SPIRIT Food Packages

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SPIRIT Food Packages
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• This module, SPIRIT Food Packages, 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.
• The series includes VENA, the Value Enhanced
  Nutrition Assessment initiative the WIC food
  packages, and nutrition risk factors.

Lets get started! You can track your progress
with this handy guide.
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Objectives

• Upon completion of this module, the CPA should be
  able to
• Identify the names of the new food packages
• List the major changes to each food package
• Define food package tailoring
• Apply the basic concepts of tailoring in the WIC
  management information system SPIRIT

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Food Packages

• Supplemental foods received will remain the same
• Milk
• Cheese
• Juice
• Cereal
• Eggs
• Beans
• Peanut Butter (special issue children gt 2 or
  women)
• Tuna (exclusively BF only)
• Carrots (exclusively BF only)

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Total of 11 food packages will be available
through SPIRIT

• Infant 1
• Infant 2
• Infant 3
• Infant 4
• Child 1
• Child 2
• Child 3

• Child/Woman with Special Needs
• Pregnant/Partially BF Woman
• Exclusively BF Woman
• Non-breastfeeding Postpartum Woman

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Default Food Packages

• These 11 food packages will be termed Default
  Food Packages in SPIRIT. These default food
  packages are what we used to term as standard
  food packages.

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Food Package vs Food Prescription

• Food Packages the basic food packages
  authorized by WIC Program Regulations for
  providing supplemental foods according to
  participant category.
• Food Prescription  the specific combination and
  quantities of allowable foods issued to WIC
  participants to address their nutritional,
  cultural and dietary related health needs.

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Infant 1 (0 - 1 month)

• Infant formula

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Infant 2 (2 - 3 months)

• Infant formula

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Infant 3 (4 - 5 months)

• Infant formula

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Infant 4 (6 11 months)

• Infant formula
• 24 ounces infant cereal
• 2 containers juice

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Major Changes to Infant Packages

• Before SPIRIT

• After SPIRIT

• Infant packages were not divided by age
• Infants received infant cereal at 4 months of age
• Infants were issued 8 ounces infant cereal with
  the option of adding 16 ounces for a total of 24
  ounces

• Infant food packages divided by age
• Infants will receive infant cereal at 6 months of
  age
• Infants will be issued 24 ounces of infant cereal
  with the option of tailoring down issued amount

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Child 1 (1 year of age)

• 3 gallons of whole milk
• 2 pounds of cheese
• 4 containers of juice
• 28 ounces cereal
• 2 dozen large white eggs
• 1 pounds beans

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Child 2 (2 years)

• 4 gallons 2, 1 or skim milk
• 2 pounds cheese
• 4 containers juice
• 28 ounces cereal
• 2 dozen large white eggs
• 1 pound beans

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Child 3 (3 5 years)

• 4 ½ gallons 2, 1 or skim milk
• 2 pounds cheese
• 6 containers juice
• 36 ounces cereal
• 2 dozen large white eggs
• 1 pound beans

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Child/Woman with Special Needs

• Formula
• 36 ounces cereal
• 3 containers juice

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Major Changes to Child Food Package

• Before SPIRIT

• After SPIRIT

• Default packages contained a standard amount and
  amounts could be tailored up to a maximum amount
• No default food package for child/woman with
  special needs in WANG

• Default packages contain maximum amounts allowed
  and amounts can be tailored down
• Default food package for child/woman with special
  needs

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Pregnant/Partially BF Woman

• 5 ½ gallons 2, 1 or skim milk
• 2 pounds cheese
• 6 containers juice
• 36 ounces cereal
• 2 dozen large white eggs
• 1 pound beans

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Exclusively BF Woman

• 5 ½ gallons 2, 1 or skim milk
• 3 pounds cheese
• 7 containers juice
• 36 ounces cereal
• 2 dozen large white eggs
• 2 pounds beans
• 2 pounds carrots
• 26 ounces tuna

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Non-BF Postpartum Woman

• 4 ½ gallons 2, 1 or skim milk
• 2 pounds cheese
• 4 containers juice
• 36 ounces cereal
• 2 dozen large white eggs

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Major Changes to Womens Food Package

• Before SPIRIT

• After SPIRIT

• Term postpartum was used
• Default packages contained a standard amount and
  amounts could be tailored up to a maximum amount
• No default food package for child/woman with
  special needs in WANG

• Term postpartum replaced with non-breastfeeding
  postpartum woman
• Default packages contain maximum amounts allowed
  and amounts can be tailored down
• Default food package for child/woman with special
  needs

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Overall Changes

• Before SPIRIT

• After SPIRIT

• Whole milk could be issued to children gt 2 years
  of age or to women if they met certain risk factor

• Whole milk will only be given to children lt 2
  years of age. The default food packages for
  children gt 2 years of age and women will not
  allow whole milk to be substituted for any risk
  factor

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Overall Changes

• Before SPIRIT

• After SPIRIT

• Buttermilk could be issued as a regular milk
  alternative

• Buttermilk will no longer be an allowed food on
  the Arkansas WIC Program

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Overall Changes

• Before SPIRIT

• After SPIRIT

• Peanut butter could be issued to any child with a
  qualifying risk factor

• Peanut butter can only be issued to children gt 2
  years of age due to possible allergies and
  choking hazards

Doing great! Keep up the pace!
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Overall Changes

• Before SPIRIT

• After SPIRIT

• Juice was designated on the checks as 12 ounce
  frozen concentrate, 11.5 ounce non-frozen
  pourable concentrate, or 46 ounce single strength

• Juice will be listed on the checks as number of
  containers. Ex. 3 containers of juice.
  Participants must select the same type of juice
  for each food instrument, but can vary the flavor

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Overall Changes

• Before SPIRIT

• After SPIRIT

• Could split certain items on a food package
• Ex. ½ package regular juice, ½ package calcium
  fortified orange juice

• Can no longer split food packages, but can
  alternate food items received monthly
• Ex. Whole package of regular juice for the month
  of May, and a whole package of calcium fortified
  orange juice for the month of June

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Food Package Tailoring
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Food Package Tailoring vs Food Package Changes

• Tailoring

• Changing

• A change in the amount of a food an addition or
  elimination of a food a change that could affect
  the nutritional value of the food package
• Ex. Adding peanut butter to an underweight
  pregnant moms food package
• Ex. Family is eligible to receive 20 gallons of
  milk per month, yet normally only use 12 gallons,
  so the CPA tailors down the amount of milk the
  family receives

• A change in the form of an existing food type
  that does not affect the nutritional value of the
  food package
• Ex. Changing from regular fluid milk to powdered
  milk

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Food Package Tailoring vs Food Package Changes

• All formula changes are considered food package
  tailoring
• All special issue food items are considered food
  package tailoring
• Special issue food items include
• Infant juice
• Concentrate or ready to use formula
• Calcium fortified orange juice
• Reduced lactose or lactose free milk
• Peanut butter
• All food package tailoring and changes are to be
  completed by the CPA

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Tailoring

• Food packages can still be tailored based upon
• Participants identified risks
• Participants request of decreased amounts or
  elimination of a food
• As determined nutritionally sound and beneficial
  by the nutritionist

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What can be tailored

• Default food packages can be tailored in SPIRIT
• Foods tailored due to nutrition risk factors
• Peanut Butter (gt 2 years of age)
• Reduced lactose or lactose free milk

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Peanut Butter

• Child
• 103 Underweight
• 134 Failure to thrive
• 135 Inadequate weight gain
• 801 Homeless
• 802 Migrant
• Pregnant
• 101 Underweight
• 131 Low maternal weight gain
• 132 Maternal weight loss during pregnancy
• 331 Pregnancy at a young age
• 338 Pregnant woman currently breastfeeding
• 801 Homeless
• 802 Migrant

• Partially Breastfeeding Woman
• 101 Underweight
• 331 Pregnancy at a young age
• 335 Multifetal gestation
• 801 Homeless
• 802 Migrant
• Exclusively Breastfeeding Woman
• 101 Underweight
• 331 Pregnancy at a young age
• 335 Multifetal gestation
• 801 Homeless
• 802 Migrant

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Reduced or Lactose Free Milk

• 355 Lactose Intolerance (child or any woman)

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Tailoring Rules

• Substitutions
• Child 2 and Child 3 food packages or
  pregnant/partially BF women may receive one 18
  ounce jar of peanut butter (with appropriate
  nutrition risk factors) in lieu of 1 lb dry
  beans.
• Exclusively BF Women may receive one 18 ounce jar
  of peanut butter (with appropriate nutrition risk
  factors) in lieu of 1 lb dry beans. They will
  still receive an additional one pound of dry
  beans which cannot be substituted with peanut
  butter.

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Tailoring Rules

• Alternating
• With SPIRIT, food items from the same category
  can be alternated on the food checks
• Ex. Participant qualifies for peanut butter,
  however, they also enjoy receiving the beans.
  The food packages can be tailored so that one
  month the participant receives peanut butter and
  the next month they receive dry beans. It would
  alternate each month until the end of the
  certification.

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Scenario 1Tailoring or Not

• Mary B., a pregnant woman, complains of stomach
  discomfort, cramps, and diarrhea whenever she
  drinks milk. She tells the clerk she no longer
  wants to receive milk because it doesnt settle
  well with her.
• What should happen next?
• The clerk removes the milk from the food package
• The clerk refers Mary to the CPA
• The clerk makes Mary an appointment to come back
  to see the CPA
• The clerk suggests getting another form of milk,
  helps Mary decide, and changes the food package

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• Answer B is correct!
• This is food package tailoring. The clerk
  should refer Mary to the CPA. Since Mary is
  considering having a food item eliminated from
  her food package, the CPA needs to determine if
  there is an alternative way to continue to
  supplement Marys diet with the nutrients she
  needs while providing her with an acceptable
  alternative.

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Scenario 2Tailoring or Not

• Henry W. is a 3 year old child who has lost
  weight since his last certification. He now
  plots at the 8th percentile for BMI for age. Due
  to his risk factors, he qualifies for peanut
  butter.
• What should happen next?
• The CPA should let it go, issue the dry beans,
  and see how his weight looks at his next
  certification
• The CPA should issue peanut butter
• The CPA should ask Henry W.s parent if they
  would like to receive peanut butter
• The CPA should suggest getting a prescription for
  PediaSure

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• Answer C is correct!
• This is food package tailoring and should be
  done by the CPA. The CPA should ask the parent
  or guardian if peanut butter is an acceptable
  substitute and if they would like to have it. If
  the parent says yes, then peanut butter would be
  issued.
• Peanut butter is not commonly consumed in all
  cultures, thus we should always take cultural
  differences into consideration when tailoring a
  food package.

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Scenario 3Food Tailoring or Not

• Alli, an exclusively breastfeeding mom, comes in
  to pick up her checks. After receiving her first
  months WIC benefits, she is now requesting to
  receive half of her milk as dry milk and half of
  her milk as fluid milk.
• What should happen next?
• The clerk should tell her she will have to wait
  till her next certification appointment to make
  any food package changes.
• The clerk tells Alli that food package items can
  no longer be split, she will either have to do
  all fluid milk or all powdered milk.
• The clerk makes an appointment for Alli to return
  to the clinic to see the CPA.
• The CPA changes the food package so that Alli
  will receive one month of fluid milk and then one
  month of powdered milk.

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• The correct answer is D!
• This is NOT food package tailoring. The
  nutritional value of the package is not changing.
  The CPA should instruct Alli on how the milk can
  be divided, offer her that solution, and if
  agreed to, change the food package so that Alli
  will receive fluid milk and powdered milk
  alternating months.

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• Food package information has been condensed to
  help the CPA to determine the correct food
  package to issue participants.
• It will be available in policy.
• It is contained on the next 2 slides.

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Youre halfway there!
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Food Packages in SPIRIT
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• Now that we have reviewed the default food
  packages available in SPIRIT, it is time to see
  what they will look like and how to edit if
  needed.

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Once your participant has been selected and you
have started the certification process you will
go through several steps to determine and
prescribe the right food package for the
participant.
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Using the Certification Guided Script, the CPA
will be able to determine when it is appropriate
to implement the food prescription.
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When it is time to prescribe the food package,
select Food Prescription.
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The next screen will display the default food
package for the patient type. Notice the date of
the Rx is the date of certification.
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Since James qualifies for peanut butter based
upon his nutrition risk factors, the CPA should
ask the parent or guardian if peanut butter would
be an acceptable alternative to the dry beans.
If the answer is yes, the CPA will then have to
edit the food package. To start editing a food
package, select the date of the food package you
want to edit.
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Once the correct food package date has been
selected, the Edit Food Prescription screen will
appear. All food items in that food package are
displayed.
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Find and select the item that needs to be edited.
In this instance we will have to delete the food
item dry beans before peanut butter can be added.
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Once you have selected Delete Food Item, a box
will appear asking Do you want to delete this
food item? In this instance, we would select
yes.
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Now the food prescription screen appears without
the dry beans food item listed. Now it is time
to add the peanut butter. By selecting Add Food
Item, we can begin this process.
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Once you have selected to Add Food Item, a new
screen will appear where you will select which
food category the item you want to add belongs.
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From the pull down menu, all food categories are
listed.
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For James, we would select Legumes (Beans/Peanut
Butter.
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When you have selected your food category,
available food items will appear.
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Now the CPA will select the peanut butter option
and click OK.
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Now the Edit Food Prescription Screen will appear
and peanut butter will now be listed as part of
the food prescription. Once all changes have
been made, clicking OK will allow the CPA to exit
this screen
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The CPA will now be returned to the Food
Prescription screen. Note the food prescription
now contains the changes made by the CPA.
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When the CPA closes the Food Prescription window,
the Certification Guided Script will appear and
the Food Prescription task will be checked as
completed.
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• Lets look at another participant.

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Our next participant is Eva. As you can see from
the screen she is a pregnant woman.
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Eva is now at the point in her certification
where her food package needs to be prescribed by
the CPA. Based upon her risk factors, Eva not
only qualifies for peanut butter, but she is
lactose intolerant.
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After selecting Food Prescription, this is the
next screen that will be shown. The default food
package for a pregnant woman is displayed, along
with the date the food prescription was given.
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Since Eva qualifies for peanut butter and lactose
free milk, these options should be discussed and
offered to her by the CPA. In this case, Eva
would like to receive both of those
substitutions. So, the date of the food
prescription will be selected so that the food
package can be edited.
Almost done!
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The first item this CPA has chosen to change is
the dry beans. The dry beans are chosen as the
food item to delete.
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The dialog box will pop up to confirm the food
item should be deleted. For Eva, yes would be
selected.
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Once an item has been deleted, the CPA will be
returned to the Edit Food Prescription screen.
From here, the CPA should choose to Add Food Item
so that peanut butter can replace the dry beans.
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Once the Add Food Item button is clicked, the Add
Food Item dialog box will appear. From this
screen, the food category of the item should be
selected.
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The drop down box will display all possible food
categories.
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The CPA should select Legumes (Beans/Peanut
Butter). By selecting this food category item,
the possible food items will be listed.
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For Eva, the CPA would select 18 oz jar(s) Peanut
Butter and click OK.
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The Food Prescription now displays the peanut
butter. It is now time for the CPA to tailor the
rest of the food package.
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Since Eva is lactose intolerant and has accepted
the lactose free milk option, the CPA will now
have to remove the milk listed in the default
food package. The first step would be to delete
the gallons of regular milk listed in the food
prescription.
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Same as with the peanut butter, the CPA will be
asked if this food item should be deleted. The
CPA will again select yes.
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The Edit Food Prescription now no longer displays
the gallons of milk. However, the CPA must
remember to remove the half gallon of milk as
well.
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The CPA would follow the same steps as before to
delete the half gallon of milk from the food
prescription.
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The CPA would be prompted to select yes on
deleting the food item.
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The food prescription is now void of all fluid
milk. Now it is time to add the lactose free
milk to the food prescription.
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The CPA would again choose Add Food Item.
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The Food Category drop down list would again be
accessed.
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This time the CPA would select the food category
of milk and click OK.
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From the list of the food items, the CPA would
scroll until they found the appropriate item.
In this case, it would be half gallon(s) Lactaid
or Dairy Ease (2, 1 or Fat Free). Note
Lactaid and Dairy Ease are not available in
gallon size containers.
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The new prescribed food package now appears on
the Edit Food Prescription screen. The CPA has
completed all necessary changes and may now click
OK.
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The tailored food prescription now appears on the
Food Prescription screen.
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Now that the CPA has completed the Food
Prescription section of the certification, it
will be checked off the Certification Guided
Script.
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• This is only a slight introduction to food
  prescriptions in SPIRIT. The main focus of this
  module should be the changes to our current food
  packages.
• By making some modifications to the food packages
  now, we will be positively positioned when we
  implement the new WIC Food Packages in 2009.

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The End!
You have just completed the SPIRIT Food Package
Training! Good job!