doing these types of appointments. Low
risk children without any major nutritional needs often had quick appointments and it was a
challenge to come up with creative education points. I was able to teach the nutritionist about
some tactics we used at my former WIC office, such as using online WICSmart appointments. I
also told her about how our office would host “group” appointments, pre-covid times, so we
could provide education to multiple parents. We’d often had cooking demos for these
appointments too. The nutritionist thought these were great ideas. She had only started working
for WIC in October 2022 so she was asking me a lot of questions!
 The formula change appointment was due to the ongoing formula recall/shortage issue
that has been going on. The nutritionist explained the struggles families and their office have
faced to find the most appropriate formula for the baby but that is also in stock. CT WIC offices
were granted a waiver to allow non-contract formulas to families since last year. CT uses Similac
products but the shortage has made it extremely difficult to find this brand at times. With the
waiver, the WIC offices are allowed to offer other brands such as Gerber, Enfamil, and a wide
range of others. A variety of different sized cans had become available too. This is almost
identical to how MA WIC was operating when I was there. The appointment was to switch the
infant’s food package so they could receive the larger sized cans. The parent said they are easier
to find. The nutritionist didn’t go into much discussion with the parent about the infant’s intake
or tolerance. The appointment was mainly to switch the food package on their WIC card. This
type of interaction was also very familiar to me too.
At the postpartum recertification appointment, the nutritionist was only directing
messages to the mother. The office's current protocol is to do the mother’s appointment over the
phone and the infant’s new certification will be done when the mother brings the newborn into
the office to complete in person. No new baby appointments are allowed to be done over the
phone so they could see the infant in person to weigh/measure. So this appointment was only for
the mother to begin her postpartum benefits. The nutritionist went through all the intake
questions, such as: postpartum depression screening, medical history, diet recall, and how she is
currently feeding the baby. The mother did not have questions about breastfeeding, however
when the question was prompted, she stated she was pumping because she wasn’t getting enough
milk. The nutritionist was able to give her some advice but not in much detail. I wondered if
maybe more details would be asked at the baby’s appointment, but I felt more of these details
should have been collected during this appointment since the first couple days and week are so
important for establishing milk supply. I had wished she asked more about her breastfeeding
goals and intentions and provided more insight on common misconceptions about milk supply
since thinking they are not making enough milk is the #1 most common reason women stop
breastfeeding, when in reality most women don’t realize your milk supply takes time to come in
and baby’s feed on demand. The nutritionist was setting up the food packages, continuing the
mothers benefits and adding the formula. The nutritionist used her resources to determine how
much formula the mother would receive based on how much breastfeeding was going on.
However, it was confusing because not many questions were probed for about the quantity of
either formula intake or breastfeeding frequency. The mom ended up receiving almost the max
formula package. With more information about breastfeeding, it could’ve been possible to pull
back on the amount of formula they received from WIC to encourage the mother to breastfeed
more. At the end, a referral to the breastfeeding peer counselor for additional support, but the
mother declined. In those circumstances you cannot force a mother to accept the referral,
however I think more efforts to encourage breastfeeding could’ve been made by the nutritionist.
After the appointment was over, the nutritionist did ask me some questions about breastfeeding
and if she could have mentioned anything else to the Mom. I was able to provide her some advice
about how to facilitate those conversations and some tricks to help with milk supply. I was happy
to help!
B. Discuss nutrition education materials. Were they in English and Spanish? Other
languages? Were the nutrition messages at this site also on the walls as posters, or were
there a supply of handouts? Did the dietitian distribute AND discuss the materials? Did the
WIC nutritionist use food models or product labels to make a point with a client?
The CT WIC education handouts were beautiful! They said they had recently been redone
and I was very impressed by how easy to read and understand they were. The food guide which
showed which items were eligible with the WIC card had awesome photo examples of all the
options. The handout is offered in English, Spanish, Arabic, Haitian Creole, and Portuguese. This
office only had hard copies of En/SP, but the other languages are available to order or can be
printed from online. Other handouts were about breastfeeding and information for dads too! All
of them were offered in English and Spanish. I wasn’t able to find these online. There were no
handouts or other props/materials used or distributed during my shadowing day since mostly
everything was done over the phone. The nutritionist said she often will email photos of them to
the participants as needed. When the child came in to get his hemoglobin checked, he was able to
pick out a book to take home!

C. When you think about behavior change theories and models you are learning about in
Val’s class, which ones could you apply to these WIC clients in these sessions? Select a
counseling session you sat in on and discuss the level at which you believe the mom/dad
appears to be in the Stages of Change Model, and support your argument:
pre-contemplation, contemplation, preparation, action, and/or maintenance.
From my experience and from what I shadowed, SMART goals are regularly used. Since
we are able to see participants every 3 months, it’s important to pick specific goals that are
attainable and realistic. I didn’t learn about SMART goals until taking Val’s class last semester so
when I was doing appointments prior I didn’t even realize I was using them. During every
appointment, goals are made and documented to follow up on at the next appointment. The
Transtheoretical Model is great to utilize during appointments. For example, during the
postpartum mother appointment.
As for the Stages of Change Model, I believe the postpartum mother we shadowed was in
the precontemplation stage. The mother was pumping because she wasn’t getting enough milk
supply and was open to hearing what the nutritionist was telling her about pumping more.
However, the mom did not express her low milk supply as a concern, it was only her response
when the nutritionist had to ask her how much breastfeeding she was doing. I feel this way
because the mother said had no question about breastfeeding and declined the referral to the
breastfeeding peer counselor. She said “No thank you, I know what I am doing”. This could
potentially be the contemplation stage but I felt she wasn’t concerned about her milk supply
since she wasn’t asking for any help and declined assistance.

D. When you think about the client flow during the time you were there, and the way the
site is physically set up, at what points do you envision more direct and in-direct nutrition
education could take place?
In a WIC office, there are opportunities for direct and indirect nutrition education.
Around the office, there were posters encouraging breastfeeding and they were in the process
updating their bulletin board in the waiting area for National Nutrition Month. From my
experience, we often kept laminated photos of MyPlate and the benefits of breastfeeding on our
desks or hung up. We also had areas for parents to grab handouts or various recipes. The waiting
period before and after appointments are good opportunities for indirect nutrition education. Also
giving out handouts at the end of appointments is great for indirect education to be brought
home. However, most of the education at WIC is direct since you are required to educate the
participant at each appointment in order for them to receive benefits on their WIC card.

Thank you! Tfdmsrdrncdn23