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Guided Goal Setting: The Logical Next Step to VENA

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Guided Goal Setting: The Logical Next Step to VENA Presented by: Shirley H. Sword, MS, RD, LDN PA Department of Health Division of WIC October 14, 2010 – PowerPoint PPT presentation

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Title: Guided Goal Setting: The Logical Next Step to VENA


1
Guided Goal Setting The Logical Next Step to
VENA
  • Presented by
  • Shirley H. Sword, MS, RD, LDN
  • PA Department of Health Division of WIC
  • October 14, 2010

2
Objectives
  • To gain insight on the history of the development
    of Guided Goal Setting
  • To understand the research behind development of
    the Guided Goal Setting Module
  • To learn the local agency perspective on how
    Guided Goal Setting is working in the clinics

3
Facts and Figures About PA
  • 9th Largest WIC Program
  • 44,817 square miles
  • 274 people per square mile
  • One-third of our 12.4 million residents live in
    rural areas, the largest non-urban population in
    the nation
  • 2nd highest percentage of residents gt65 years old
    in the country

4
Facts and Figures About PA WIC
  • 67 Counties
  • 24 Local Agencies
  • Community Action Programs
  • Medical Centers
  • County Health Departments
  • Private, Non-Profits
  • 265,000 Monthly Caseload

5
(No Transcript)
6
Service Delivery System
  • 329 Total WIC Clinics
  • 116 Primary Sites
  • 213 Satellite Sites
  • Users in total - 832
  • 383 CPAs
  • 449 Non-CPAs
  • 1767 WIC Authorized Stores
  • On-site, On-demand Check Printing

7
How It All Got Started
8
Special Project Grants
  • Special funding from USDA for special State
    projects of regional or national significance to
    improve the services of the program
  • Address issues of critical and timely importance
  • Requires a rigorous evaluation component
  • Results are widely disseminated to other States

9
Development and Evaluation of Guided Goal
Setting (GGS) as a Behavior Change Approach and
Monitoring Protocol in Pennsylvania WIC
Our Special Project Grant
10
Partners in This Project
  • PA WIC
  • Shirley Hsi Sword, Project Director
  • Indiana U of PA
  • Stephanie Taylor-Davis, Principal Investigator
  • Mia M. Barker, Co-Investigator
  • William F. Barker, Evaluator
  • Pao Ying Hsiao, Research Assistant

11
Goals of this Project
  • To enhance the quality of WIC services provided
    to PA WIC participants
  • To further VENA initiatives via an evaluated and
    measurable, participant-centered nutrition
    education counseling approach that
  • Maintains continuity from visit to visit
  • Empowers participants
  • Benefits the participant

12
The Basis for Goal Setting
  • Straight-forward behavioral change approach that
    accommodates a variety of achievement levels
  • Emphasizes small, progressive steps that are
    concrete
  • Relevant to address emerging prevention-oriented
    public health concerns
  • Supported in scientific and behavioral literature
    with a variety of populations and topic areas

13
Guided Goal Setting (GGS) Defined
An approach used by the nutritionist in
conjunction with the participant that involves
critical thinking based on assessment to develop
strategies for goal setting to achieve desired
participant outcomes
14
Central Mission
  • Identification, development, implementation, and
    evaluation of GGS as a WIC counseling method to
  • Increase participant-centered approach
  • Enhance staff competency and critical thinking
    skills
  • Assess participant commitment to food-based
    behavior change
  • Extend nutrition education by supplementing
    contact points with targeted reinforcements

15
Results by Year2005-2008
GGS Special Project Grant
16
Goals by Year
  • Year 1 Profile Identification and WIC
    Evaluation
  • Assess the state of being in PA WIC with respect
    to goal setting as a nutrition education
    counseling approach
  • Year 2 Guided Goal Setting Practices
    Assessment
  • Formalize the GGS process through development and
    pilot testing of a training module and assessment
    tools
  • Year 3 Improvement Nutrition Education
    Outcomes
  • Project 1 Provide standardized training to
    nutritionists to improve staff competency
  • Project 2 Run an experimental protocol with GGS
    that uses reinforcement and is participant-centere
    d and individualized

17
Year 1 Projects
  • Interview and survey WIC staff to identify
    nutrition education best practices and barriers
    to best practices (n147)
  • Survey WIC participants (not initially in
    proposal) (n4665)

18
Year 1 Data Collection
  • Demographic Survey
  • Written Surveys
  • Semi-structured interviews
  • Face-to-face
  • Telephone
  • Nutrition Education Services Survey
  • Director Survey
  • Nutrition Education Coordinator Survey
  • WIC Participant Survey

19
Year 1 Research Study Participants
20
ResultsYear 1 Staff Insights
  • Common themes for implementing
  • Time
  • Environment
  • Distractions
  • Training
  • Resources
  • Attitudes about goal setting

21
ResultsYear 1 Staff Insights
  • Best practices
  • Participant-centered
  • Committed and knowledgeable staff
  • Receptive participants
  • Good assessment with critical thinking
  • Personalizing process
  • Establish expectation for goal setting

22
ResultsYear 1 Staff Insights
  • Attributes
  • Knowledge
  • Professional behaviors with participants
  • Professional behaviors within WIC
  • Program beliefs
  • Other
  • Professional values

23
ResultsYear 1 Participant Insights
  • Participant attitude different than staff
    perceptions
  • Liked best
  • Helpful suggestions from nutritionist
  • Caring Staff
  • Handouts and brochures
  • Recipes

24
Results Participant Insights (contd)
Participant Response (n4,665) Regarding What
They Like About WIC Nutrition Information
25
Collective VoiceYear 1 Findings
  • TIME
  • Staff issues
  • Perceptions
  • Participant issues
  • Training issues
  • Resources
  • Sites
  • Information
  • Communication

26
Year 2 Projects
  • Develop test a standardized, yet flexible,
    theory-based, user-friendly training module and
    associated instrumentation that will strengthen
    staff skills and competencies to facilitate the
    GGS Process

27
General Concept of GGS Module Development
Literature

Nutrition Ed Coordinator
Agency Staff
LA Directors
Nutritionists
Participants
GGS Module Units Objectives
GGS Practices Assessment Instruments
28
Theoretical Basis GGS Framework
29
Additional Year 1 Project Findings Incorporated
  • Key principles, assumptions and expected
    components of a GGS contact document
  • Recommendations regarding time and delivery
    system to support nutritionist and
    paraprofessional training
  • Best practices and success story reports from
    semi-structured interviews

30
The GGS Module
  • Ten, 15 to 20-minute hands-on units
  • Activity rich
  • Case study oriented
  • Learner workbook
  • Evaluations pre, one minute, post, workshop
    evaluation, and 6 week follow-up with skill set
    use
  • Pilot tested using facilitated group training

31
GGS Module Units 1-5
  • Definition and Relevance
  • Counseling Strategy for Behavior Change
  • Assessment and the Contribution of the WIC Staff
  • Personalizing the Process
  • Linking Risk Codes to Participant Goals

32
GGS Module Units 6-10
  • The Team Approach and Goal Priority
  • Structure of Measurable Goals
  • Documentation
  • Follow-Up and Goal Achievement
  • Action Plan

33
Year 3 Projects
  • Staff Training using GGS module
  • Experimental protocol to test effectiveness of
    GGS with participants

34
Year 3 Results Staff Training
  • Alpha testing (February 2008)
  • n10
  • Beta testing (July 2008)
  • n12

Pre- and post-training surveys One minute
evaluations for each unit Overall workshop
evaluation Six week follow-up skill set use
survey
35
GGS Training Evaluations
36
GGS EvaluationMost Important Things Learned
37
GGS Evaluation Least Important Things Learned
38
GGS EvaluationHow Use Information
39
Suggestions after Pilot Testing
  • Based on ß Site
  • Based on a Site
  • Spend more time on the last five units and less
    time on the overview
  • Split into two sessions
  • More examples of goals and documentation
  • Fewer evaluations or group them
  • Good information but could go at faster pace
  • Modified the units to make them more consistent
    in presentation style
  • Added a small amount of time to each unit
  • Most substantial revision was to Unit 6 TEAM
    approach
  • Modified the way the documentation template was
    introduced in Unit 8
  • Added the Modified response option to Skill Set
    Survey Instrument

40
Conclusions after Pilot Testing
  • By establishing a baseline and a consistent
    structure for participant goal setting within PA
    WIC, there are now parameters upon which to
    evaluate the nutritionist-participant interaction
    and assess the efficacy of this counseling method
    to support participant behavior change.
  • The GGS Training Module and Assessment
    Instruments provide a mechanism to address staff
    (both CPA/Nutritionist and Other Staff)
    competency to facilitate the goal setting process
    with WIC participants.

41
The Local Agency Perspective
42
The Old Days
43
The New Age - GGS
44
Staff Reaction
  • Better working relationship with the clients
  • More open communication between staff and clients
  • More aware of the clients perception of their
    familys nutritional needs

45
Client Reaction
  • Your nutritionist was very well informed and
    offers great ideas and information.
  • Staff was very friendly and explained everything
    in detail and offered excellent help.
  • Staff made us feel comfortable with her advice
    and help.
  • The Staff spoke to me, not at me.

46
Hurdles to Cross
  • Dont jump to conclusions!
  • Set small, achievable goals
  • Time
  • Documentation

47
Effect on Clinic Operations
  • No change in staff duties
  • No operational changes within the clinic
  • Continuing education for professional and
    paraprofessional staff

48
Our Results
49
Acknowledgements
  • USDA, Food and Nutrition Service
  • FNS Project Officers
  • Cherisa Toomer (May 2007 December 2008)
  • Carol Stiller, MS, RD (September 2005 April
    2007)
  • Home Nursing Agency staff and participants
  • Adagio Health, Inc.
  • PA Department of Health, Bureau of Information
    Technology and Ciber, Inc.

50
Contact Information
  • Shirley H. Sword, MS, RD, LDN
  • ssword_at_state.pa.us
  • Stephanie Taylor-Davis, PhD, RD, LDN
  • stdavis_at_iup.edu
  • Mia Barker, PhD
  • mabarker_at_iup.edu
  • Tracy Kelley
  • tkelley_at_homenursingagency.com
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